neoplasia anatomiya... · 2020. 4. 9. · neoplasia (tumors) azerbaijan medical university...

NEOPLASIA (TUMORS)

Azerbaijan Medical UniversityDepartment of Pathological Anatomy

Lecture 6

Mushfig Orujov, MD, [email protected]

II Part

mailto:[email protected]

Plan of the Lecture

• Mesenchymal tumors - Soft Tissue and Bone Tumors

• Tumors of Hemopoietic Tissue - Leukemias• Tumors of Lymphoid Tissue - Lymphomas

• Mesenchymal tumors are tumors, which grow from derivates of mesenchymal tissues: fibrous connective, adipose, muscle, vascular, bone, cartilage tissues, synovial and serous membranes.

• These tumors do not have organ specificity, meet rarer than epithelial tumors.

Benign Malignant

MESENCHYMAL TUMORS(Soft Tissue and Bone Tumors)

Benign mesenchymal tumors• Fibroma• Leiomyoma• Rhabdomyoma• Lipoma• Hybernoma• Granular cell tumor – Myoblastoma - Abrikosov tumor• Hemangioma• Lymphangioma• Synovioma• Mesothelioma• Osteoma• Chondroma

Fibroma

• Arises from fibrous connective tissue.• There are hard and soft fibromas.• Meet in a skin, ovaries, extremities, grow slowly, expansively.

Types of fibroma:FibromatosisDesmoidDermatofibromaElastofibromaRetromesenteric fibroma

• FIBROMATOSIS – is tumor, consist of some nodes.• DESMOID (aggressive fibromatosis) – cytologically benign,

but biologically likes malignant tumor. Grows infiltratively, painful and have recurrences.

Classification on localization:• Extra-abdominal desmoid – develops in the muscles of

shoulder, scapula, thoracic and femoral regions.• Abdominal desmoid – occurs during the pregnancy and next

periods in women.• Intra-abdominal desmoid – develops in mesentery or in wall

of the pelvis.

Dermatofibroma (Cutaneous Fibrous Histiocytoma)• Dermatofibroma is a common benign fibrous nodule that most often

arises on the skin of the lower legs. • Microscopically: characterized by a poorly defined proliferation of

fibrohistiocytic cells within the dermis with an overlying Grenz zone of sparing. At the periphery of the lesion, there is entrapment of collagen.

• Characteristic histological sign are large and multinucleated Touton(giant) cells.

• In cytoplasm of Touton cells are accumulated the lipid and hemosiderin.• The are 4 types of dermatofibroma according of Touton cells contents:Common dermatofibromaLipidized dermatofibromaHemosiderotic dermatofibromaMixed dermatofibroma

Dermatofibroma

https://www.webmd.com/skin-problems-and-treatments/picture-of-dermatofibromahttps://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/dermatofibroma

The epidermis over the dermatofibroma often shows hyperplasia and basilar hyperpigmentation.

https://www.webmd.com/skin-problems-and-treatments/picture-of-dermatofibromahttps://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/dermatofibroma

Touton giant cells

https://en.wikipedia.org/wiki/Touton_giant_cell#/media/File:Juvenile_xanthogranuloma_-_very_high_mag.jpg

https://en.wikipedia.org/wiki/Touton_giant_cell%23/media/File:Juvenile_xanthogranuloma_-_very_high_mag.jpg

Elastofibroma

• Elastofibroma is a rare, benign, slow-growing connective-tissue tumor that occurs most often in the subscapular area in elderly women.

