oral tumors,in oral cavity

8/9/2019 Oral Tumors,In Oral Cavity

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Benign and malignantepithelial tumors

Localization in oral cavity

Benign and malignantmesenchymal tumors

Localization in oral cavity

Other types tumors (pigment,nervous system, odontogenic)

Synpsis

Benign tumors of mesenchymal origin. Malignant tumors of mesenchymal origin. Benign tumors of epithelial origin – adenoma, papilloma. Malignant tumors of epithelial origin – carcinoma. Localization in

oral cavity. Tumors of melanocyte origin. Tumors of the central nervous system. Tumors of the peripheral nervous system. Benign tumors of connective tissue. Benign and malignant tumors of smooth and striated muscles. Tumors from vessels’ wall – benign and malignant. Malignant tumors of connective tissue origin. Osteogenic sarcoma. Malignant synovioma. Teratogenic tumors – teratoma


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CLASSIFICATION OFTUMOURS

Behavioural classification

benign or malignant

Histogenetic classification -cell of origin

Epithelial

Mesenchymal

Mixed

Teratomas

Precise classification of individual tumors isimportant for planning treatment

Principal characteristics of benign andmalignant tumours

Special features of theepithelial tumors indifferent organs

Epithelial tumors

The most often tumors

ectoderm -skin

mesoderm-kidney

endoderm - GIT

Structure the parenchyma

neoplastic epithelial cells

Benign

malignant

non-neoplastic stroma


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Epithelial tumors

Benign Papilloma

from the surface epithelium

Adenoma from the glandular epithelium

Malignant carcinomas

Skin Epithelial lining of glands

and ducts Gastro-intestinal tract

Oral cavity, esophagus,stomach, intestine,hepato-biliary system,pancreas

Respiratory passages Nasal cavity, larynx,

trachea, bronchi

Urinary tract epithelium

Male and female genitalsystems

Placental epithelium

Endocrine glands

Tumors of epithelial origin

Tissue of origin Benign Malignant

Special features of epithelialtumors

Benign and malignant epithelial tumors are the mostcommon in adults.

Epithelial cells grow as cohesive groups

Malignancy can be diagnosed by invasion through tissuelayers -basement membrane, muscularis mucosae intact basement membrane in benign tumors

Carcinomas spread generally by lymphatics to lymph nodes,

later -via the blood stream (liver, pulmo, bones)

Treatment is by surgical resection In carcinomas response to radiation and chemotherapy varies

with type

Benign epithelial tumors

2 types according to the epithelium

Papilloma – from the surface epithelium

Skin, urinary tract epithelium

Adenoma – from the glandular epithelium


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Papillomas

Tumors with finger-likeprojections

Macroscopic features Exophytic lesions

Rarely endophytic lesions

Histology Papillae

Epithelium lining

Squamous cell epithelium

Transitional epithelium

Preserved basement membrane

Connective tissue core

Squamous cell papilloma

Verrucae skin

viruses

Squamous cell papilloma esophagus larynx

children – juvenile papillomatosis

trachea

precancerosis

Condylomata genitals, anus

condyloma acuminatum HPV (human papilloma virus -1,

2, 4, 7 type) condyloma lata

syphilis

Urothelial papillomas

Transitional epithelium ofureter, bladder, uretra

Precancerosis

Urothelial carcinoma withlow grade malignancy

Histology Fragile papillae

Urine -cytology

Papilloma vesicae urinariae


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Adenomas

Glandular epithelium Endocrine glands

functional activity – clinical syndromes Pituitary Thyroid gland Suprarenal glands Endocrine pancreas

