Sunteți pe pagina 1din 33

17/5/2014

Benign and malignant


mesenchymal tumors

Benign and malignant


epithelial tumors
Localization in oral cavity

Localization in oral cavity

Synpsis
Other types tumors (pigment,
nervous system, odontogenic)

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

17/5/2014

Principal characteristics of benign and


malignant tumours

CLASSIFICATION OF
TUMOURS

Behavioural classification

Histogenetic classification -cell of origin

benign or malignant
Epithelial
Mesenchymal
Mixed
Teratomas

Precise classification of individual tumors is


important for planning treatment

Special features of the


epithelial tumors in
different organs

Epithelial tumors

The most often tumors

ectoderm -skin
mesoderm-kidney
endoderm - GIT

Structure

the parenchyma

neoplastic epithelial cells

Benign
malignant

non-neoplastic stroma

17/5/2014

Tumors of epithelial origin

Epithelial tumors

Benign

Papilloma

Adenoma

from the surface epithelium

Skin
Epithelial lining of glands
and ducts

Malignant

Oral cavity, esophagus,


stomach, intestine,
hepato-biliary system,
pancreas
Nasal cavity, larynx,
trachea, bronchi

Urinary tract epithelium


Male and female genital
systems
Placental epithelium

Endocrine glands

Special features of epithelial


tumors

Benign and malignant epithelial tumors are the most


common in adults.
Epithelial cells grow as cohesive groups
Malignancy can be diagnosed by invasion through tissue
layers -basement membrane, muscularis mucosae

Benign epithelial tumors

2 types according to the epithelium

Papilloma from the surface epithelium

Adenoma from the glandular epithelium

Skin, urinary tract epithelium

intact basement membrane in benign tumors

Carcinomas spread generally

Malignant

Respiratory passages

carcinomas

Benign

Gastro-intestinal tract

from the glandular epithelium

Tissue of origin

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

17/5/2014

Papillomas

Tumors with finger-like


projections
Macroscopic features

Exophytic lesions
Rarely endophytic lesions

Squamous cell papilloma

esophagus
larynx

precancerosis

Papillae

Epithelium lining

skin
viruses

Squamous cell papilloma

Histology

Verrucae

Squamous cell epithelium


Transitional epithelium

Preserved basement membrane


Connective tissue core

children juvenile papillomatosis


trachea

Condylomata

genitals, anus

condyloma acuminatum

condyloma lata

Urothelial papillomas

syphilis

Papilloma vesicae urinariae

Transitional epithelium of
ureter, bladder, uretra

Precancerosis

HPV (human papilloma virus -1,


2, 4, 7 type)

Urothelial carcinoma with


low grade malignancy

Histology

Fragile papillae

Urine -cytology

17/5/2014

Adenomas

Glandular epithelium

functional activity clinical syndromes


Pituitary
Thyroid gland
Suprarenal glands
Endocrine pancreas

Skin - oil and sweat glands


Salivary gland

Breast

Adenoma gl. Parotis

nodules, capsulated
Mucosa surface
pedunculated and sessile
polyps
Single, multiple

Various size

Fibroadenoma

Macroscopy

Exocrine glands

Endocrine glands

Adenomas

Exocrine pancreas
Gastrointestinal tracts
Respiratory tract
Ovarium

Liver
Kidney

familial polyposis coli


< 1 cm
> 3 cm

Dysplasia
Adenomas

Histology

Glands

Various shape and size


Preserved basement
membrane
dysplasia

low-grade or high-grade
high grade often
classified with
carcinoma-in-situ
may develop into malignancy
Uterine cervix
Colon polyps

