Medical

1. Pathology of
Neoplasia

2. Neoplasia
Shashi-Jun-20
Neoplasia (Хавдар)
 Хавдар гэдэг үг нь:
 Growth – English
 Рост - Russia
 Ургалт - Mongolia

3. Neoplasia
Shashi-Jun-20
 Ургаж үржиж байгаа зүйлийг хавдрын
(Neoplastic Proliferation) ба хавдрын бус
(Non-Neoplastic Proliferation) ургалт гэж
ангилдаг.

4. Neoplasia
Shashi-Jun-20
Non-Neoplastic Proliferation:
*Controlled & Reversible
 Hypertrophy – Size
 Hyperplasia – Number
 Metaplasia – Change
 Dysplasia – Disordered

5. Neoplasia
Shashi-Jun-20
Neoplastic Proliferation:
Uncontrolled & Irreversible*
 Benign
– Localized, non-invasive.
Malignant (Cancer)
–Spreading, Invasive.

6. Neoplasia
Shashi-Jun-20
Definition
 Neoplastic Proliferation
Progressive, Purposeless, Pathologic,
Proliferation of cells characterized by loss of
control over cell division.
 Хавдрын ургалт
Эд эс нь боловсорч гүйцээгүй, эмх
замбараагүй, зохицуулгагүй, хязгааргүй,
эмгэг байдлаар ургадаг үйл явцыг хэлдэг.

7. Neoplasia
Shashi-Jun-20
Cause (Etiology)
 Carcinogens – Chemical, physical &
genetic  DNA damage  Neoplasm.
 Хавдар үүсгэж байгаа шалтгааны
хүчин зүйлийг канцероген
(карциноген) гэдэг.

8. Neoplasia
Shashi-Jun-20
Pathogenesis of Neoplasia:
 Normal  Hyperplasia  Metaplasia (DNA
damage)  Dysplasia  (DNA damage)  (DNA damage)
Anaplasia (DNA damage) Infiltration  (DNA
damage)  Metastasis….
 Progressive DNA Damage – features of
neoplasia.

9. Neoplasia
Shashi-Jun-20
Anaplasia
 Анаплази гэдэг нь мутацид өртсөн эс
хэвийн эрүүл эсээс ялгаран хөгжил,
бөөм/сийвэнгийн харьцаа (Norm 1/6)
будагдах байдал, хэлбэр дүрсийн хувьд
гажигшилд орсон байдлыг хэлдэг.
 Үүнийг мөн preneoplasia (хавдрын
урьдал) гэдэг. Ө/х: Анаплази-s цааш нэг
алхлаа Neoplasia

10. Neoplasia
Shashi-Jun-20
 Бөөм/сийвэнгийн харьцаа алдагдаж
үүдэл эстэй төстэй болдог. Үүдэл
эсийн бөөм хэмжээний хувьд ямар
байдаг вэ?
 Гематоксины будгаар тод хар хөх
будагддаг. (гиперхром)
 Метахромази будагны өнгө хувирах
Ө/х: улаанаар будагдах ёстой
байтал хөхөөр будагдах жишээтэй.
 Мөн олон өнгө үзүүлдэг.
Why?

11. Neoplasia
Shashi-Jun-20
Pathogenesis of Neoplasia:
 Non lethal DNA Damage leading to
uncontrolled cell division.
 Smile Angry

12. Neoplasia
Shashi-Jun-20
Controls of Growth:
 Cytokines: Cyclins, Cyclin dependent
kinases (CDK).
 Growth factors – PDGF, FGF
 Growth Inhibitors.
 Cancer suppressor genes – p53
 Oncogenes – c-onc, p-onc, v-onc etc.

13. Neoplasia
Shashi-Jun-20
Non-Neoplastic Neoplastic
(Polyclonal) (Monoclonal)
Normal Adaptation Benign Malignant
Mechanism of Neoplams

14. Neoplasia
Shashi-Jun-20
Structure of Neoplasm:
 Neoplastic cells parenchyma.
 Дан эсүүдээс бүрдсэн хэсгийг паренхим
гэдэг.
 Non-neoplastic - stroma
 Тухайн эсийг агуулсан арын дэвсгэрийг
строма гэдэг.
(For example this slide)
 Fast growth  less stroma
 Less stroma  more necrosis,