Exocrine glands Skin - oil and sweat glands Salivary gland

Adenoma gl. Parotis

Breast Fibroadenoma

Exocrine pancreas Gastrointestinal tracts Respiratory tract Ovarium

Liver

Kidney

Adenomas

Macroscopy

nodules, capsulated

Mucosa surface – pedunculated and sessilepolyps

Single, multiple familial polyposis coli

Various size < 1 cm

> 3 cm

Adenomas

Histology

Glands

Various shape and size

Preserved basementmembrane

± dysplasia

low-grade or high-grade

high grade oftenclassified withcarcinoma-in-situ

may develop into malignancy

Uterine cervix

Colon polyps

Dysplasia

Normal gland

Mild dysplasia Severe dysplasia

Moderate dysplasia


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Adenomas

Histological types acinar

Small glands lumen, endocrineglands

trabecular Tarbeculae, liver, suprarenal glands

tubular tubule, GIT

Villous Papillae, GIT

Mixed tubulovilous, GIT

Solid Nests, bronchi

Cystic Papillary cystadenoma – serous,

mucous, ovary

Adenoma рleomorphe glаndulaeparotis

Tumor mixtus

Capsulated,mucinous cut surface

Histology Gland structures

Myoepithelial cells

Mucoid substance

Basophilic

Resemblecartilagous

Fibroadenoma gl. mammae

Female, young age

Capsulated, firmnodules

Histology parenchyma

Gland structures Loose connective tissue

pericanalicular

intracanalicular

Fibrous stroma

Ovarian cystadenoma


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Malignant epithelial tumors

= Carcinomas

Risk factors Preneoplastic syndromes –chronic inflammation,

hyperplasia, regeneration

Benign epithelial tumors

Macroscopy Rapid growth – necrosis, haemorrages Noncapsulated Infiltrative Exophytic and endophytic growth

Histology invasion through tissue layers -basement

membrane, muscularis mucosae differentiation

Grading - high-, moderate-, poor differentiation

Metastases Lymph nodes Distant metastases Seeding

TNM staging

Carcinomas

High morbidity andmortality

may be due to: pressure on and destruction

of adjacent tissue

metastases

blood loss from ulceratedsurfaces

obstruction of flow(intestinal obstruction)

paraneoplastic effects

weight loss, cachexia

Carcinomas

From surface epithelium Squamous cell carcinoma

Basal cell carcinoma

Transitional (urothelial)carcinoma

From glandular epithelium

Adenocarcinoma

Hepatocellular carcinoma

Renal cell carcinoma

Seminoma

Choricarcinoma

Poorly differentiated carcinoma

Malignant tumors of surfaceepithelium

Squamous cell carcinoma skin

Face

Oral cavity

leukoplakia

Metaplasia of stratifiedsquamous non-ketatinized

epithelium into keratinized Esophagus

Larynx

Bronchus

Squamous cell metaplasia

Cervix uteri, vagina

http://www.microscopyu.com/galleries/pathology/ovarianadenocarcinoma.html


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Squamous cell carcinoma

Histology

atypical cells at alllevels of the epidermis,with nuclear crowdingand disorganization

invasions of basementmembrane

variable differentiation

Keratinization

perls

Squamous cell carcinoma

High differentiation With keratinization

= carcinoma planocellulare keratodes

Moderate differentiation keratinization

Low differentiation Without keratinization

= carcinoma planocellulare non-keratodes

WELL?

MODERATE?

POOR?

Grading for Squamous Cell Carcinoma

Basal cell carcinoma =Ulcus rodens Tumor cells resemble the normal epidermal basal cell layer from

which they are derived

2 patterns: superficial type or nodular lesions

palisading with separation from the stroma, creating a cleft

Slow growth, local invasion, no metastases


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Malignant tumors of glandularepithelium

= Adenocarcinoma Breast

Salivary glands

Gastro-intestinal tract

esopagus – Barrett esophagus

stomach – H.pylori gastritis

colon – adenomas

Pancreas

Endocrine glands

Female genital system

endometrium

ovarium

Male denital system testis - seminoma

Adenocarcinomas

Histology

Gland structures

Various shape

cellular atypia

invasion through tissuelayers

basement membranes

muscularis mucosae

Adenocarcinomas

Histological types Mucinous –

Mucin production Intra-, extracellular

"signet-ring" cells

Papillary carcinoma

Cystadenocarcinoma

Adenoacantoma

+ squamous cell metaplasia

Adenosquamous carcinoma

+ squamous cell carcinoma

Mucoepidermoid carcinoma

Mucinous adenosquamouscarcinoma

Adenocarcinoma ventriculi

Intestinal type Diffuse type


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Adenocarcinoma uteri Seminoma Testis