Normal gland

Moderate dysplasia

Mild dysplasia

Severe dysplasia

17/5/2014

Adenoma leomorphe glndulae


parotis

Adenomas

Histological types

acinar

Small glands lumen, endocrine


glands

trabecular

tubular

Tarbeculae, liver, suprarenal glands

tubule, GIT

Papillae, GIT

tubulovilous, GIT

Nests, bronchi

Villous

Mixed

Solid

Cystic

Tumor mixtus
Capsulated,
mucinous cut surface
Histology

Gland structures
Myoepithelial cells
Mucoid substance

Papillary cystadenoma serous,


mucous, ovary

Fibroadenoma gl. mammae

Basophilic
Resemble
cartilagous

Ovarian cystadenoma

Female, young age


Capsulated, firm
nodules
Histology

parenchyma

Gland structures
Loose connective tissue

pericanalicular
intracanalicular

Fibrous stroma

17/5/2014

Malignant epithelial tumors

= Carcinomas

Risk factors

Preneoplastic syndromes chronic inflammation,


hyperplasia, regeneration
Benign epithelial tumors

Grading - high-, moderate-, poor differentiation

Metastases

Lymph nodes
Distant metastases
Seeding

TNM staging

From surface epithelium

Squamous cell carcinoma


Basal cell carcinoma
Transitional (urothelial)
carcinoma

Squamous cell carcinoma

skin

Oral cavity

From glandular epithelium

Poorly differentiated carcinoma

leukoplakia
Metaplasia of stratified
squamous non-ketatinized
epithelium into keratinized

Esophagus
Larynx
Bronchus

Cervix uteri, vagina

Face

Adenocarcinoma

Hepatocellular carcinoma
Renal cell carcinoma
Seminoma
Choricarcinoma

pressure on and destruction


of adjacent tissue
metastases
blood loss from ulcerated
surfaces
obstruction of flow
(intestinal obstruction)
paraneoplastic effects
weight loss, cachexia

Malignant tumors of surface


epithelium

Carcinomas

may be due to:

invasion through tissue layers -basement


membrane, muscularis mucosae
differentiation

Rapid growth necrosis, haemorrages


Noncapsulated
Infiltrative
Exophytic and endophytic growth

Histology

High morbidity and


mortality

Macroscopy

Carcinomas

Squamous cell metaplasia

17/5/2014

Squamous cell carcinoma


Squamous cell carcinoma

Histology

atypical cells at all


levels of the epidermis,
with nuclear crowding
and disorganization
invasions of basement
membrane
variable differentiation

With keratinization

= carcinoma planocellulare keratodes

Moderate differentiation

Low differentiation

Keratinization

High differentiation

perls

keratinization
Without keratinization
= carcinoma planocellulare non-keratodes

Basal cell carcinoma

WELL?

=Ulcus rodens

Tumor cells resemble the normal epidermal basal cell layer from
which they are derived
2 patterns: superficial type or nodular lesions

Slow growth, local invasion, no metastases

MODERATE?

palisading with separation from the stroma, creating a cleft

POOR?
Grading for Squamous Cell Carcinoma

17/5/2014

Malignant tumors of glandular


epithelium
= Adenocarcinoma

Breast
Salivary glands
Gastro-intestinal tract

esopagus Barrett esophagus


stomach H.pylori gastritis
colon adenomas

Pancreas
Endocrine glands
Female genital system

Histology

Gland structures

Various shape
cellular atypia
invasion through tissue
layers
basement membranes
muscularis mucosae

endometrium
ovarium

Male denital system

testis - seminoma

Adenocarcinomas

Adenocarcinomas

Adenocarcinoma ventriculi

Histological types

Mucinous

Mucin production

Intra-, extracellular

"signet-ring" cells
Papillary carcinoma
Cystadenocarcinoma
Adenoacantoma

Adenosquamous carcinoma

+ squamous cell metaplasia


+ squamous cell carcinoma

Mucoepidermoid carcinoma

Mucinous adenosquamous
carcinoma

Intestinal type

Diffuse type

17/5/2014

Adenocarcinoma uteri

Seminoma Testis

Hepatocellular carcinoma

Choriocarcinoma

10

17/5/2014

Poorly differentiated carcinomas

Renal cell carcinoma


3 types:
Clear Cell Carcinoma

the most often

Papillary Renal Cell


Carcinoma
Chromophobe Renal
Carcinomas

Special features of the


mesenchymal tumors in
different organs.

