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  1. NEOPLASIA Dr.CSBR.Prasad, M.D.,
  2.  Metaplasia  Dysplasia  Anaplasia  Complication of chronic inflammation / irritation
  3. Clinical examples of Neoplasia
  4. Nomenclature  Neoplasia  Neoplasm  Tumor  Oncology  Clonal / Clonality  Benign  Malignant (Latin)  Cancer
  5. Neoplasia - Definition Neoplasia = New growth  Neo = New  Plasia = Growth  Tumor = Swelling  Cancer = Crab (L)  Oncology = Study of tumor / Neoplasm (Oncos = Tumor)
  6. Nomenclature  Normal  Abnormal  Non neoplastic  Hyperplasia  Metaplasia  Precancerous (dysplasia / in situ carcinomas)  Neoplastic  Benign  Epithelial  Mesenchymal  Malignant  Epithelial  Mesenchymal
  7. Cancer (L. Crab)  Any malignant growth of cells (clonal)  Nearly 7 lakh people die of cancer in India (2015) Gross features Microscopic features
  8. Cancer (L. Crab)
  9. Cancer (L. Crab)
  10. The following figure shows how cancer cases have been progressively increasing from 2004 to 2010
  11. Definition  “Willis” definition of Neoplasia - (new growth) abnormal mass of tissue, the growth of which exceeds and is uncoordinated with the normal tissues and continues to grow even after the cessation of the stimulus that evoked the initial response  New Definition: (Robbins Path) a neoplasm can be defined as a disorder of cell growth that is triggered by a series of acquired mutations affecting a single cell and its clonal progeny
  12. Normal – Hyperplasia – Dysplasia – Carcinoma
  13. Neoplasm The causative mutations give the neoplastic cells a survival and growth advantage, resulting in excessive proliferation that is independent of physiologic growth signals (autonomous)
  14. Makes an interesting reading…
  15. Neoplasia  It is autonomous, purposeless  Proliferation is uncontrolled  Competes with normal cells for its needs  It is a clonal disorder  It is a genetic disorder  In 95% of cases acquired genetic disorder  In 5% of cases inherited
  16. Nomenclature  All tumors have two components  Parenchyma  Represents tumor proper; the growth of the tumor is due to proliferation of these cells  Stroma  Provides the framework, blood supply and nutrition for the parenchymal cells
  17. Parenchyma Stroma
  18. Desmoplasia  Formation of abundant collagenous stroma  Stimulated by parenchymal cells • Ex: Schirrous. ca of breast Linitus plastica (ca stomach) Carcinoma prostate
  19. Scirrhous carcinoma of breast
  20. Scirrhous carcinoma of breast
  21. Linitus plastica
  22. Nomenclature  Tumors are designated by attaching suffix “–oma” to the cell or tissue of origin  Fibroma, chondroma, lipoma, osteoma etc  Benign tumor arising from glandular structure is called adenoma  Benign tumor arising from epithelial surface having finger like projections is called papilloma  Malignant tumor arising from epithelial tissue is called Carcinoma  Malignant tumor arising from mesenchymal tissue is called Sarcoma
  23. Papilloma / Polyp / Adenoma
  24. Papilloma / Polyp / Adenoma Pedunculated polyp Sessile polyp
  25. Papilloma / Polyp / Adenoma
  26. Malignant Tissue of Origin Benign Composed of One Parenchymal Cell Type Tumors of mesenchymal origin Connective tissue and Fibroma Fibrosarcoma derivatives Liposarcoma Chondrosarcoma Osteogenic sarcoma Lipoma Chondroma Osteoma Endothelial and related tissues Hemangioma Lymphangioma Blood vessels Lymph vessels Synovium Mesothelium Brain Coverings Meningioma Angiosarcoma Lymphangiosarcoma Synovial sarcoma Mesothelioma Invasive meningioma
  27. Tissue of Origin Benign Malignant Blood cells and related cells Hematopoietic cells Leukemias Lymphoid tissue Lymphomas Muscle Smooth Leiomyoma Leiomyosarcoma Striated Rhabdomyoma Rhabdomyosarcoma
  28. Tumors of epithelial origin Stratified squamous Basal cells of skin or adnexa Epithelial lining of glands or ducts Squamous cell Squamous cell carcinoma papilloma Basal cell carcinoma Adenoma Adenocarcinoma Papilloma Cystadenoma Papillary carcinomas Cystadenocarcinoma Bronchogenic carcinoma Respiratory passages Renal epithelium Bronchial adenoma Renal tubular adenoma Renal cell carcinoma Liver Cell Urothelial cell Adenoma Papilloma Hepatocellular carcinoma Urothelial carcinoma