• Can have very large dimensions.

researchgate.net/publication/6567830_Pathologic_and_MR_Imaging_Features_of_Benign_Fibrous_Soft-Tissue_Tumors_in_Adults1/figures?lo=1

Leiomyoma

http://www.pathologyoutlines.com/caseofweek/case429image5.jpghttps://www.stepwards.com/?page_id=2886

• Leiomyoma is a benign smooth muscle tumor that very rarely becomes cancer.• They can occur in any organ, but the most common forms occur in the uterus,

small bowel, and the esophagus.• Occurs at different ages and in different sizes.

http://www.pathologyoutlines.com/caseofweek/case429image5.jpghttps://www.stepwards.com/?page_id=2886

Rhabdomyoma

• Rhabdomyoma is a benign tumor of striated muscle.• Rhabdomyomas may be either "cardiac" or "extra cardiac"

(occurring outside the heart).• Extracardiac forms of rhabdomyoma are subclassified into three

distinct types: adult type, fetal type, and genital type.• Cardiac rhabdomyomas are the most common primary tumor of

the heart in infants and children.• It is most commonly associated with the tongue, and heart, but

can also occur in other locations, such as the vagina.

Gross view and microscopy of rhabdomyoma

https://en.wikipedia.org/wiki/Rhabdomyoma

https://en.wikipedia.org/wiki/Rhabdomyoma

Lipoma

https://voices.uchicago.edu/grosspathology/bone-soft-tissue/lipoma/http://www.pathologyoutlines.com/wick/softtissue/lipomamicro1.jpg

https://voices.uchicago.edu/grosspathology/bone-soft-tissue/lipoma/http://www.pathologyoutlines.com/wick/softtissue/lipomamicro1.jpg

Hibernoma

https://www.webpathology.com/image.asp?case=438&n=5


Granular cell tumor (Abrikosov tumor, Granular cell myoblastoma)

https://slideplayer.com/slide/8772734/

https://slideplayer.com/slide/8772734/

Granular cell tumor of Sigmoid colonS-100 immunostain

https://www.pinterest.com/pin/16325617376067794/

https://www.pinterest.com/pin/16325617376067794/

Hemangioma

https://www.mountsinai.org/about/patient-stories/hemangioma-upper-eyelidhttps://librepathology.org/wiki/Hemangioma

https://www.mountsinai.org/about/patient-stories/hemangioma-upper-eyelidhttps://librepathology.org/wiki/Hemangioma

Lymphangioma

https://medicoapps.org/m-lymphangioma/http://www.pathologyoutlines.com/topic/softtissuelymphangioma.html

https://medicoapps.org/m-lymphangioma/http://www.pathologyoutlines.com/topic/softtissuelymphangioma.html

Osteoma

• Osteoma is a benign osteogenic lesion characterized by proliferation of compact, lamellar cortical bone.

• It presents as an exophytic mass usually arising from the bones of the skull and paranasal sinuses.

• Large osteomas may develop on the clavicle, pelvis, and tubular bones (parosteal osteomas).

• Although any age may be affected, most osteomas occur in adults between the ages of 30 and 50 years.Osteomas occur more often in women than men (3:1).

• Compact osteomas, on microscopic examination, are consisted of mature lamellar bone.

• They have no Haversian canals and no fibrous component. • Trabecular osteomas are composed of cancellous trabecular bone with

hematopoietic elements surrounded by a cortical bone margin.• They may be found centrally (endosteal) or peripherally (subperiosteal) in

the bone.

http://atlasgeneticsoncology.org/Tumors/OsteomaID5427.html


Osteoma

Figure 2: The lesion consists of dense and lamellar cortical bone with a focal area of active bone modeling.Figure 3: Photomicrograph of the more solid area of the lesion to demonstrate the cellular woven character of the bone.



Osteoid-osteoma

Osteoclastoma (Giant cell tumor of bone)

https://radiopaedia.org/cases/osteoclastoma-1http://www.pathologyoutlines.com/topic/bonegiantcelltumor.html

https://radiopaedia.org/cases/osteoclastoma-1http://www.pathologyoutlines.com/topic/bonegiantcelltumor.html

Chondroma

https://www.pathologyoutlines.com/topic/bonechondromajuxtacortical.htmlhttps://www.orthobullets.com/pathology/8019/periosteal-chondromas

https://www.pathologyoutlines.com/topic/bonechondromajuxtacortical.htmlhttps://www.orthobullets.com/pathology/8019/periosteal-chondromas

Condroblastoma



PATHOLOGY OF THE MALIGNANT MESENCHYMAL

TUMORS

Malignant mesenchymal tumors

• They are named sarcomas from the Greek word of sarcos - meat, meet rarely.