Undifferentiated
carcinomas
2 types

Scirousum

stroma firm
breast

medullare

stroma - soft

Mesenchymal tumors
A broad group of non-epithelial tumors, deriving from
different mesenchymal tissue types

Soft tissue tumors

Connective/fibrous tissue
Adipose tissue
Muscle tissue
Vascular tissue

Bone tumors
Joint tumors

11

17/5/2014

Mesenchymal tumors

SOFT TISSUE TUMORS

Tumors of Adipose Tissue

Lipomas

Liposarcoma
Tumors and Tumor-like Lesions of
Fibrous 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 Uncertain
Histogenesis
Synovial sarcoma
Alveolar soft part sarcoma
Epithelioid sarcoma
Granular cell tumor

Special features of the mesenchymal


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 tumors parenchyma and stroma

Benign

by adding -oma to cell type, from which tumor


arise

fibroma, lipoma, chondroma

Malignant

Sarcomas

Fibrosarcoma, liposarcoma, chondrosarcoma

Chromosomal and Genetic Abnormalities in Soft Tissue Sarcomas


Tumor

Cytogenetic Abnormality

Extraosseous Ewing sarcoma and


primitive 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

Liposarcomamyxoid and round cell


type

t(12:16)(q13;p11)

CHOP/TLS fusion gene

Synovial sarcoma

t(x;18)(p11;q11)

SYT-SSX fusion gene

Rhabdomyosarcomaalveolar 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 fusion
gene

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

A great diversity of tumors

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

Similar histology spindle cell type

Need of consultation

mitosis

Genetic Abnormality

Immunohistochemistry histogenetic markers

12

17/5/2014

SOFT TISSUE TUMORS

Fat (adipose) tissue


Fibrous tissue
Fibrohistiocytic
Skeletal muscle
Smooth muscle
Vascular
Peripheral nerve
Uncertain

Benign tumors of fat


The most common soft tissue tumors of
adulthood.
Solitary lesions

Localization

Macroscopy

Histology

Lipomas

Malignant

Liposarcoma

Lipoma

Back, shoulders, thigh


Submucosa of GIT
soft, yellow, well-encapsulated masses
Conventional - mature adipocytes

Benign

Multiple in rare autosomal dominant


syndromes.

Varied in size
Clear empty cytoplasm
Peripheral nucleus

Angiolipoma

synovial sarcoma, alveolar soft part sarcoma, epitheliod sarcoma

Lipoma

Tumors of Adipose Tissue

Numerous capillaries

Treatment

complete excision is usually curative

13

17/5/2014

Liposarcoma

Liposarcoma

Malignant neoplasm of adipocytes


Rare tumors,
Adults, 60-70 y - f > m

Localization

Macroscopy

chromosomal translocation - myxoid liposarcomas


deep soft tissues, retroperitoneum
in visceral sites
relatively well-circumscribed lesions , large size
polylobulated
myxoid cut surface

Histology

Lipoblasts

myxoid liposarcoma

fetal fat cells with cytoplasmic lipid vacuoles


Mucoid stroma

Pleomorphic variant

Atypical cells, inc. multinuclated cells


mitoses

Tumors and Tumor-like Lesions


of Fibrous Tissue

Benign

Fibroma

Malignant

Fibrosarcoma

Fibroma

Benign tumor of fibrous


connective tissue
A common tumor of the skin
Macroscopy

Histology

Capsulated nodule
Fibrocytes

Spindle cells with sharp edges


nuclei
storiform pattern of growth

+ collagen fibers

hard fibroma -fibroma durum


Soft fibroma -fibroma molle

14

17/5/2014

Fibroma cutis

Fibrosarcomas

Malignant neoplasms composed of


fibroblasts

tend to grow slowly


often recur locally after excision (>50% of
cases)
can metastasize hematogenously (>25% of
cases) - lungs

Adults
Localization

Macroscopy

deep tissues of the thigh, knee, and


retroperitoneal area
soft unencapsulated, infiltrative masses
areas of hemorrhage and necrosis

Histology

all degrees of differentiation


spindled cells growing in a herring bone
fashion

Fbrosarcoma

pleomorphism,
mitoses
necrosis

Tumors of Smooth Muscle

Leiomyoma
Smooth muscle tumors of uncertain
malignant potential (atypical leiomyomas)