15. Neoplasia
Shashi-Jun-20
Biology of Neoplasm:
 Cell of origin
 Rate of growth
 Differentiation
 Local Invasion
 Metastasis
 Lung cancer
 Grade - low, high
 Well, Mod, P, Un.
 Staging
 Staging
Lung cancer:
Squamus cell carcinoma.
Poorly differentiated, high grade, stage 4, Liver+

16. Neoplasia
Shashi-Jun-20
Benign Malignant:
 Slow growing,
 capsulated,
 Non-invasive
 do not
metastasize,
 well
differentiated,
 suffix “oma”
eg. Fibroma.
 Fast growing,
 non capsulated,
 Invasive &
Infiltrate
 Metastasize.
 poorly
differentiated,
 Suffix
“Carcinoma” or
“Sarcoma”

17. Neoplasia
Shashi-Jun-20

18. Neoplasia
Shashi-Jun-20
Nomenclature: Cell of origin + Suffix
Suffix - oma
 Fibroma
 Osteoma
 Adenoma
 Papilloma
 Chondroma
Carcinoma / Sarcoma
 Fibrosarcoma
 Osteosarcoma
 Adencarcinoma
 Squamous cell carcinoma
 Chondrosarcoma
Exceptions: Leukemia, Lymphoma, Glioma,

19. Neoplasia
Shashi-Jun-20
Grading & Staging of Tumor
 Grading – Cellular Differentiation
(Microscopic) - микроскопоор харахад эс
хэлбэрээ хэр зэрэг алдсанаар нь G1, G2,
G3, G4 гэж 4 зэрэг болгодог.
 Staging – Progression or Spread (clinical)

20. Neoplasia
Shashi-Jun-20
TNM: Staging of tumor:

21. Neoplasia
Shashi-Jun-20
Pathways of Spread:
Direct Spread
Body cavities
Blood vessels
Lymphatic vessels
 Lungs – Systemic Venous blood
 Liver – GIT venous return, nutrition.
 Brain – End arteries.

22. Neoplasia
Shashi-Jun-20
Tumor Diagnosis:
 History and Clinical examination
 Imaging - X-Ray, US, CT, MRI
 Tumor markers Laboratory analysis
 Cytology –Pap smear, FNAB
 Biopsy - Histopathology, markers.
 Molecular Tech – Gene detection.

23. Neoplasia
Shashi-Jun-20
Clinical Features.
 Tumor Impingement on nearby
structures
– Pancreatic ca on bile duct  Obst. Jaund.
 Ulceration/bleeding
– Colon, Gastric, and Renal cell carcinomas
 Infection (often due to obstruction)
– Pneumonia, Urinary inf.
 Rupture or Infarction
– Ovarian, Bladder, colon,

24. Neoplasia
Shashi-Jun-20
Cancer Cachexia
 Progressive weakness, loss of
appetite, anemia and profound
weight loss (>20%)
 Often correlates with tumor mass &
spread
 Etiology includes a generalized
increase in metabolism and central
effects of tumor on hypothalamus
 Probably related to macrophage
production of TNF-a

25. Neoplasia
Shashi-Jun-20
Paraneoplastic Syndromes
 Due to Products released by tumor
 Cushing’s Syndrome
 Adrenal, Lung Ca – ACTH
 Inappropriate ADH syndrome
(Hyponatremia) – lung ca
 Hypothalamic tumors (vasopressin)
 Hypercalcemia – Ca is the common cause.
– lung.
 Hypoglycemia - insulin or insulin like
activities Fibrosarcoma, Cerebellar
hemangioma.

26. Neoplasia
Shashi-Jun-20
summary
 neoplasia- uncontrolled cell division
non responsive to growth controls.
 Benign and Malignant
 Naming – Cell of origin + Suffix
 Oma, Carcinoma, Sarcoma
 benign  slow-growing, well-
differentiated, localized, do not
metastasize, amenable to surgery.

27. Neoplasia
Shashi-Jun-20
summary
 malignant neoplasms tend to be fast-
growing lesions which invade normal
structures
 malignant neoplasms vary in the
degree of differentiation and some
show anaplasia.
 malignant neoplasms are capable of
infiltration, invasion & metastasis.

28. Neoplasia
Shashi-Jun-20
summary
 The prognosis of a patient with any
type of neoplasm depends on a
number of factors including: the rate
of growth of the tumor, the size of
the tumor, the tumor site, the cell
type and degree of differentiation,
the presence of metastasis,
responsiveness to therapy, and the
general health of the patient.

29. NEOPLASM
Uncontrolled cell Division
(DNA abnormality)

30. Neoplasia
Shashi-Jun-20