Choriocarcinoma

Хепатоцелуларен карцином

Hepatocellular carcinoma


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Renal cell carcinoma

3 types:

Clear Cell Carcinoma

the most often

Papillary Renal CellCarcinoma

Chromophobe RenalCarcinomas

Poorly differentiated carcinomas

Undifferentiatedcarcinomas

2 types

Scirousum stroma – firm

breast

medullare

stroma - soft

Special features of themesenchymal tumors indifferent organs.

Mesenchymal tumors

Soft tissue tumors

Connective/fibrous tissue

Adipose tissue

Muscle tissue

Vascular tissue

Bone tumors

Joint tumors

A broad group of non-epithelial tumors, deriving fromdifferent mesenchymal tissue types


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SOFT TISSUE TUMORS Tumors of Adipose Tissue

Lipomas Liposarcoma

Tumors and Tumor-like Lesions ofFibrous Tissue Fibroma Nodular fasciitis Fibromatoses Fibrosarcoma

Fibrohistiocytic Tumors Fibrous histiocytoma Malignant fibrous histiocytoma

Tumors of Skeletal Muscle Rhabdomyoma Rhabdomyosarcoma

Tumors of Smooth Muscle Leiomyoma Smooth muscle tumors of uncertain

malignant potential Leiomyosarcoma

Vascular Tumors

Hemangioma

Lymphangioma

Hemangioendothelioma

Hemangiopericytoma

Angiosarcoma

Tumors of UncertainHistogenesis

Synovial sarcoma

Alveolar soft part sarcoma

Epithelioid sarcoma

Granular cell tumor

Mesenchymal tumors

Benign

by adding “-oma” to cell type, from which tumorarise

fibroma, lipoma, chondroma

Malignant

Sarcomas

Fibrosarcoma, liposarcoma, chondrosarcoma

Special features of the mesenchymaltumors

A great diversity of tumors Compared to the epithelial tumors

Appear at any age children adults

Risk factors Physical –trauma, radiation, thermal burn associations Genetic

Chromosome translocations Part of many syndromes

No clear distiction between the tumor’s parenchyma and stroma Mesenchymal origin of the components Diffuse growth

Sarcomas spread generally by via the blood stream to the pulmo, liver Diagnosis

Difficult differentiation between some benign and malignant variants Tumors of borderline malignancy

