Neoplasia ospe rapid review

By: Abbas Naseem (BDS)
abbas_naseem@yahoo.com

Neoplasia OSPE Rapid Review - By Abbas Naseem (bds) Dated: June 27, 2010

• ADENOMA: A benign tumor with glands.
• LIPOMA: A benign tumor filled with empty looking cells.

• >> A benign Tumor will be Encapsulated in most cases.
• >> A benign Tumor cells resemble like normal parenchyma cells.

If a tumor exhibits Anaplasia, Necrosis, easy to find mitotic figures, hemorrhage
&/OR obvious Invasion, this is probably a cancer ….
Otherwise it is probably a Benign tumor.

CARCINOMA : Cells lining up, adhering to one another & moulding one another.

ADENOCARCINOMA : Papillae, signet ring cells, lumen, back to back glands
(swiss cheese; easy to cell part of two different glands) &
lakes of mucin.
SQUAMOUS CELL CARCINOMA :
Squamous keratin pearls, desmosomes,
& lone apoptotic cells.
OAT CELL CARCINOMAFeatures small blue, about 20 microns across,
:
Moulding each other, without a visible stroma.

SARCOMA :Spindle cell cancers( i.e those with lots of nuclei oriented parallel)

MELANOMA : Melanin in cancer cells.

LYMPHOMA: Features sheets of relatively uniform round cells, not moulding
each other, but effacing the architechture of lymphoid organ.

NOW SEE Some SLIDES with Q & A’s To Improve
Skills

This 57 year old man gave a history of a lesion of the face which was removed and irradiated.
Recently he noted a recurrent lesion which was firm and nodular with an area of ulceration at
the angle of the left nares.

The disease process which best characterizes this slide is
squamous cell carcinoma

Neoplasia OSPE Rapid Review - By Abbas Naseem (bds)

Mr. Helms sure enjoyed his smokes. Now after 20 years he is coughing
up blood. This photomicrograph of his bronchial biopsy specimen best
illustrates carcinoma in situ


This 54-year-old woman was admitted for the acute onset of abdominal pain and nausea and
vomiting for 24 hours. A mass was felt in the lower abdomen and the abdomen was tender. At
operation a fistula was found between the transverse and sigmoid colon. A biopsy was taken.
The disease process which best characterizes these pictures is adenocarcinoma


The following two pictures are of a radical mastectomy specimen removed for
infiltrative duct cell carcinoma. Note the skin retraction in the first picture. The
abundance of non-neoplastic connective tissue in association with neoplastic cells is
called desmoplasia

A 35 year-old woman was found to have several firm, rubbery nodules on the
dome of the uterus four years ago. These had slowly increased in size and now
were about twice the size it was when first discovered. She is asymptomatic.
These well encapsulated uterine nodules most likely represent
benign neoplasm


This is a section of duodenum showing an
aggregate of pancreatic tissue in the wall. The
pancreatic tissue is normal in appearance but
in an abnormal location. This is a non-
neoplastic process


Hyperplastic polyps
These are hamartomatous
polyps of the GI tract which
are the MOST COMMON type
of non-neoplastic
polyp. Microscopically, they
show increased numbers of
goblet cells.


Bronchial hamartoma
This is a non-neoplastic lesion
composed of tissues normally found
in the organ where the hamartoma
arises. The tissues in the
hamartoma are typically
disorganized in their arrangement


Malignant lymphoma
This slide shows diffuse
involvement of the
mediastinum by a tan "fish-
flesh" mass. This is a classic
pattern seen in malignant
lymphomas involving this
area. The tumor arises from
solid lymphoid tissue


Hemangioma
This is a benign neoplasm
arising from endothelial cells
of blood vessels.

Hemangioma
This is the microscopic
appearance of a hemangioma
showing dilated blood vessels
filled with red blood cells and
lined by benign endothelial
cells.


Malignant cells
This slide shows several
features of malignancy. The
cell in the central portion of
the slide shows a TETRAPOLAR
mitotic figure which is
abnormal. Other cells show
hyperchromatic nuclei or large
and irregular nuclei and
nucleoli all of which are
features of malignancy.


