NOMENCLATURE
papillary patterns that protrude into cystic
Neoplasia – “new growth”
Oncology – (Gk. oncos = tumor) study of tumors or
neoplasms
Neoplasm (or tumor) – an abnormal mass of tissue,
the growth of which exceeds and is uncoordinated
with that of the normal tissues and persists in the
same excessive manner after cessation of the stimuli
which evoked the change
2 Basic Components of All Tumors
1. Proliferating neoplastic cells that constitute their
parenchyma
2. Supportive reactive stroma made up of
connective tissue, blood vessels, and variable
numbers of cells of the immune system
*classification of tumors and their biologic behaviour
– based on parenchymal component
*growth and spread – critically dependents on their
stroma
Benign Tumors
- gross and microscopic appearances are
considered relatively innocent, implying that it
will remain localized, will not spread to other
sites, and is amenable to local surgical removal
- (in general) designated by attaching the suffix –
oma to the name of the cell type from which the
tumor originates
 tumors of mesenchymal cells generally follow
this rule
 eg. fibroma (from fibrous), chondroma (from
cartilaginous)
- in benign epithelial tumors, some are classified
based on their cells of origin, others on
microscopic pattern, and still others on their
macroscopic architecture
 Adenoma – applied to benign epithelial
neoplasms derived from glands (may or may
not form glandular structures); Eg. those
arising from renal tubular cells, from adrenal
cortical cells
 Papillomas – benign epithelial neoplasms
producing microscopically or macroscopically
visible fingerlike or warty projections from
epithelial surfaces
 Cystadenomas – benign epithelial neoplasms
that form large cystic masses; eg in ovary
 Papillary cystadenomas – tumors that produce
spaces
 Polyp – a neoplasm (benign or malignant)
that produces a macroscopically visible
projection above a mucosal surface and
projects, for example, into the gastric or
colonic lumen
Malignant Tumors
- Collectively referred to as cancers
- Can invade and destroy adjacent structures and
spread to distant sites (metastasize) to cause
death
- Those arising in mesenchymal tissues are usually
called sarcomas (eg fibrosarcoma,
chondrosarcoma, leiomyosarcoma,
rhabdomyosarcoma)
- Those arising from blood-forming cells are
designated leukemias or lymphomas
- Those of epithelial cell origin, derived from any of
the three germ layers, are called carcinomas
 Squamous cell carcinoma – denotes a cancer
in which the tumor cells resemble stratified
squamous epithelium
 Adenocarcinoma – denotes a lesion in which
the neoplastic epithelial cells grow in a
glandular pattern
 Sometimes the tissue or organ of origin can
be identified and is added as descriptor. (eg
renal cell adenocarcinoma, bronchogenic
squamous cell carcinoma)
Tumors that appear to have more than one
parenchymal cell type:
Mixed Tumors
- Created by divergent differentiation of a single
neoplastic clone capable of producing both
epithelial and myoepithelial cells
- The preferred designation of this neoplasm is
pleomorphic adenoma
- Eg mixed salivary gland tumors containing
epithelial cells and myxoid stroma
Teratoma
- a tumor that contains recognizable mature or
immature cells or tissues belonging to more than
one germ layer (and sometimes all three)
- can have both benign and malignant forms
- typically arise from totipotental cells in testis or
ovary, or rarely in abnormal midline embryonic
rests
Non-neoplastic lesions that grossly resemble tumors:
Choristoma
- term applied to heterotropic rest of cells
- ectopic rests of non-transformed tissues
Hamartoma
- disorganized but benign masses composed of
cells indigenous to the involved site
CHARACTERISTICS OF BENIGN AND MALIGNANT
NEOPLASMS
Differentiation and Anaplasia
Differentiation
- the extent to which neoplastic parenchymal cells
resemble the corresponding normal parenchymal
cells, both morphologically and functionally
- In general, benign tumors are well differentiated
and resemble their normal cells of origin, and
mitoses are usually rare and are of normal
configuration. On the other hand, malignant
neoplasms are composed of poorly differentiated
cells that have no resemblance to the normal cells
from which they have arisen, and are said to be
anaplastic.