mitosis

Similar histology – spindle cell type Immunohistochemistry –histogenetic markers

Need of consultation

Chromosomal and Genetic Abnormalities in Soft Tissue Sarcomas

Tumor Cytogenetic Abnormality Genetic Abnormality

Extraosseous Ewing sarcoma andprimitive neuroectodermal tumor

t(11:22)(q24;q12) FLI-1-EWS fusion gene

t(21:22)(q22;q12) ERG-EWS fusion gene

t(7;22)(q22;q12) ETV1-EWS fusion gene

Liposarcoma —myxoid and round celltype

t(12:16)(q13;p11) CHOP/TLS fusion gene

Synovial sarcoma t(x;18)(p11;q11) SYT-SSX fusion gene

Rhabdomyosarcoma —alveolar type t(2;13)(q35;q14) PAX3-FKHR fusion gene

t(1;13)(p36;q14) PAX7-FKHR fusion gene

Extraskeletal myxoid chondrosarcoma t(9;22)(q22;q12) CHN-EWS fusion gene

Desmoplastic small round cell tumor t(11;22)(p13;q12) EWS-WT1 fusion gene

Clear cell sarcoma t(12;22)(q13;q12) EWS-ATF1 fusion gene

Dermatofibrosarcoma protuberans t(17:22)(q22;q15) COLA1-PDGFB fusiongene

Alveolar soft part sarcoma t(X;17)(p11.2;q25) TFE3-ASPL fusion gene

Congenital fibrosarcoma t(12;15)(p13;q23) ETV6-NTRK3 fusion gene


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SOFT TISSUE TUMORS

Fat (adipose) tissue

Fibrous tissue

Fibrohistiocytic

Skeletal muscle

Smooth muscle

Vascular

Peripheral nerve

Uncertain synovial sarcoma, alveolar soft part sarcoma, epitheliod sarcoma

Tumors of Adipose Tissue

Benign

Lipomas

Malignant

Liposarcoma

Lipoma

Benign tumors of fat

The most common soft tissue tumors ofadulthood.

Solitary lesions Multiple – in rare autosomal dominant

syndromes.

Localization Back, shoulders, thigh

Submucosa of GIT

Macroscopy soft, yellow, well-encapsulated masses

Histology Conventional - mature adipocytes

Varied in size Clear empty cytoplasm Peripheral nucleus

Angiolipoma Numerous capillaries

Treatment com lete excision is usuall curative

Lipoma


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Liposarcoma Malignant neoplasm of adipocytes

Rare tumors,

Adults, 60-70 y - f > m chromosomal translocation - myxoid liposarcomas

Localization deep soft tissues, retroperitoneum

in visceral sites

Macroscopy relatively well-circumscribed lesions , large size

polylobulated

± myxoid cut surface

Histology Lipoblasts

fetal fat cells with cytoplasmic lipid vacuoles

myxoid liposarcoma Mucoid stroma

Pleomorphic variant Atypical cells, inc. multinuclated cells mitoses

Liposarcoma

Tumors and Tumor-like Lesionsof Fibrous Tissue

Benign

Fibroma

Malignant

Fibrosarcoma

Fibroma

Benign tumor of fibrousconnective tissue

A common tumor of the skin

Macroscopy Capsulated nodule

Histology Fibrocytes

Spindle cells with sharp edgesnuclei

storiform pattern of growth

+ collagen fibers

hard fibroma -fibroma durum

Soft fibroma -fibroma molle


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Fibroma cutis Fibrosarcomas

Malignant neoplasms composed offibroblasts tend to grow slowly

often recur locally after excision (>50% ofcases)

can metastasize hematogenously (>25% ofcases) - lungs

Adults Localization

deep tissues of the thigh, knee, andretroperitoneal area

Macroscopy soft unencapsulated, infiltrative masses

± areas of hemorrhage and necrosis

Histology all degrees of differentiation spindled cells growing in a herring bone

fashion pleomorphism, mitoses necrosis

Fbrosarcoma Tumors of Smooth Muscle

Leiomyoma

Smooth muscle tumors of uncertainmalignant potential (atypical leiomyomas)

DD leiomyoma/leiomyosarcoma Leiomyosarcoma - > 10/10 HPF mitoses

Leiomyosarcoma


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Leiomyoma

Benign tumor of smooth muscle cells

Low malignant potential

Localization

Myometrium – multiple nodules

Submucosa, intramural, subserosal

Age – female

estrogen-dependent

Macroscopy

Well circumscribed, grey-white firmnodules, up to 20 cm

Fascicled cut surface

Histology

Spindle cells (smooth muscle), fascicles

Round edges of the nuclei

± fibrosis, calcifications, necrosis, cysts

Leiomyoma (HE)