DD leiomyoma/leiomyosarcoma

Leiomyosarcoma - > 10/10 HPF mitoses

Leiomyosarcoma

15

17/5/2014

Leiomyoma

Benign tumor of smooth muscle cells

Localization

Low malignant potential


Myometrium multiple nodules

Submucosa, intramural, subserosal

Age female

Macroscopy

estrogen-dependent
Well circumscribed, grey-white firm
nodules, up to 20 cm
Fascicled cut surface

Histology

Spindle cells (smooth muscle), fascicles

fibrosis, calcifications, necrosis, cysts

Round edges of the nuclei

Leiomyosarcoma

Leiomyosarcoma

Malignant tumor of smooth muscle


cells

Leiomyoma (HE)

10% - 20% of sarcomas

Adult, f> m
Localization

skin,
Deep tissues of extremities
Retroperitoneum, uterus

Local invasion, metastasis

Macroscopy

Histology

Large, firm tumor mass


spindle cells with cigar-shaped
nuclei
arranged in interweaving fascicles

16

17/5/2014

Tumors of Skeletal Muscle

Rhabdomyoma

Rhabdomyoma
Rhabdomyosarcoma

Benign tumor of striated musle


cells
Very rare

Age

More common

malformation
Adult type
Fetal type

Localization

Skeletal muscles
Heart

Sclerosis tuberans

Histology

Large round cells with


eozinophilic granular cytoplasm

Rhabdomyosarcoma

Vascular tumors

Tumors of blood vessels and lymphatics

Malignant tumor of striated muscle cells

head, neck, face


extremties
genitourinary tract

Macroscopy

Histology

poorly defined, infiltrating masses

Rhabdomyoblast - round or elongated cells

Embryonal variant

Alveolar variant

Small round cells

Alveoli, fibrous septa

Pleomorphic variant

Immunohistochemistry

Hemangioma
Lymphangioma

Hemangioendothelioma

Angiosarcoma

Locally aggressive, rarely metastasize

Malignant

hamartomas, not even true


neoplasms

Intermediate

granular eosinophilic cytoplasm, filaments

Benign

sarcoma botryoides -soft, gelatinous, grapelike masses

> 50% of sarcomas in children

Localization

Frequent and early metastases


lungs

Diagnosis

endothelium lined blood filled


spaces

immunohistochemistry - factor VIII

mitosis

Desmin, myoglobin, actin, myosin

17

17/5/2014

Hemangioma

Vascular tumors

Benign

Rare mitosis
Mild, rare atypia

No metastases

Malignant

Common mitosis
Frequent, severe
atypia
Early, frequent
metastases
via bloodstream

= a generic term for any benign blood vessel


tumor
Capillary (small vascular spaces)

Cavernous (large vascular spaces)

Also called juvenile, often called birth marks


Usually regress with age
Also called adult
Usually do not regress

Smooth-muscle hemangioma
Pyogenic hemangioma

Hemangioma
Hemangioma cavernosum hepatis

18

17/5/2014

Pyogenic granuloma

Glomus tumor

Oral cavity most common


Regress
Histology

like capillary hemangioma


Indistinguishable from normal
granulation tissue

Lymphangiomas

Benign lymphatic analogue of


hemangiomas.
Generally rare
Simple (Capillary) Lymphangioma

Angiosarcoma

vessels lumens

atypical endothelial cells

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

Malignant vascular tumors

small lymphatic channels

Producing gross deformities - neck

composed of dilated lymphatic spaces and


connective tissue stroma, Ly aggregates

Most commonly
under nail
Small tumor, 1 cm
Painful

Factor VIII
Cellular pleomorphism
Mitoses, atypical

Lymphangiosarcoma

After mastectomy
Papillary projections of
atypical endothelial cells

19

17/5/2014

Tumors of Uncertain
Histogenesis

Synovial sarcoma
Alveolar soft part sarcoma
Epithelioid sarcoma

Synovial sarcoma

Uncertain cellular origin, agressive,


malignant

Localization

Young adults

The cells are not synoviocytes


metastases lung, bones, LN
Joints - 10%, knee
extrajoints
Chromosomal translocations t(X;18)

SYT gene (transcription factor)

