Adenoma

Epithelial tumor arising in glands or forming glandular patterns May secrete mucin or hormone Occurs in Colorectum Salivary glands Ovaries Breast Endocrine glands Liver, kidneys etc. Colorectal adenoma Exophytic protrusion of the mucosa composed of neoplastic glands Common, solitary or multiple Classified based on architecture: tubular (pedunculated polyp; majority < 1 cm), tubulovillous or villous (broad based; 1-5 cm) Glands dysplay dysplasia cc Risk of malignancy: correlates to size (polyps more than 4 cm have a 40% risk harboring cancer) and severity of dysplasia Symptomless or intestinal bleeding Photo: tubular adenoma, tubulovillous adenoma, villous adenoma Photo: Pedunculated polyp. Histology displayed tubular adenoma Photo: Two large tubular adenomas: histology revealed malignant transformation Photo: Villous adenoma underwent malignant transformation (adenocarcinoma in the submucosa) Parotid gland: pleiomorphic adenoma (mixed tumor). Proliferation of myoepithelial and ductal, cells; myxoid stroma; difficult to remove surgically (photo) Ovarian adenoma Derives from surface epithelium (transformed mesothelial cells) covering the ovaries. The same embryonic mesothelial cells have participated in the formation of epithelium lining inside the mllerian ducts which give rise to the fallopian tubes, uterus, endocervix, and the upper third of the vagina. Ovarian surface epithelium retains the capacity to differentiate into epithelium similar to the Fallopian tubes, endocervix or endometrium. May be large; more than 20 cm; unilateral or bilateral; cystic masses (cystadenomas) with abundant secretory activity Types according to the secreted substance: serous cystadenoma; LM: ciliated cylindrical cells similar to those in the Fallopian tube; mucinous cystadenoma; LM: cells similar to those in the endocervix Both types may transform into cystadenocarcinoma Photo: Mucinous cystadenoma: delicate septa form cysts; mucin fills the cysts Photo: Mucinous cystadenoma: the tumor cells resemble to those of endocervix Fibroadenoma of breast (photo) Common in young women Pathomechanism: elevated estrogen levels 1-10 cm, firm, encapsulated Elongated ducts surrounded by loose fibrous stroma Adenoma in endocrine glands May produce hormone or may be hormonally inactive (silent tumor) Pancreas: insulinoma, glucagonoma Thyroid gland: follicular adenoma hyperthyroidism Anterior pituitary: prolactinoma, ACTH-producing adenoma, etc., or silent adenoma. Apoplexy of silent adenoma may be lethal Photo: Follicular adenoma of the thyroid gland Photo: Apoplexy of pituitary silent adenoma. Blockade of CSF flow acute increase in liquor pressure death

Carcinoma
Greek karkinos, a crab. Refers to the irregular jagged shape of the tumor, due to the local spread General features Photo: Carcinoma: the tumor cells form nests surrounded by nonneoplastic connective tissue stroma. Sarcoma: the tumor cells are intermingled with the noneoplastic stromal cells Photo: Invading epithelium arranged in nests. Silver impregnation: no intercellular fibres among tumor cells ( sarcoma) Photo: Antibodies to various cytokeratin filaments identify different epithelial cell types. CK 7: epithelium of urinary tract; CK 20: GI tract. The cytokeratin profile of metastatic carcinoma may guide te oncologist to find the primary site of carcinoma Carcinoma cells induce stroma formation via production of GFs Scirrhous cc Hard consistency Abundant stroma (desmoplasia), scanty parenchyma In stomach, breast, biliary ducts Medullary cc

 Soft consistency Scanty stroma, abundant parenchyma In thyroid gland, breast Photo: Desmoplasia: desmos - connective, plasia - formation Photo: Scirrhous carcinoma of stomach leading to a rigid, thickened gastric wall termed linitis plastica (tube-like alteration of the stomach; literally leather bottle) Histologic types of carcinoma Squamous cell carcinoma Adenocarcinoma Urothelial cell carcinoma Carcinoma of breast: from ductal epithelium - ductal cc; from lobules - lobular cc Small cell carcinoma of bronchi: from neuroendocrine cells Carcinoma arising from parenchymal cells: hepatocellular carcinoma, renal cell carcinoma, etc. Squamous cell carcinoma Dysplasia cc in situ invasive cc Sites On the skin In mucosal sites covered by stratified squamous epithelium: lips, tongue, pharynx, esophagus, etc. On surfaces covered by cylindrical epithelium e.g. bronchus, uterine cervix: cylindrical epithelium is replaced by squamous cell metaplasia dysplasia LM features Well differentiated: central keratin pearls, intercellular bridges (tonofilaments) Moderately differentiated Poorly differentiated: some dyskeratotic cells, intercellular bridges are scanty Photo: Central keratin pearls in well differentiated squamous cell cc Photo: Intercellular bridges in well differentiated squamous cell cc Photo: Keratinization in moderately differentiated squamous cell cc Photo: Poorly differentiated squamous cell cc: some dyskeratotic cells, scanty intercellular bridges Squamous cell carcinoma of skin In elderly people On skin exposed to sunlight (e.g. face) Grows slowly Well differentiated Regional lymph node metastases occur relatively late Overall prognosis is good Special skin cancer: basal cell cc (basalioma) (Photo) Very frequent Semimalignant Related to chronic sun exposure In the elderly; in the face, near the eyes and nose Ulcerative lesion (rodent ulcer) Photo: LM: cells similar to those of the normal basal layer Squamous cell carcinomas arising in mucous membranes Growth is more rapid Moderately or poorly differentiated Due to the rich lymphatic drainage, metastases to regional lymph nodes occur early Poor prognosis, e.g., cc of oesophagus Carcinoma of nasopharynx: 3 types 1) Keratinizing squamous cell cc EBV genome Radioresistant 2) Non-keratinizing squamous cell cc EBV genome + 3) Undifferentiated cc EBV genome+ Non-neoplastic lymphoid stroma Lymph node metastases develop early Radiosensitive Photo: Undifferentiated cc of nasopharynx. Lymphocytes infiltrate the scanty stroma Carcinoma of glandular epithelium: adenocarcinoma (photo) Forms atypical glandular structures Differentiation according to the extent of lumen formation - well diff.: tubular or acinar - moderately diff.: cribriform (colon, prostate) or papillary (thyroids, bronchi, ovary) - poorly diff.: solid nests Photo: Well differentiated, moderately differentiated, poorly differentiated (mucin staining may verify abortive mucin production)

Mucin production in adenocarcinoma Mucinous adenocarcinoma: frequent in the large bowel. The mucin is secreted into the lumina of glands or into the interstitium of the gut wall. Poorer prognosis compared to nonmucinous adenocarcinomas of colon. Signet-ring carcinoma: mucin accumulates within the cytoplasm and pushes the nucleus to the periphery. frequent in the stomach; fibrous thickening of the stomach due to desmoplasia induced by cancer cells. Higly malignant. Photo: Signet ring cc of stomach: tube-like thickening of the wall; histologically, tumor cells have signet-ring appearance Mucinosus cystadenocarcinoma: in the ovary Photo: Ovarian mucinous cystadenocarcinoma with hemorrhage and necrosis; invasion of surface lining carcinosis of peritoneum