Leiomyosarcoma

Malignant tumor of smooth musclecells 10% - 20% of sarcomas

Adult, f> m Localization

skin,

Deep tissues of extremities

Retroperitoneum, uterus Local invasion, metastasis

метастази

Macroscopy Large, firm tumor mass

Histology spindle cells with cigar-shaped

nuclei

arranged in interweaving fascicles

Leiomyosarcoma


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Tumors of Skeletal Muscle

Rhabdomyoma

Rhabdomyosarcoma

More common

Rhabdomyoma

Benign tumor of striated muslecells

Very rare

malformation

Age

Adult type

Fetal type

Localization

Skeletal muscles

Heart

Sclerosis tuberans

Histology

Large round cells with

eozinophilic granular cytoplasm

Rhabdomyosarcoma

Malignant tumor of striated muscle cells > 50% of sarcomas in children

Localization head, neck, face extremties genitourinary tract

sarcoma botryoides -soft, gelatinous, grapelike masses

Macroscopy poorly defined, infiltrating masses

Histology Rhabdomyoblast - round or elongated cells

granular eosinophilic cytoplasm, filaments

Embryonal variant Small round cells

Alveolar variant Alveoli, fibrous septa

Pleomorphic variant

Immunohistochemistry Desmin, myoglobin, actin, myosin

Vascular tumorsTumors of blood vessels and lymphatics

Benign hamartomas, not even true

neoplasms

Intermediate Locally aggressive, rarely metastasize

Malignant

Frequent and early metastases – lungs

Diagnosis “endothelium” lined blood filled

spaces immunohistochemistry - factor VIII

mitosis

Hemangioma

Lymphangioma

Hemangioendothelioma

Angiosarcoma


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Vascular tumors

Benign

Rare mitosis

Mild, rare atypia

No metastases

Malignant

Common mitosis

Frequent, severeatypia

Early, frequentmetastases

via bloodstream

Hemangioma

= a generic term for any benign blood vesseltumor

Capillary (small vascular spaces) Also called “juvenile”, often called “birth marks”

Usually regress with age

Cavernous (large vascular spaces) Also called “adult”

Usually do not regress

Smooth-muscle hemangioma

Pyogenic hemangioma

Hemangioma

Hаemangioma cavernosum hepatis


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Pyogenic granuloma

Oral cavity most common

Regress

Histology

like capillary hemangioma

Indistinguishable from normalgranulation tissue

Glomus tumor

Most commonlyunder nail

Small tumor, 1 cm

Painful

Lymphangiomas

Benign lymphatic analogue ofhemangiomas.

Generally rare

Simple (Capillary) Lymphangioma

small lymphatic channels

absence of blood cells

head, neck, axillary subcutaneous tissues

flat lesions - 1 to 2 cm

Cavernous Lymphangioma (Cystic Hygroma) typically found in the neck or axilla of

children

common in Turner syndrome

can be enormous (≤15 cm in diameter), not

encapsulated

Producing gross deformities - neck

composed of dilated lymphatic spaces andconnective tissue stroma, Ly aggregates

Malignant vascular tumors

Angiosarcoma

± vessels lumens

Factor VIII

atypical endothelial cells

Cellular pleomorphism

Mitoses, atypical

Lymphangiosarcoma

After mastectomy

Papillary projections ofatypical endothelial cells


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Tumors of UncertainHistogenesis

Synovial sarcoma

Alveolar soft part sarcoma

Epithelioid sarcoma

Synovial sarcoma

Uncertain cellular origin, agressive,malignant The cells are not synoviocytes

metastases –lung, bones, LN

Localization Joints - 10%, knee

extrajoints

Young adults Chromosomal translocations t(X;18)

SYT gene (transcription factor)

Histology Biphasic variant

Epithelial-like cells, glands Spindle cells

Monophasic variant Spindle cells – fascicles

DD fibrosarcoma – keratin, EMA

Bone tumors

Bone

Cartilage

Fibrous

Other

Ewing’s “sarcoma”

Giant cell tumor Metastases

Benign

Malignant

Classification of Primary Tumors Involving Bones

Histologic Type Benign Malignant Hematopoietic (40%) Myeloma

Malignant lymphoma

Chondrogenic (22%) Osteochondroma Chondrosarcoma

Chondroma Dedifferentiated chondrosarcoma

Chondroblastoma Mesenchymal chondrosarcoma

Chondromyxoid fibroma

Osteogenic (19%) Osteoid osteoma Osteosarcoma

Osteoblastoma

Unknown origin (10%) Giant cell tumor Ewing’s sarcoma

Giant cell tumor

AdamantinomaHistiocytic origin Fibrous histiocytoma Malignant fibrous histiocytoma