• On a cut the tumors have a white-grey color, like fish-meat.

• Such tumors metastasize by hematogenous way mainly.

Classification of sarcomas1. Fibrosarcoma2. Malignant dermatofibroma3. Leiomyosarcoma4. Rhabdomyosarcoma5. Liposarcoma6. Malignant hybernoma7. Malignant myoblastoma 8. Angiosarcoma 9. Hemangiopericytoma10.Kaposi’s sarcoma 11.Lymphangiosarcoma12.Malignant synovioma13.Malignant mesothelioma14.Osteosarcoma15.Chondrosarcoma16.Ewing sarcoma

Fibrosarcoma (fibroblastic sarcoma)

• Fibrosarcoma is a malignant mesenchymal tumor derived from fibrous connective tissue.

• It is usually found in males aged 30 to 40.• Fibrosarcomas involve deep soft tissues of extremities, trunk, head

and neck.• The typical fibrosarcoma is a circumscribed white or tan mass,

variably firm in relation to the collagen content.• Haemorrhage and necrosis can be seen in high grade tumors.• Fibrosarcoma characterized by the presence of

immature proliferating fibroblasts orundifferentiated anaplastic spindle cells in a storiform pattern.

Fibrosarcoma

• http://www.tumorlibrary.com/case/images/2103.jpg

OSTEOSARCOMA• Malignant tumor of bone tissue.• Develops mainly in young men in the long tubular bones

(especially in knee joint region, distal metaphysis of femur, proximal metaphysis of tibia).

There are 3 types

Osteoblastic Osteoclastic Mixed

Osteosarcoma

• http://www.ijoonline.com/articles/2014/48/3/images/IndianJOrthop_2014_48_3_238_132491_u6.jpg

Osteosarcoma

Kaposi sarcoma

Vascular neoplasm caused by human herpesvirus 8 (HHV8)Atypical spindle cellsMore extensive, compressed, slit-like vascular channels infiltrating deeper dermis

Ewing sarcoma /Primitive neuroectodermal tumor (PNET)

• Ewing sarcoma and PNET are defined as round cell sarcomas that show varying degrees of neuroectodermal differentiation.

• The term Ewing sarcoma has been used for those tumors that lack evidence of neuroectodermal differentiation as assessed by light microscopy, immunohistochemistry, and electron microscopy, whereas, the term PNET has been employed for tumors that demonstrate neuroectodermal features as evaluated by one or more of these modalities.

• ICD-O codes• Ewing sarcoma 9260/3• PNET 9364/3• Askin tumour 9365/3

Ewing sarcomaEpidemiology

• Ewing sarcoma / PNET is relatively uncommon accounting for 6-8% of primary malignant bone tumors and is less common than myeloma, osteosarcoma and chondrosarcoma.

• It is the second most common sarcoma in bone and soft tissue in children.

• Ewing sarcoma / PNET shows a predilection for males with the ratio of 1.4 to 1.

Ewing sarcomaMacroscopy

• The tumor in bone and soft tissue is tan–grey and often necrotic and hemorrhagic.

• Necrotic yellowish and semi-fluid tissue obtained from intramedullary or subperiosteal lesion at open biopsy might grossly be erroneously interpreted as pus by surgeons.

• Some soft tissue tumors may be associated with a large peripheral nerve.

Ewing sarcomaHistopathology

• The morphology of the tumor is variable.• Most cases are composed of uniform small round cells with round

nuclei containing fine chromatin, scanty clear or eosinophilic cytoplasm, and indistinct cytoplasmic membranes, whereas in others, the tumor cells are larger, have prominent nucleoli, and irregular contours.

• The cytoplasm of the tumour cells frequently contains PAS positive glycogen.

• In soft tissue tumors, the tumor cells rarely have a spindle cell morphology.