Histology

Biphasic variant

Monophasic variant

Epithelial-like cells, glands


Spindle cells
Spindle cells fascicles

DD fibrosarcoma keratin, EMA

Classification of Primary Tumors Involving Bones

Bone tumors

Histologic Type

Chondrogenic (22%)

Bone
Cartilage
Fibrous
Other
Ewings sarcoma
Giant cell tumor
Metastases

Benign
Malignant

Benign

Hematopoietic (40%)

Malignant
Myeloma

Osteochondroma

Malignant lymphoma
Chondrosarcoma

Chondroma

Dedifferentiated chondrosarcoma

Chondroblastoma

Mesenchymal chondrosarcoma

Chondromyxoid fibroma
Osteogenic (19%)

Osteoid osteoma

Osteosarcoma

Unknown origin (10%)

Osteoblastoma
Giant cell tumor

Ewings sarcoma

Histiocytic origin

Fibrous histiocytoma

Giant cell tumor


Adamantinoma
Malignant fibrous histiocytoma

Fibrogenic

Metaphyseal fibrous defect


(fibroma)

Notochordal
Vascular

Hemangioma

Lipogenic
Neurogenic

Lipoma
Neurilemmoma

Desmoplastic fibroma
Fibrosarcoma
Chordoma
Hemangioendothelioma
Hemangiopericytoma
Liposarcoma

20

17/5/2014

Benign
osteogenic bone tumors
= Bone Forming, 19%

Osteoma

Solitary tumor
Mean age
Face, skull

Exophytic growth,
attached to the bone
Histology

Osteoid Osteoma

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

Osteoma

metaphysis femur, tibia


10-20yrs
Histology similar to woven bone

Osteoblastoma

similar to normal bone

vertebral column
10-20yrs
Histology -similar to osteoid osteoma
Frontal sinus

Malignant

osteogenic bone tumors

Osteosarcoma

Osteosarcoma (osteogenic sarcoma)

Primary

secondary - associated with pre-existing disorders such

Metaphysis of distal femur, proximal; 10-20 yrs

as 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

21

17/5/2014

Benign cartilagenous bone tumors

Sarcoma osteogenes

= Cartilage forming, 22%


Osteochondroma (exostosis)

Chondroma

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


Histology hyaline cartilage

Chondroblastoma

Metaphysis of long bones; 10-30 yrs;


Histology - cartilage and bone tissue

Knees, epiphyses, teenagers, m>>f,


Histology - much less matrix than a chondroma

Chondromyxoid fibroma
Myxoid, atypia

Osteochondroma (exostosis)

Common
Often multiple as a
hereditary syndrome
m>>>f
Pelvis, scapulae, ribs
Metaphysis
Cartilage and bone
present

Chondroma

Hyaline cartilage
Multiple enchondromas

Olliers disease
Maffucci syndrome - if hemangiomas present

22

17/5/2014

Malignant
cartilagenous bone tumors

Chondroma

Chondrosarcoma

Femur, humerus, pelvis

within medullary cavity

40-60 yrs
Histology atypical chondroblasts
abnormal cartilage

conventional hyaline/myxoid
Mesenchymal
Clear cell
dedifferentiated

Chondrosarcoma

Other Bone Tumors

Giant cell tumor


Ewing sarcoma

Metastases

Variants -conventional hyaline/myxoid; mesenchymal; clear

the most common bone tumors

osteoblastic/ lytic

male: prostate
female: breast
renal, thyroid also seek bone early also

23

17/5/2014

Ewing sarcoma (tumor)

Giant cell tumor of bone

Localization

cortical lesions

Young adults -20-40 yrs


Histology

PNET (primitive
neuroectodermal tumor)
Localization

epiphysis of long bones

Diaphysis and metaphysis

Macrophages
Giant cells

medullary lesions

Age -10-20 yrs

Chromosomal translocation
-t(11;22)

FLI-EWS gene fusion

Histology - small round


cells

Resemble lymphoma

General features of the CNS tumors

85 % - intracranial, 15% - intraspinal tumors

20% of all - tumors of childhood.