Fibrogenic Metaphyseal fibrous defect(fibroma)

Desmoplastic fibroma

Fibrosarcoma

Notochordal Chordoma

Vascular Hemangioma Hemangioendothelioma

Hemangiopericytoma

Lipogenic Lipoma Liposarcoma

Neurogenic Neurilemmoma


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Benignosteogenic bone tumors

= Bone Forming, 19% Osteoma

face, skull; 40-50yrs Histology - similar to normal bone

Osteoid Osteoma metaphysis femur, tibia 10-20yrs Histology – similar to woven bone

Osteoblastoma vertebral column 10-20yrs Histology -similar to osteoid osteoma

Osteoma

Solitary tumor

Mean age

Face, skull

Exophytic growth,attached to the bone

Histology similar to normal bone

Frontal sinus

Malignantosteogenic bone tumors

Osteosarcoma (osteogenic sarcoma) Primary

Metaphysis of distal femur, proximal; 10-20 yrs

secondary - associated with pre-existing disorders suchas benign tumors, Paget disease

Femur, humerus, pelvis, > 40 yrs

Histologic variants osteoblastic, chondroblastic, fibroblastic, telangiectatic,

small cell, and giant cell

Different degree of differentiation

The most common subtype is osteosarcoma that arises in the

metaphysis of long bones; solitary, intramedullary, and poorly

differentiated; produces a predominantly bony matrix

Osteosarcoma


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Sarcoma osteogenes Benign cartilagenous bone tumors

= Cartilage forming, 22%

Osteochondroma (exostosis) Metaphysis of long bones; 10-30 yrs;

Histology - cartilage and bone tissue

Chondroma Small bones of hands and feet; 30-50 yrs; medullary cavity

Histology – hyaline cartilage

Chondroblastoma Knees, epiphyses, teenagers, m>>f, Histology - much less matrix than a chondroma

Chondromyxoid fibroma

Myxoid, atypia

Osteochondroma (exostosis)

Common

Often multiple as ahereditary syndrome

m>>>f

Pelvis, scapulae, ribs

Metaphysis Cartilage and bone

present

Chondroma

Hyaline cartilage

Multiple enchondromas Ollier’s disease

Maffucci syndrome - if hemangiomas present


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Giant cell tumor of bone

Localization

epiphysis of long bones

cortical lesions

Young adults -20-40 yrs

Histology Macrophages

Giant cells

Ewing sarcoma (tumor)

PNET (primitiveneuroectodermal tumor)

Localization Diaphysis and metaphysis

medullary lesions

Age -10-20 yrs Chromosomal translocation

-t(11;22)

FLI-EWS gene fusion

Histology - small roundcells Resemble lymphoma

Tumors of the central nervous system

General features of the CNS tumors

85 % - intracranial, 15% - intraspinal tumors primary tumors and metastatic

20% of all - tumors of childhood. differ from those in adults both in histologic subtype and location

arise in the posterior fossa ( in adults -mostly supratentorial)

Tumors of the nervous system have unique characteristics Histologic distinction between benign/malignant lesions – not clear

low-grade lesions (low mitotic rate, cellular uniformity, and slowgrowth) may infiltrate large regions of the brain

The anatomic site of the neoplasm - lethal consequencesirrespective of histologic classification

A benign meningioma in the medulla cardiorespiratory arrest

The ability to resect a lesion may be limited

The pattern of spread of primary CNS neoplasms differs from thatof other tumors -rarely metastasize outside the CNS

the subarachnoid space - a seeding along the brain and spinal cord


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CNS TUMORS

GLIOMAS

Astrocytoma (I, II, III, IV) Oligodendroglioma

Ependymoma

MENINGIOMAS

NEURONAL

POORLY DIFFERENTIATED (medulloblastoma)