Anaplasia
- “to form backward”
- lack of differentiation
- hallmark of malignancy
Morphological Changes in Anaplasia
 Pleomorphism
 variation in size and shape; cells within the
same tumor are not uniform, but range from
small cells with an undifferentiated
appearance to tumor giant cells many times
larger than their neighbours
 Abnormal nuclear morphology
 nuclei are disproportionately large for the
cell, with a nuclear-to-cytoplasm (N-C) ratio
that may approach 1:1 instead of the normal
1:4 or 1:6
 nuclear shape is variable and often irregular
 chromatin is often coarsely clumped,
distributed along the nuclear membrane,
more darkly stained (hyperchromatic)
 abnormally large nucleoli
 Mitoses
 Atypical, bizarre mitotic figures, sometimes
with tripolar, quadripolar, or multipolar
spindles
 Reflect high proliferative activity of
parenchymal cells
 Loss of polarity
 Sheets or large masses of tumor cells grow in
an anarchic, disorganized fashion
 Other changes
 Growing tumor cells  increased
requirement for blood supply  insufficient
vascular stroma  ischemic necrosis in
malignant tumors
Metaplasia
- replacement of one type of cells with another
type; nearly always found in association with
tissue damage, repair, and regeneration
Dysplasia
- “disordered growth;” encountered principally in
epithelia and is characterized by a constellation
of changes that include loss in the uniformity of
the individual cells as well as a loss in their
architectural orientation; exhibit considerable
pleomorphism and often contain large
hyperchromatic nuclei with high N-C ratio
- Carcinoma in situ – pre-invasive neoplasm; when
dysplastic changes are marked and involve the
full thickness of the epithelium, but the lesion
does not penetrate the basement membrane
*once the tumor cells breach the basement
membrane, the tumor is said to be invasive
- Although dysplasia may be a precursor to
malignant transformation, it does not always
progress to cancer
Local Invasion
- The growth of cancers is accompanied by
progressive infiltration, invasion, and destruction
of the surrounding tissue
 Malignant tumors are, in general, poorly
demarcated from the surrounding normal
tissue, and a well-defined cleavage plane is
lacking
 However, slowlyexpanding malignant tumors
may develop an apparently enclosing fibrous
capsule and may push along a broad from
into adjacent normal structures
(pseudoencapsulated)
- Nearly all benign tumors grow as cohesive
expansile masses that remain localized to their
site of origin and lack the capacity to infiltrate,
invade, or metastasize to distant sites
 Benign tumors usually develop a rim of
compressed fibrous tissue called a capsule
that separates them from the host tissue
 Such encapsulation does not prevent tumor
growth, but it creates a tissue plane that
makes the tumor discrete, readily palpable,
moveable (non-fixed), and easily excisable by
surgical enucleation. However, there are few
exceptions (eg hemangiomas)
- Invasiveness, then, is the most reliable feature
that differentiates cancers from benign tumors
Metastasis
- Defined by the spread of a tumor to sites that are
physically discontinuous with the primary tumor,
and unequivocally marks a tumor as malignant,
as by definition benign neoplasms do not
metastasize
- All malignant tumors can metastasize, but some
do so very infrequently (eg gliomas, basal cell
carcinomas)
- In general, the likelihood of a primary tumor
metastasizing correlated with lack of
differentiation, aggressive local invasion, rapid
growth, and large size (however, there are
innumerable exceptions)
- Metastatic spread strongly reduces the possibility
of cure; hence, short of prevention of cancer, no
achievement would be of greater benefit to
patients than an effective means to block
metastasis
- Blood cancers (leukemias and lymphomas, aka
liquid tumors) are often disseminated at
diagnosis, being derived from blood-forming cells
that normally have the capacity to enter the
bloodstream and travel distant sites. Therefore,
they are always taken to be malignant
Pathway of Spread
1. Seeding of Body Cavities and Surfaces
 May occur whenever a malignant tumor
penetrates into a natural “open field” lacking
physical barriers
 Most often involved is the peritoneal cavity
2. Lymphatic Spread
 Most common pathway for the initial
dissemination of carcinomas
 The pattern of lymph node involvement
follows the natural routes of lymphatic
drainage
 Sentinel lymph node – the first node in a
regional lymphatic basin that receives lymph
flow from the primary tumor
3. Hematogenous spread
 Typical of sarcomas but also seen with
carcinomas
 Arteries, with their thicker walls, are less
readily penetrated that are veins
 Arterial spread: when tumor cells pass
through the pulmonary capillary bends or
pulmonary arteriovenosus shunts or when
pulmonary metastases themselves give rise to
additional tumor emboli
 Venous invasion: bloodborne cells follow the
venous flow draining the site of the neoplasm,
and the tumor cells often come to rest in the
first capillary bed they encounter
 Liver and lungs are most frequently involved
because all portal area drainage flows to the
liver and all caval blood flows to the lungs