Neoplasia

With Kartik Rangaraj, MD

Basics

• Neoplasia = new growth, not reversible

• Dysplasia = disordered growth that is reversible and often results in neoplasia

• Tumor = can be benign or malignant

• Cancer = malignant neoplasm

Naming Tumors

Tissue Benign Malignant

Epithelium Adenoma, papilloma Adenocarcinoma,

papillary carcinoma

Mesenchyme e.g., Fibroma, lipoma Sarcoma

Melanocytes Nevus Melanoma

Lymphocytes Lymphoma
Benign Neoplasms

• Small size

• Slow-growing

• Encapsulated or well-demarcated borders

• Well-differentiated (resembles normal

tissue)

https://openi.nlm.nih.gov/detailedresult.php?img=PMC2740070_1757-1626-0002-0000007180-003&query=Benign+Neoplasia+encapsulated&lic=by&req=4&npos=13
Benign Epithelial and Benign Connective Tissue
Tubular adenoma Leiomyomas Lipoma

Epithelial tissue: ectodermal/

endodermal origin

Connective tissue: mesodermal

origin
F.l.t.r.: PubMed, A laterally spreading tumor (LST) observed by computed tomographic colonography (CTC) in a 75-year-old man, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876067/figure/f1-
ijms-14-23629/, cropped & sliced, CC BY 3.0
Ed Uthman, Leiomyoma, https://www.flickr.com/photos/78147607@N00/119271509, CC BY 2.0, flickr
Sebastian E Valbuena, et. al., Lipoma 06, https://es.m.wikipedia.org/wiki/Archivo:Lipoma_06.jpg, CC BY 2.0
Teratoma

• Ectoderm, endoderm, mesoderm

• Usually benign; calcifications on CT scan

• Tend to be located toward the midline:

ovary/testis; anterior mediastinum; pineal
gland

Ed Uthman, Mature Cystic Teratoma of the Ovary, https://www.flickr.com/photos/euthman/5560431170, CC BY 2.0, flickr

Teratoma

• Ectoderm, endoderm, mesoderm

• Usually benign; calcifications on CT scan

• Tend to be located toward the midline:

ovary/testis; anterior mediastinum; pineal
gland

Agarwal G., Kar DK.: https://openi.nlm.nih.gov/detailedresult.php?img=PMC2259367_1752-1947-2-23-2&query=CT+teratoma&it=xg&lic=by&req=4&npos=3, CC by 2.0

Teratoma

• Ectoderm, endoderm, mesoderm

• Usually benign; calcifications on CT scan

• Tend to be located toward the midline:

ovary/testis; anterior mediastinum; pineal
gland

AFIP, PD
Malignant Neoplasms

• Large, rapid growth

• Necrosis and hemorrhage
• Poorly demarcated
• Poorly differentiated
• Pleomorphism: cells vary in size and shape
• Increased nuclear to cytoplasmic ratios
• Nuclear hyperchromasia and prominent
nucleoli
• High mitotic activity with abnormal mitotic
figures
PubMed, A photomicrograph of a gastric adenoma from this patient demonstrates a tubular adenoma with low grade dysplasia, characterized by nuclear hyperchromasia and glandular
crowding, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943270/figure/F1/, cropped & sliced, CC BY 2.0
Henry B Armah, Alyssa M Krasinskas, Anil V Parwani, Tubular adenoma with high grade dysplasia, https://commons.wikimedia.org/wiki/File:Tubular_adenoma_with_high_grade_dysplasia.jpg, CC
BY 2.0
Differentiation (Grade)

Well differentiated (low-grade) Poorly differentiated (high-grade, anaplastic)

Adenocarcinoma with well-formed glands

PubMed, Histopathological features of primary cutaneous squamous cell carcinoma, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663071/figure/F1/, cropped & sliced, CC BY 2.5
Bronchogenic Carcinoma and Osteogenic Sarcoma

Tissue markers

Carcinomas: +
cytokeratin

Sarcomas: +
vimentin

Lymphomas: +
CD45

f.l.t.r., USUHS, PD
PubMed, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938449/figure/f4/, cropped & sliced, CC BY 4.0
Diagnosis of Cancer

Immunohistochemistry

• Cytokeratin: epithelial cells • CD: lymphomas and leukemias

• Desmin: muscle cells • Estrogen receptors: breast cancer

• Vimentin: mesenchymal cells • S100: melanoma and neural tumors

• Prostate-specific antigen • Thyroglobulin: thyroid cancer

• Actin: smooth and skeletal muscle

Malignant Neoplasms

Clonal Metastatic Adhesion to Passage Intra- Interaction Tumor Adhesion Extra- Meta- Angio- Growth
expansion, subclone and invasion through vasation with host cell to base- vasation static genesis
growth, of basement extra- lymphoid embolus ment deposit
diversification, membrane cellular cells membrane
angiogenesis matrix

Metastatic
Platelets tumor

Transformed
cell
Basement
Primary tumor membrane
Host Extracellular
lymphocyte matrix

Lumen Colon
© by Lecturio
Malignant Neoplasms

Invasion and metastasis

• The ability to metastasize defines a tumor

as malignant.

• Infiltration of adjacent tissue or vessels

occurs.

• Carcinomas usually move via lymphatics;

sarcomas, via blood vessel.

• Lymph node involvement follows

natural routes of lymphatic drainage.

© by Lecturio
Metastasis

Lymphatic: First site for carcinoma

Hematogenous: First site for sarcomas

Seeding: Surface-derived ovarian, pleura, CSF

If carcinomas get through lymph nodes into

efferents, they become hematogenous.
Haymanj, PD
Bone Metastasis

Osteoblastic:  Alk Phos Osteolytic:  Serum Ca2+

Vertebra MC site: Batson paravertebral plexus Multiple myeloma

F.l.t.r.: PMC: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050950/figure/f3-1830456/, PD

PubMed, X‐ray of skull bone shows multiple punched‐out lesions (arrows), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290494/figure/ccr3817-fig-0001/, CC BY 4.0
Bone Metastasis

Vertebra MC site: Batson paravertebral plexus

Osteoblastic: Alk Phos

Vertebra MC site: Batson paravertebral plexus

Osteolytic: 2

Multiple myeloma

PMC: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050950/figure/f3-1830456/, PD
Bone Metastasis

Vertebra MC site: Batson paravertebral plexus

Osteoblastic: Alk Phos

Vertebra MC site: Batson paravertebral plexus

Osteolytic: Serum Ca2

Multiple myeloma

PubMed, X‐ray of skull bone shows multiple punched‐out lesions (arrows), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290494/figure/ccr3817-fig-0001/, CC BY 4.0
Cancer Epidemiology

Men Women

Incidence*

Prostate (14%) Breast (15%)

Lung (approx. 12% both sexes) Lung (12%)

Colorectal (approx. 8% both sexes) Colorectal (11%)

Mortality**

Lung (approx. 21% both sexes) Lung (25%)

Prostate (6%) Breast (7%)

Colorectal (approx. 9% both sexes) Colorectal (11%)

*Percentage of all new cancer cases. **Percentage of all cancer deaths. Source: 2022 statistics from the National Cancer Institu
and End Results Program
Incidence/Mortality

Gynecologic cancers
Incidence Mortality

Endometrial Ovarian

Ovarian Endometrial

Cervical Cervical