LYMPHOMAS

METASTATIC

CNS TUMORS

Symptoms? Headache Vomiting

Mental Changes

Motor Problems Seizures Increased Intracranial Pressure

any localizing CNS abnormality

CNS TUMORS

History

Physical Neurologic exam

LP (including cytology)

CT MRI

Brain angiography

Biopsy

Gliomas

Tumors of the brain parenchyma thathistologically resemble different types

of glial cells

astrocytomas,

oligodendrogliomas ependymomas


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Astrocytomas

Different categories of astrocytictumors

characteristic histologic features

distribution within the brain

age groups

Fibrillary

Pilocytic astrocytomas

Fibrillary astrocytomas

80% of adult primarybrain tumors

Age – 40 -60 y Localization

cerebral hemispheres seizures, headaches, and

focal neurologic deficits

Macroscopy a poorly defined, gray,

infiltrative tumor

cut surface - firm, or soft orgelatinous

± cystic degeneration andhemorrhage

Fibrillary astrocytomas

Microscopy I –IV grades

cellularity

nuclear pleomorphism

necrosis

mitoses

Astrocytoma (I, II gr. Anaplastic astrocytoma (III

gr.)

Glioblastoma- IV grade vascular or endothelial cell

proliferation and pseudo-palisading nuclei

Astrocytoma


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Glioblastoma MultiformePilocytic Astrocytoma

Relatively benign tumors

Age - children and young adults

Localization

Cerebellum,

in the floor and walls of the thirdventricle

the optic nerves

Macroscopy

well circumscribed, often cystic

with a mural nodule in the wall of thecyst

Microscopy

areas with bipolar cells with long, thin"hairlike" processes, GFAP (+)

Rosenthal fibers (eosinophilic granularbodies)

Necrosis and mitoses are rare.

Oligodendrogliomas

Frequency -5-15% Age – 40-50 y Localization

cerebral hemispheres

Macroscopy infiltrative tumors - gelatinous, gray ± cysts, focal hemorrhage, and calcifications

Microscopy sheets of regular cells with spherical nuclei

containing finely granular chromatin (similarto normal oligodendrocytes) surrounded by aclear halo of cytoplasm

a delicate network of anastomosingcapillaries.

Calcifications

Mitoses -rare Except in anaplastic oligodendroglioma

Oligodendrogliomas


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Ependymoma

Frequency -5-10%

Age – 10-20 y

Localization

IV –th ventricle hydrocephalus

Macroscopy

solid or papillary masses

Microscopy

cells with regular, round to ovalnuclei with abundant granularchromatin

perivascular pseudo-rosettes

Variants

Anaplastic increased cell density, high

mitotic rates, necrosis

Ependymoma

Poorly Differentiated NeoplasmsMedulloblastoma

Neuroectodermal cells Age - children Localization

cerebellum (vermis)

Макроскопски well circumscribed, gray,

friable

Histology with sheets of anaplastic

("small blue") cells with little cytoplasm and

hyperchromatic nuclei Rossetes of Homer-Wright

mitoses – abundant

Medulloblastoma


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Meningiomas

Benign tumors of adults

from the meningothelial cell of thearachnoid

Localization any of the external surfaces of the

brain

ventricular system

from the arachnoid cells of the

choroid plexus

Macroscopy well-defined dural-based masses

compress underlying brain

Meningiomas

Microscopy -variants

Fibroblastic - with elongated cells andabundant collagen deposition

Psammomatous - with numerouspsammoma bodies

Secretory - with PAS-positiveintracytoplasmic droplets

Microcystic - with a loose, spongyappearance

Atypical meningiomas – mitosis

Anaplastic (malignant) meningiomas resemble a high-grade sarcoma

MeningeomaMetastatic brain tumors

Most common brain tumor inadults.

Common primary sites:melanoma, lung, breast, GItract, kidney.

Most are in cerebrum in gray-white junctions due to

rich capillarity

Single or multiple.