Retinoblastoma
This is a retinoblastoma. This malignant
tumor is associated with inactivation of
the Rb tumor suppressor gene.


Burkitt's lymphoma
This lymphoma, especially the
African type, is associated with
a 8;14 chromosomal
translocation.


Kaposi sarcoma
Multiple vascular lesions are
noted. This tumor is
associated with HIV and arises
from endothelial cells. There is
a high correlation with Kaposi
sarcoma herpesvirus (KSHV) or
human herpesvirus-8 (HHV-8)


Squamous cell carcinoma of
skin
This neoplasm is associated
with UVB light damage and
immunosuppression. It is
found on sun-exposed areas,
particularly the face.


Metastasis
Each of the organ systems
featured on the slides
represent favored sites for
metastasis. The bone is a
common site for metastasis
from prostate, lung, and
thyroid cancers. CNS is a
common site of metastasis
from small cell carcinomas of
lung and breast cancers. Liver
is a common site of metastasis
from lung and colon tumors.


Metastasis
The lung is a common site of
metastasis from colon and
other visceral
neoplasms. "Cannon-ball"
metastasis is produced by
hematogenous spread of
choriocarcinoma, osteogenic
sarcomas, and renal cell
carcinoma.


Lymphangitic spread
This slide shows a lymphatic
vessel containing nests of
malignant adenocarcinoma
cells.


Lymph node metastasis
This is an example of a
papillary carcinoma of the
thyroid which has
metastasized to a lymph node.


Osteoblastic metastasis
Certain neoplasms have a
tendency to metastasize to
bone and if so, produce
stimulation of the osteoblasts
with new bone formation. The
bone alkaline phosphatase will
be elevated in the
serum. Tumors associated
with osteoblastic metastasis
include prostate, thyroid,
breast, and carcinoid.

Well-differentiated squamous cell carcinoma
This slide shows two nests of well-
differentiated squamous cells (low grade)
demonstrating features of normal squamous
cells.


Well-differentiated
adenocarcinoma
This slide shows a well-
differentiated adenocarcinoma
with well formed glands and
distinct lumens

Squamous cell carcinoma of the larynx
Note the fungating mass on the lateral border
of the larynx with central ulceration. These
tumors are associated with smoking and
chronic alcohol use. The first symptom is
hoarseness.


Squamous cell carcinoma of
the lung
This slide shows an airway that
is opened. The mucosa
appears rough and there is an
infiltrating mass involving the
wall of the bronchi before and
after the branching. This is
most likely a squamous cell
carcinoma.


Adenocarcinoma of colon
This tumor is a fungating mass with central
necrosis which arises from colonic mucosa. It
tends to infiltrate the wall of the colon in a
"napkin-ring" fashion producing
obstruction. Obstructive lesions occur in the
descending colon.


Adenocarcinoma of the colon
This lesion is growing as a
polypoid mass into the lumen
of the ascending colon. Right
sided colonic masses typically
present with anemia and
bleeding.


Familial polyposis
This autosomal dominant
condition is associated with
multiple tubular adenomas
and tubulovillous tumors in
the colon. The patient has >
100 polyps and is at risk for
colon cancer. There is an
association with the APC
tumor suppressor gene.


Hepatocellular carcinoma
This tumor arises from
hepatocytes. Conditions
which predispose to this tumor
include post-necrotic (post-
infectious) cirrhosis, pigment
cirrhosis (hemosiderosis),
alcoholic cirrhosis, aflatoxins,
and thorotrast.


Renal cell carcinoma
proximal tubular cells in the
kidney and is typically in the
upper pole of the kidney. It will
be very vascular. The tumor
presents with hematuria, flank
mass, flank pain, or with
paraneoplastic hormone
production. The tumor tends
to invade the renal vein and
spread to the lungs with
cannon-ball metastasis.


Transitional cell carcinoma
This slide shows a papillary
tumor by cytoscopy. It is
arising from the transitional
mucosa of the bladder and
usually presents with
hematuria.


Leiomyosarcoma
This is the most common
sarcoma of the female genital
tract, although rare. It usually
arises de novo. It is bulky and
hemorrhagic. Microscopic
grading is based on the
numbers of mitoses counted
per high powered field.


