Oral Tumors,In Oral Cavity
December 2, 2016 | Author: jhnkiski | Category: N/A
Short Description
Classification of oral tumors in oral cavity...
Description
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
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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
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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
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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
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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
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Adenoma рleomorphe glаndulae 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
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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
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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
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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
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Adenocarcinoma uteri
Seminoma Testis
Hepatocellular carcinoma
Choriocarcinoma
Хепатоцелуларен карцином
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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
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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 tumor’s 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
Liposarcoma—myxoid and round cell type
t(12:16)(q13;p11)
CHOP/TLS fusion gene
Synovial sarcoma
t(x;18)(p11;q11)
SYT-SSX fusion gene
Rhabdomyosarcoma—alveolar 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
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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
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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
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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
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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 метастази
Macroscopy
Histology
Large, firm tumor mass spindle cells with cigar-shaped nuclei arranged in interweaving fascicles
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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
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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 Hаemangioma cavernosum hepatis
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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
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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 Ewing’s “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
Ewing’s 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
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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
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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
Ollier’s disease Maffucci syndrome - if hemangiomas present
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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
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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
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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
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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
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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
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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
Макроскопски
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
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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.
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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
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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)
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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, Clark’s staging
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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.
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