Ewing sarcomaE

http://www.pathologyoutlines.com/topic/boneewing.html

http://www.pathologyoutlines.com/topic/boneewing.html

Ewing sarcomaImmunophenotype

• CD99 is expressed in almost all cases in a characteristic membranous fashion, though it is not specific.

• Vimentin stains most tumor cells and neural markers such as neuron specific enolase (NSE), are frequently expressed.

• Ewing sarcoma / PNET has also been shown to stain with keratin in some cases.



TUMORS OF HEMOPOIETIC AND LYMPHOID TISSUES

Tumors of Hemopoietictissues

LEUKEMIAS

Tumors of Lymphoid tissues

LYMPHOMASBoth tumors are malignant

Leukemias

• Uncontrolled production of white blood cells caused by the malignancies of the bone marrow.

• Features of leukemia:– abnormal proliferation of leukemic cells– about 95% originate from leukocytes, 3-5% from

erythrocytes and megakaryocytes.– leukemic cells cause leukemic infiltrates to form in all

organs and tissues.– suppression of normal hemopoiesis– extramedullary hematopoietic foci occur outside the bone

marrow.• Trepanobiopsy (taken from the posterior iliac crest) is

important in the diagnosis.• Clinical signs and complications: Anemia, hemorrhagic

syndrome, recurrent infections, sepsis.

https://ppt-online.org/106117

https://ppt-online.org/106117

Histogenetic Classification of Acute Leukemias

•Undifferentiated•Lymphoblastic•Plasmoblastic•Monoblastic (myelomonoblastic) •Myeloblastic•Erythromyeloblastic•Megakaryoblastic

Histogenetic Classification of Chronic Leukemias

I. Chronic Lymphocytic Leukemias1. Chronic lympholeukemia2. Cutaneous lymphomatosis or Sezary disease3. Paraproteinemic Leukemias:a) Myeloma (plasmocytoma)b) Primary macroglobulinemia (Waldenstrom disease)c) Heavy chain disease (Franklin’s disease)


II. Chronic Monocyte-derived Leukemias1. Chronic monocytic leukemias2. Histiocytosis:a) Eosinophilic granulomab) Letterer-Siwe diseasec) Hand-Schuller-Christian disease


III. Chronic Myelocytic Leukemias1. Chronic myeloid leukemia (Chronic myelosis)2. Chronic erythromyelosis (Chronic erythemia)3. Erythrocytosis megalosplenica (Osler-Vaquez

disease)4. Chronic megakaryocytic leukemia

• It is more common in boys aged 3-5 years.• Leukemic infiltrates are more common - they occur in almost all

organs and tissues except the hematopoietic and gonadal glands, especially in the thymus.

• Leukemic infiltrates are mainly focal and develop nodules of leukemic cells.

• The most common (80%) is acute lymphoblastic leukemia.• Acute myelooblastic leukemia is very rare.• Acute non-lymphoblastic leukemia occurs mainly in adults (85%).• Special forms of acute leukemia in childhood are congenital

leukemia and chloroleukemia.

Features of childhood acute leukemia

• Often, no symptoms are noticed initially.• As it progresses, bone pain, bleeding, frequent infections, and anemia may

occur.• Complications may include amyloidosis.• Atypical cells of the lympho-plasmocytic row - myeloma cells - appear in

the bone marrow and extramedullary organs and tissues.• Immunohistochemistry can detect plasma cells that express

immunoglobulin in the cytoplasm and occasionally on the cell surface; myeloma cells are often CD56, CD38, CD138, and CD319 positive and CD19, CD20, and CD45 negative.

• In the diagnosis of myeloma, the detection of Bens-Jones protein (light immunoglobulins - from the L-chain) in the urine is important.Morphological types of multiple myeloma:

• Nodular (focal) type• Diffuse type• Diffuse-nodular type

Multiple myeloma(Plasma cell myeloma, myelomatosis, Kahler's disease)

Multiple myeloma

https://en.wikipedia.org/wiki/Multiple_myeloma

https://en.wikipedia.org/wiki/Multiple_myeloma

Lymphomas

• These are regional tumors of hematopoietic and lymphoid tissue.• Lymphomas that first develop in one or a group of lymph nodes

can then spread to other groups of lymph nodes (metastasis) and generalize.

