patoloji-ders-notlari

Title

Serdar Balcı

Teratomas, biphasic tumors and tumors of unknown origin

Serdar BALCI, MD

TERATOMAS

Mature Teratomas

• Mature ovarian teratomas are benign
• Most benign teratomas are cystic
  • Rarely solid
• Dermoid cysts
• Young women, reproductive years
• Incidentally
• Bilateral in 10-15% of cases

Robbins and Cotran’s Pathological Basis of Diseases

Stratified squamous epithelium, sebaceous glands, hair shafts, skin adnexal structures, cartilage, bone, thyroid tissue, neural tissues

Robbins and Cotran’s Pathological Basis of Diseases

• Rarely (1%) malignant transformation
  • most commonly squamous cell carcinoma
  • thyroid carcinoma, melanoma
• Paraneoplastic syndromes
  • Inflammatory limbic encephalitits
• Monodermal or Specialized Teratomas
  • Struma ovarii
    • Thyroidal neoplasms
    • May hyperfunction, hyperthyroidism
  • Carcinoid
    • Arises from intestinal epithelium in a teratoma
    • May be functional, large (>7 cm) tumors
    • 5-hydroxytryptamine, carcinoid syndrome

Immature Teratomas

Malignant

Component resemble embryonal and immature fetal tissue

Prepubertal adolescents and young women, mean 18 years

Predominantly solid

Areas of necrosis and hemorrhage

Hair, sebaceous material, cartilage, bone, and calcification may be present

Varying amounts of immature neuroepithelium, cartilage, bone, muscle

Graded according to proportion of tissue containing immature neuroepithelium

Grow rapidly

Penetrate the capsule, and spread either locally or distantly

Robbins and Cotran’s Pathological Basis of Diseases

Testicular Teratomas

In the postpubertal male all teratomas are regarded as malignant

Capable of metastatic behavior whether the elements are mature or immature

Robbins and Cotran’s Pathological Basis of Diseases

Robbins and Cotran’s Pathological Basis of Diseases

Teratoma with malignant transformation

• Malignancy in derivatives of one or more germ cell layers
• Squamous cell carcinoma, mucin-secreting adenocarcinoma, or sarcoma
• Isochromosome 12p
  • Similar to the germ cell tumors they arose

BIPHASIC TUMORS

Pleomorphic Adenoma

• Benign
• Epithelial
  • ductal cells or myoepithelial cells
  • duct formations, acini, irregular tubules, strands, or sheets of cells
  • squamous cells
• Mesenchyme-like background
  • Loose myxoid tissue containing islands of chondroid and, foci of bone
• Carcinoma arising in a pleomorphic adenoma
  • Carcinoma ex pleomorphic adenoma
  • Malignant mixed tumor

Rubin’s Pathology 7th Ed

Rubin’s Pathology 7th Ed

Rubin’s Pathology 7th Ed

Robbins and Cotran’s Pathological Basis of Diseases

Fibroadenoma

Fibroadenoma

Benign biphasic tumor of breat

Robbins and Cotran’s Pathological Basis of Diseases

Fibroadenoma

Benign biphasic tumor of breat

Robbins and Cotran’s Pathological Basis of Diseases

Fibroadenoma

Benign biphasic tumor of breat

Robbins and Cotran’s Pathological Basis of Diseases

Phylloides tumor

Biphasic tumor of breast

Robbins and Cotran’s Pathological Basis of Diseases

TUMORS OF UNKNOWN ORIGIN

Ewing Sarcoma

• Ewing / PNET
  • Primitive Neuroectodermal Tumor
• Malignant small round-cell tumors of bone and soft tissue
• Translocation (11;22) (q24;q12)
  • EWS gene on chromosome 22
  • FLI1 a gene encoding an ETS family transcription factor

Rubin’s Pathology 7th Ed

Robbins and Cotran’s Pathological Basis of Diseases

Synovial Sarcoma

• Morphologically biphasic or monophasic
• Epithelial and/or mesenchymal
• t(x;18)(p11;q11)
  • SS18-SSX1, SSX2, or SSX4 fusion genes, encode chimeric transcription factors

Robbins and Cotran’s Pathological Basis of Diseases

SMALL BLUE ROUND CELL TUMORS

Small blue round cell tumors

• Small cell carcinoma
  • High grade neuroendocrine tumor of lung
• Lymphoma
• Ewing/PNET
• Wilms
• Rhabdomyosarcoma
• Sinonasal carcinoma
• Medulloblastoma
• Desmoplastic small-round-cell tumour
• Neuroblastoma
• Synovial Sarcoma
• Carcinoid tumor
• Retinoblastoma
• Hepatoblastoma

TUMORS OF UNKNOWN PRIMARY

Tumors of unknown primary

• Rarely the primary origin of a metastatic tumor cannot be determined

  • Morphology, immunohistochemistry
  • Clinical, radiological features

• Sometimes therapies are given accepting the most likely primary

• Sometimes general therapies are preferred, therapies are changed as a response to treatment

• Malignant epithelial tumor

• Malignant mesenchymal tumor

• Malignant neoplasm

• Tumor of origin tests

  • Genetic tests to identify these cases
  • Gives %, likelihood and a list of possibilities
  • Wrong results if normal tissue, inflammatory areas are also included in the preparation
  • Very new and not accepted yet