Discrete, globoid, sharplydemarcated tumors

amenable to surgical resection.


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Tumors of the peripheralnervous system

Tumors of the peripheralnervous system

Arise from cells of the peripheral nerve

Schwann cells,

perineurial cells

Fibroblasts

Schwannoma

Neurofibroma

Malignant Peripheral Nerve Sheath Tumor

Schwannoma

From Schwann cells

Symptoms – due to local compression

Localization

in the cerebellopontine angle -attached tothe vestibular branch of the 8 th nerve(vestibular schwannoma)

sensory nerves, large nerve trunks

Macroscopy

well-circumscribed encapsulated massesthat are attached to the nerve

Morphology – 2 growth patterns

Schwannoma Antoni A - Antoni B

Antoni A pattern of growth

elongated cells with cytoplasmicprocesses - fascicles

Verocay bodies

the "nuclear-free zones" ofprocesses that lie between the

regions of nuclear palisading

Antoni B pattern of growth less densely cellular areas

microcysts and myxoid changes

Immuhistochemistry

S-100 protein


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Neurofibroma

Well differentiated, benign

Form whorls of fibroblasts

Two types:

Classic form

Cutaneous / nerves – solitary

collagen matrix, spindle cells,

Plexiform

Neurofibromatosis type 1

Multiple, infiltrative

Myxoid stroma

Malignant Peripheral NerveSheath Tumor

Sarcoma Highly malignant

multiple recurrence

metastases

Origin De novo plexiform neurofibroma

Macroscopy poorly defined tumor masses

±infiltration along the axis of nerve

± invasion of adjacent soft tissues

Histology the tumor cells resemble Schwann cells - elongated nucleiand prominent bipolar processes, fascicle formation

Mitoses, necrosis, nuclear anaplasia

Tumors and Tumor-LikeLesions of Melanocytes

Benign – melanocytic nevusMalignant - melanoma

Melanocytic nevus

Benign congenital or acquiredneoplasm of melanocytes

Numerous types, with varied clinicalappearance

Macroscopy relatively small,

symmetric,

and uniformly pigmented

Morphology Junctional

more pigmented,

more closely associated withmelanoma)

Intradermal

Compound (both)


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Melanocytic nevus

Junctional nevus

Dermal nevus

MALIGNANT MELANOMA

Malignant proliferations of melanocytes.

Incidence rising, Related to sun like all other skin cancers

The only primary skin cancer that canquickly metastasizes

Sporadic

Hereditary -5-10% Germ-line mutations in the CDKN2A gene

(9p21)

MALIGNANT MELANOMA

Difficult to differentiate fromnevus clinically often microscopically

Clinical features Skin

a change in the color or size of apigmented lesion

less common sites - oral andanogenital mucosal surfaces, theesophagus, the meninges, eye.

Morphology Vertical growth phase

Horizontal growth phase Related with prognosis

Breslow, Clark’s staging

MALIGNANT MELANOMA

Morphology

Malignant cells with largenuclei with irregularcontours

chromatin characteristicallyclumped at the periphery ofthe nuclear membrane

prominent eosinophilicnucleoli -"cherry red"

nests or individual cells atall levels of the epidermis


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MALIGNANT MELANOMA Teratomas

=mixed tumors originate from totipotential stem cells

the capacity to differentiate into any of the celltypes found in the adult body

Ovary, testis

3 variants Mature teratomas

contain fully differentiated tissues from one ormore germ cell layers

neural tissue, cartilage, adipose tissue, bone,epithelium in a haphazard array

Immature teratomas contain immature somatic elements reminiscent

of those in developing fetal tissue mediastinum

Teratomas with malignancies malignancy in preexisting teratomatous elements

squamous cell carcinoma or adenocarcinoma Mixed germ cell tumors of testis, 40%

combination of teratoma, embryonalcarcinoma, and yolk sac tumors.

Cystic teratoma of ovary

oral tumors,in oral cavity

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