  29. Placental epithelium Hydatidiform mole Choriocarcinoma Testicular epithelium (germ cells) Seminoma Melanocytic Tumors Nevus Embryonal carcinoma Malignant melanoma More Than One Neoplastic Cell Type-Mixed Tumors, Usually Derived from One Germ Cell Layer Salivary glands Pleomorphic adenoma (mixed tumor of salivary origin) Malignant mixed tumor of salivary gland origin Renal anlage Wilms’ tumor More Than One Neoplastic Cell Type Derived from More Than One Germ Cell Layer-Teratogenous Totipotential cells in gonads or in embryonic rests Mature teratoma, dermoid cyst Immature teratoma, teratocarcinoma
  30. Tissues with NO benign tumors  Synovium  Mesothelium  Lymphoid tissue  Hematopoietic cells  Basal cells of skin or adnexa
  31. Nomenclature  Malignant tumor arising from epithelial structures is called “Carcinoma”  Malignant tumor of the mesenchymal tissues is called “Sarcoma”  Embryonal tumors usually have the suffix “Blastoma”  Malignant lesions of the blood are called “Leukemia”  Malignant lesions of the lymphoid tissue is called “Lymphoma”
  32. Neoplasms of Totipotent Cells
  33. Neoplasms of Embryonic Pluripotent Cells  Pluripotent cells can mature into several different cell types  These neoplasms are generally called Embryomas or Blastomas
  34. Blastoma  All blastomas are childhood tumors  All blastomas are malignant tumors Except:  Chondroblastoma  Osteoblastoma  Pulmonary blastoma
  35. Neoplasms of pluripotent embryonic-type cells (BLASTOMAs)
  36. Nomenclature of Neoplasms of Differentiated Cells
  37. Exceptions to These Rules  Neoplasms That Sound Benign But Are Really Malignant  Neoplasms That Sound Malignant But Are Really Benign  Leukemias  Mixed Tumors Whose Cell o f Origin Is  Neoplasms Unknown Lymphoma Plasmacytoma Melanoma Glioma Astrocytoma Osteoblastoma Chondroblastoma
  38. Nomenclature  Some malignant tumors named like benign tumors  Melanoma, Hepatoma, Lymphoma  Some benign tumors named like malignant tumors  Cystosarcoma phylloides, chondroblastoma  Some unusual tumors  Mixed tumor of salivary gland (pleomorphic adenoma)  Teratoma
  39. Mixed tumor  Tumors with single type of parenchymal cells that differentiates into many cell lines –Eg: Pleomorphic adenoma of salivary gland.
  40. Pleomorphic adenoma - Parotid
  41. Teratoma  Tumor arising from totipotent cells (germ cells) showing differentiation towards tissues derived from all the three germ cell layers  Seen usually along the midline  Common sites  Ovary, testis, sacro-coccygeal region, retro- peritoneum, mediastinum, base of the brain etc
  42. What are the common sites for teratomas ?  Gonads  Mid line  Lines of fusion
  43. Along the lines of fusion
  44. Neoplasms of Totipotent Cells
  45. Sacrococcygeal teratoma
  46. Teratoma
  47. Teratoma
  48. Named tumors
  49. Hamartomas & Choristomas  A hamartoma is composed of tissues that are normally present in the organ in which the tumor arises  Eg: a hamartoma of the lung consists of a disorganized mass of bronchial epithelium and cartilage that may become so large that it presents as a lung mass. Its growth is coordinated with that of the lung itself  A choristoma resembles a hamartoma but contains tissues that are not normally present in its site of origin  Eg: A orderly mass of pancreatic acini and ducts in the wall of the stomach is properly called a choristoma.
  50. Sarcomas are very vascular -local rise of temperature
  51. Hamartoma • Definition - Jumbled mixture of tissue native to the site / organ • Eg: Hamartoma of lung
  52. Choristoma • • Definition – Normal organized tissue at an abnormal site (ectopic rest of normal tissue) Eg: adrenal cells under kidney capsule, pancreas in stomach
  53. A wrong decision Johannes Fibiger Nobel prize winner in 1926 Katsusaburo Yamagiwa
  54. In 1915 Drs. Koichi Ichikawa and Katsusaburo Yamagiwa of the Hokkaido University, Japan painted coal tar on the ears of 101 rabbits every 2 or 3 days.
  55. In 1775, Dr. Percivall Pott, a British surgeon, reported one of the earliest observations on environmental / occupational cancer
  56. Two common cancers in our country in India, cancers of lung and mouth in men and cervix and breast in women are the biggest killers
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