Transfusion Pathology

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Neoplasia II Tumor Characteristics
Kristine Krafts, M.D. October 5, 2009
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Neoplasia Outline

• Tumor nomenclature
• Tumor characteristics
• Epidemiology
• Cancer pathogenesis

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Neoplasia Outline

• Tumor nomenclature
• Tumor characteristics
• Differentiation and anaplasia
• Rate of growth
• Local invasion
• Metastasis

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Neoplasia Outline

• Tumor nomenclature
• Tumor characteristics
• Differentiation and anaplasia

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Differentiation and Anaplasia

• Differentiation how much the tumor cells
  resemble their cells of origin
• well-differentiated closely resembles
• moderately-differentiated sort of resembles
• poorly-differentiated doesnt resemble
• Benign tumors are usually well-differentiated
• Malignant tumors can show any level of
  differentiation

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Thyroid adenoma (well-differentiated)
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Squamous cell carcinoma, well-differentiated
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Squamous cell carcinoma, moderately-differentiated
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Squamous cell carcinoma, poorly-differentiated
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Intercellular bridges
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Differentiation and Anaplasia
Anaplasia a state of complete un-differentiation

• Literally, to form (-plasia) backwards (ana-)
• Misnomer! Cells dont de-differentiate.
• Just means cells are very poorly-differentiated
• Almost always indicates malignancy

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Differentiation and Anaplasia
Anaplastic cells show

• Pleomorphism
• Hyperchromatic, large nuclei
• Bizarre nuclear shapes, distinct nucleoli
• Lots of mitoses, and atypical mitoses
• Architectural anarchy

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Anaplastic carcinoma
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Abnormal mitoses
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Differentiation and Anaplasia
Dysplasia disorderly (dys-) growth (-plasia)

• Dysplasia is used to describe disorderly
  changes in non-neoplastic epithelial cells.
• Graded as mild, moderate or severe.
• Mild-moderate usually reversible
• Severe usually progresses to carcinoma in situ
  (CIS).
• Next step after CIS invasive carcinoma.

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Differentiation and Anaplasia
Dysplastic cells show

• Pleomorphism
• Hyperchromatic, large nuclei
• Lots of mitoses
• Architectural anarchy

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Q. Wait a minute, dysplasia sounds suspiciously
similar to differentiation whats the
difference?
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Q. Wait a minute, dysplasia sounds suspiciously
similar to differentiation whats the
difference?

• A. Both terms describe whether cells look normal
  or not!
• But
• differentiation is only used with neoplastic
  cells, and dysplasia is only used with
  non-neoplastic cells!
• dysplasia is only used with epithelial cells,
  but differentiation can apply to any cell type.

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Non-neoplastic epithelial cells
carcinoma in situ
mild dysplasia
moderate dysplasia
severe dysplasia
Neoplastic cells
well-differentiated
moderately-differentiated
poorly-differentiated
anaplastic
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Dysplasia
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Normal glands
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Normal gland
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Mild dysplasia
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Moderate dysplasia
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Severe dysplasia
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Normal squamous epithelium
Moderate dysplasia
Severe dysplasia
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Normal epithelium
Dysplastic epithelium
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Invasive squamous cell carcinoma
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Neoplasia Outline

• Tumor nomenclature
• Tumor characteristics
• Differentiation and anaplasia
• Rate of growth

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Rate of Growth
Generalizations

• Malignant tumors grow faster than benign ones.
• Poorly-differentiated tumors grow faster than
  well-differentiated ones.
• Growth is dependent on
• Blood supply
• Hormonal factors
• Emergence of aggressive sub-clones

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Rate of Growth
Growth fraction cells that are actively dividing

• Age of tumor
• Early on (subclinical), GF high.
• Later (clinically detectable), GF low.
• Type of tumor
• Leukemias, lymphomas, small-cell lung cancer
  high GF
• Breast, colon cancer low GF
• Important for treatment
• High GF tumor treat with chemotherapy/radiation
• Low GF tumor treat by debulking

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Tumor cells undergoing apoptosis
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Neoplasia Outline

• Tumor nomenclature
• Tumor characteristics
• Differentiation and anaplasia
• Rate of growth
• Local invasion

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Local Invasion

• Benign tumors
• Stay where they are.
• Cant invade or metastasize.
• Usually encapsulated.
• Malignant tumors
• Infiltrate, invade, destroy surrounding tissue.
• Then metastasize to other parts of body.
• Not encapsulated.

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Malignant tumor invading kidney
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Malignant tumor invading kidney
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Malignant tumor invading kidney
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Neoplasia Outline

• Tumor nomenclature
• Tumor characteristics
• Differentiation and anaplasia
• Rate of growth
• Local invasion
• Metastasis

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Carcinoma in situ
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Invasive carcinoma
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Invasive carcinoma
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Metastasizing carcinoma
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Liver with multiple metastases
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Metastasis

• Metastasis development of secondary tumor
  implants in distant tissues
• Half of all patients with malignancies have mets
  at the time of diagnosis!!
• Metastasis depends on
• Type of tumor
• Size of tumor
• Degree of differentiation of tumor

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Metastasis
Three ways tumors metastasize

• Seeding
• Lymphatic spread
• Hematogenous spread

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Metastasis
Three ways tumors metastasize

• Seeding
• Tumor invades body cavity
• Bits break off and implant on peritoneal surfaces
• Ovarian cancer

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Liver seeded with metastatic ovarian carcinoma
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Metastasis
Three ways tumors metastasize

• Seeding
• Lymphatic spread
• Tumor spreads to local lymph nodes
• Sentinel lymph node first
• Moves through thoracic duct
• Empties into subclavian vein

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Tumor in lymphatic
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Tumor in lymph node
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Tumor in lymph node
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Metastasis
Three ways tumors metastasize

• Seeding
• Lymphatic spread
• Tumor spreads to local lymph nodes
• Sentinel lymph node first
• Moves through thoracic duct
• Empties into subclavian vein
• Carcinomas like to spread this way

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Metastasis
Three ways tumors metastasize

• Seeding
• Lymphatic spread
• Hematogenous spread
• Veins are easier to invade than arteries
• Liver and lungs are most common metastatic
  destinations
• Some tumors like other sites better
• prostate ? bone
• most lung cancers ? adrenals, brain
• Sarcomas like to spread this way (but so do
  carcinomas)

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Sarcoma metastatic to lung
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Sarcoma metastatic to lung