• According to histogenesis, they are divided into 3 groups:1. B cell lymphomas 2. T cell lymphomas 3. Undifferentiated lymphomas

Lymphomas

• Types of lymphoma according to clinical and morphological features:1. Lymphosarcoma:A − Nodular lymphosarcomaB − Diffuse lymphosarcoma2. Reticulosarcoma3. Mycosis fungoides4. Sezary disease5. Lymphogranulomatosis (Hodgkin lymphoma).

• The first 4 diseases are called non-Hodgkin lymphomas.

• It is the most common of lymphomas.• It is found in all ages.• Occurs most often in men.• It is mainly chronic, but often recurrent.• It usually begins with damage to the peripheral lymph nodes,

especially the cervical or supraclavicular, mediastinal lymph nodes.

• Characteristic atypical cells for lymphogranulomatosis are:1 – Small Hodgkin’s cells - are mononuclear small cells. 2 – Big Hodgkin’s cells - are mononuclear big cells.3 – Reed-Sternberg cells – are giant-sized, multinucleated, bright cytoplasmic cells.

Hodgkin lymphoma

https://en.wikipedia.org/wiki/Reed%E2%80%93Sternberg_cell#/media/File:Reed-Sternberg_lymphocyte_nci-vol-7172-300.jpg

https://en.wikipedia.org/wiki/Reed%E2%80%93Sternberg_cell%23/media/File:Reed-Sternberg_lymphocyte_nci-vol-7172-300.jpg

Hodgkin lymphoma

• According to their morphological features and prevalence in the body, there are 2 types of Hodgkin lymphoma - local and generalized types.

• Histological types of Hodgkin lymphoma1. Nodular sclerosing2. Mixed cellularity3. Lymphocyte rich4. Lymphocyte depleted

NEOPLASIA (TUMORS)Plan of the LectureСлайд номер 3Benign mesenchymal tumorsFibromaСлайд номер 6Слайд номер 7Dermatofibroma (Cutaneous Fibrous Histiocytoma)DermatofibromaTouton giant cellsElastofibromaLeiomyomaRhabdomyomaGross view and microscopy of rhabdomyomaLipomaHibernomaGranular cell tumor �(Abrikosov tumor, Granular cell myoblastoma)Granular cell tumor of Sigmoid colon�S-100 immunostainHemangiomaLymphangiomaOsteomaOsteomaOsteoid-osteomaOsteoclastoma (Giant cell tumor of bone)ChondromaCondroblastomaPATHOLOGY OF THE �MALIGNANT MESENCHYMAL TUMORSMalignant mesenchymal tumorsClassification of sarcomasFibrosarcoma (fibroblastic sarcoma) FibrosarcomaOSTEOSARCOMAOsteosarcomaOsteosarcomaKaposi sarcomaEwing sarcoma /�Primitive neuroectodermal tumor (PNET)Ewing sarcoma�EpidemiologyEwing sarcoma�MacroscopyEwing sarcoma�HistopathologyEwing sarcomaEwing sarcoma�ImmunophenotypeTUMORS OF HEMOPOIETIC AND LYMPHOID TISSUESСлайд номер 43LeukemiasСлайд номер 45Слайд номер 46Слайд номер 47Histogenetic Classification of Acute LeukemiasHistogenetic Classification of Chronic LeukemiasHistogenetic Classification of Chronic LeukemiasHistogenetic Classification of Chronic LeukemiasFeatures of childhood acute leukemiaMultiple myeloma� (Plasma cell myeloma, myelomatosis, Kahler's disease)Multiple myelomaLymphomasLymphomasHodgkin lymphomaСлайд номер 58Hodgkin lymphoma

neoplasia anatomiya... · 2020. 4. 9. · neoplasia (tumors) azerbaijan medical university...

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