Choriocarcinoma
Multiple slides show an
invasive choriocarcinoma. This
tumor is very aggressive and
arises from gestational
trophoblastic epithelium. It is
common in the Asian
population. No chorionic villi
are formed, only
cytotrophoblast and
syncytiotrophoblast tissues.


Neuroblastoma
This is a small cell tumor
arising from the medullary
portion of the adrenal or other
sites in the sympathetic
nervous system. It is one of
the most common extracranial
childhood solid tumors. The
circular structures within the
tumor are called Homer-
Wright pseudorosettes. A
marker is the n-myc oncogene.


Osteogenic sarcoma
This tumor arises from bone
forming cells. Excluding
multiple myeloma, it is the
most common primary
malignant tumor of bone. It
usually occurs in the second
decade of life. Most common
site is in the area around the
knee. It may occur in an older
age group in association with
Paget's disease of bone.


Chrondrosarcoma
mesenchymal cells that
produce a cartilaginous
matrix. Chrondrosarcomas
occur in older patients with a
peak incidence in the sixth
decade. These tumors arise in
central portionsof the skeleton
such as the shoulder area,
pelvis, proximal femur, and
ribs.

Basal cell carcinoma
This tumor is associated with
sun exposure. They are
typically "pearly grey" papules
on the side of the nose or
upper lip. They rarely, if ever,
metastasize.


Basal cell carcinoma
This is a microscopic section of
a basal cell carcinoma showing
the tumor cell nests. The
peripheral group of cells in a
nest are oriented
perpendicular to the rest of
the cells similar to a picket
fence.


Astrocytoma
The left side of the cortex
shows loss of the normal
demarcation between grey
and white matter. This is an
area where the tumor has
infiltrated the brain tissue with
indistinct
margins. Astrocytomas are
the most common histologic
type of primary brain
tumors. They occur in the
supra tentorial areas in adults
and in the cerebellum in
children.


BRAIN

Neoplasia OSPE Rapid Review - By Abbas
Naseem (bds)

UTERUS FIBROID + LIEOMYOMA

Naseem (bds)

POLIPS

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NEURAL TUMOUR SHAWANOMA

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TUMOUR OF BREAST ( FIBROADENOMA)

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LIPOMA IN INTESTINE

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CARCINOMA OF CERVIX

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Neoplasia OSPE Rapid Review - By Abbas LUNG CARCINOMA
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HCC

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RCC

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MELANOMA

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BREAST

FIBROUS TISSUE

CALCIFICATION

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LIPOSARCOMA

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Mixed or pleomorphic adenoma: Tumor that contain that more than 1 type of parenchymal cells
derived from same germ layer

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• Teratoma: tumor that contain recognizable mature or immature cell or tissues representative of
more than 1 germ layer

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Teratoma, ovary

• Teratomas: more than one germ layer

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• Choristoma(ectopic rest of normal tissue) presence of mass of well developed n normally
organized tissue of 1 organ in another.

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• Hamartoma: mass of disorganized overgrowth of mature cells normally found in an organ.

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ADENOMA

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DYSPLASIA

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CARCINOMA IN SITU

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LIVER WITH METS
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PSEDUOMAXOMA PERITONEAI

CANCER

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SQUAMOUIS CELL CARCINOMA

D
E
S
M
O
S
O
M
E

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ADENOACRCINIMA

GAINT CELLS

ABNORMAL
MITOSIS

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SQUAMOUS CELL CARCINOMA

KERATIN
EPITHELIAL
PEARLS

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ADENOMA

BACK TO BACK


• Pleomorphism: variation in size and shape


• Abnormal nuclear morphology: hyperchormatic (abundant DNA), increased N:C ratio
(normal 1:4- 1:6)


• Mitoses: increased, bizarre


• Loss of polarity


• Tumor giant cells


Normal Adenoma


Retinoblastoma


Retinblastoma


“ Yesterday I dared to struggle
Today I dare to win ”
Bernadette Devlin
For Comments & Suggestions
abbas_naseem@yahoo.com

Abbas Naseem
Dated: June 27, 2010

Neoplasia ospe rapid review

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