Tumors of the central nervous system

primary tumors and metastatic

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 slow


growth) may infiltrate large regions of the brain

The anatomic site of the neoplasm - lethal consequences


irrespective 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 that


of other tumors -rarely metastasize outside the CNS

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

24

17/5/2014

CNS TUMORS

GLIOMAS

Astrocytoma (I, II,

CNS TUMORS

III,

IV)

Symptoms?

Headache
Vomiting
Mental Changes
Motor Problems
Seizures
Increased Intracranial Pressure

Oligodendroglioma
Ependymoma

MENINGIOMAS
NEURONAL
POORLY DIFFERENTIATED
LYMPHOMAS
METASTATIC

(medulloblastoma)

any localizing CNS abnormality

CNS TUMORS

History
Physical
Neurologic exam
LP (including cytology)
CT
MRI
Brain angiography
Biopsy

Gliomas

Tumors of the brain parenchyma that


histologically resemble different types
of glial cells

astrocytomas,
oligodendrogliomas
ependymomas

25

17/5/2014

Fibrillary astrocytomas

Astrocytomas

Different categories of astrocytic


tumors
characteristic histologic features
distribution within the brain
age groups

Fibrillary
Pilocytic astrocytomas

80% of adult primary


brain tumors
Age 40 -60 y
Localization

seizures, headaches, and


focal neurologic deficits

Macroscopy

Fibrillary astrocytomas

cerebral hemispheres

a poorly defined, gray,


infiltrative tumor
cut surface - firm, or soft or
gelatinous
cystic degeneration and
hemorrhage

Astrocytoma

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 pseudopalisading nuclei

26

17/5/2014

Glioblastoma Multiforme

Pilocytic Astrocytoma

Relatively benign tumors


Age - children and young adults
Localization

Cerebellum,
in the floor and walls of the third
ventricle
the optic nerves

Macroscopy

well circumscribed, often cystic

Oligodendrogliomas

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

Macroscopy

with a mural nodule in the wall of the


cyst

Microscopy
areas with bipolar cells with long, thin
"hairlike" processes, GFAP (+)
Rosenthal fibers (eosinophilic granular
bodies)
Necrosis and mitoses are rare.

Oligodendrogliomas

cerebral hemispheres
infiltrative tumors - gelatinous, gray
cysts, focal hemorrhage, and calcifications

Microscopy

sheets of regular cells with spherical nuclei


containing finely granular chromatin (similar
to normal oligodendrocytes) surrounded by a
clear halo of cytoplasm
a delicate network of anastomosing
capillaries.
Calcifications
Mitoses -rare

Except in anaplastic oligodendroglioma

27

17/5/2014

Ependymoma

Frequency -5-10%
Age 10-20 y
Localization

IV th ventricle

hydrocephalus

Macroscopy

Microscopy

solid or papillary masses


cells with regular, round to oval
nuclei with abundant granular
chromatin

perivascular pseudo-rosettes

Variants

Anaplastic

increased cell density, high


mitotic rates, necrosis

Poorly Differentiated Neoplasms


Medulloblastoma

Neuroectodermal cells
Age - children
Localization

Ependymoma

Medulloblastoma

cerebellum (vermis)

well circumscribed, gray,


friable

Histology

with sheets of anaplastic


("small blue") cells

with little cytoplasm and


hyperchromatic nuclei
Rossetes of Homer-Wright
mitoses abundant

28

17/5/2014

Meningiomas

Benign tumors of adults

Microscopy -variants

from the meningothelial cell of the


arachnoid

Localization

any of the external surfaces of the


brain
ventricular system

Meningiomas

from the arachnoid cells of the


choroid plexus

Macroscopy

well-defined dural-based masses


compress underlying brain

Fibroblastic - with elongated cells and


abundant collagen deposition
Psammomatous - with numerous
psammoma bodies
Secretory - with PAS-positive
intracytoplasmic droplets
Microcystic - with a loose, spongy
appearance
Atypical meningiomas mitosis
Anaplastic (malignant) meningiomas

Meningeoma

resemble a high-grade sarcoma

Metastatic brain tumors

Most common brain tumor in


adults.
Common primary sites:
melanoma, lung, breast, GI
tract, kidney.
Most are in cerebrum

in gray-white junctions due to


rich capillarity

Single or multiple.
Discrete, globoid, sharply
demarcated tumors

amenable to surgical resection.

29

17/5/2014

Tumors of the peripheral


nervous system
Tumors of the peripheral
nervous system

Arise from cells of the peripheral nerve

Schwannoma
Neurofibroma

Malignant Peripheral Nerve Sheath Tumor

Schwannoma
Antoni A - Antoni B

Schwannoma

From Schwann cells


Symptoms due to local compression
Localization

in the cerebellopontine angle -attached to


the vestibular branch of the 8th nerve
(vestibular schwannoma)
sensory nerves, large nerve trunks

elongated cells with cytoplasmic


processes - fascicles
Verocay bodies

the "nuclear-free zones" of


processes that lie between the
regions of nuclear palisading

Antoni B pattern of growth

well-circumscribed encapsulated masses


that are attached to the nerve

Morphology 2 growth patterns

Antoni A pattern of growth

Macroscopy

Schwann cells,
perineurial cells
Fibroblasts

less densely cellular areas


microcysts and myxoid changes

Immuhistochemistry

S-100 protein

30

17/5/2014

Malignant Peripheral Nerve


Sheath Tumor

Neurofibroma

Well differentiated, benign

Classic form

Cutaneous / nerves solitary


collagen matrix, spindle cells,

Neurofibromatosis type 1
Multiple, infiltrative
Myxoid stroma

De novo
plexiform neurofibroma

Macroscopy

Highly malignant
multiple recurrence
metastases

Origin

Plexiform

Sarcoma

Form whorls of fibroblasts

Two types:

poorly defined tumor masses


infiltration along the axis of nerve
invasion of adjacent soft tissues

Histology

the tumor cells resemble Schwann cells - elongated nuclei


and prominent bipolar processes, fascicle formation
Mitoses, necrosis, nuclear anaplasia

Melanocytic nevus

Tumors and Tumor-Like


Lesions of Melanocytes

Benign congenital or acquired


neoplasm of melanocytes
Numerous types, with varied clinical
appearance
Macroscopy

Benign melanocytic nevus


Malignant - melanoma

relatively small,
symmetric,
and uniformly pigmented

Morphology

Junctional

more pigmented,
more closely associated with
melanoma)

Intradermal

Compound (both)

31

17/5/2014

MALIGNANT MELANOMA

Melanocytic nevus

Dermal nevus

Malignant proliferations of melanocytes.


Incidence rising,

Junctional nevus

Difficult to differentiate from


nevus clinically

often microscopically

Morphology

Skin

a change in the color or size of a


pigmented lesion

Vertical growth phase


Horizontal growth phase

Related with prognosis

Malignant cells with large


nuclei with irregular
contours

less common sites - oral and


anogenital mucosal surfaces, the
esophagus, the meninges, eye.

Morphology

Germ-line mutations in the CDKN2A gene


(9p21)

MALIGNANT MELANOMA

Clinical features

The only primary skin cancer that can


quickly metastasizes
Sporadic
Hereditary -5-10%

MALIGNANT MELANOMA

Related to sun like all other skin cancers

chromatin characteristically
clumped at the periphery of
the nuclear membrane
prominent eosinophilic
nucleoli -"cherry red"

nests or individual cells at


all levels of the epidermis

Breslow, Clarks staging

32

17/5/2014

MALIGNANT MELANOMA

Teratomas

=mixed tumors

originate from totipotential stem cells

Ovary, testis

the capacity to differentiate into any of the cell


types found in the adult body

3 variants

Mature teratomas

contain fully differentiated tissues from one or


more germ cell layers

Cystic teratoma of ovary

contain immature somatic elements reminiscent


of those in developing fetal tissue

neural tissue, cartilage, adipose tissue, bone,


epithelium in a haphazard array

Immature teratomas
mediastinum

Teratomas with malignancies

malignancy in preexisting teratomatous elements

squamous cell carcinoma or adenocarcinoma


Mixed germ cell tumors of testis, 40%
combination of teratoma, embryonal
carcinoma, and yolk sac tumors.

33