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BENIGN AND MALIGNANT EPITHELIAL
TUMORS
(Squamous cell carcinoma, Basal cell carcinoma, Adenocarcinoma, Medular type
of adenocarcinoma,Scirrhotic type of adenocarcinoma, Ductal mammary
carcinoma, Lobular mammary carcinoma, Papiloma, Adenomaous polyp)
General medicine
MUDr. Michal Palkovič
MUDr. Svetoslav Štvrtina
Department of pathology, Comenius University
Sasinkova 4, Bratislava
Prof. MUDr. Ľudovít Danihel, CSc.
Benign and malignant epithelial tumors
Tumor (neoplasma)
• Extensive and excessive growth
– proliferation of the cells – changes in the regulation
• Uncoordinated growth
– without any regulation of the organism
• Independent growth
– autonomous growth
Benign and malignant epithelial tumors
Tumor
By the biological behaviour:
• benign
• malignant
Benign vs malignant tumor
Benign tumor
• slow growing
• capsulated
• non-invasive
• do not metastasize
• suffix –oma
Malignant tumor
• fast growing
• non capsulated
• Invasive / infiltrate
• metastasize
• suffix – carcinoma /
sarcoma
Benign and malignant epithelial tumors
Pseudotumors
• Inflammatory tumor
• Hyperplasia
• Cysts
Congenital cysts
Acquired cysts
Implant cysts
Parasitic cysts
• Pathologic material deposition
Benign and malignant epithelial tumors
Malignant tumor
• Grading – histological differentiation of
tumor
• Staging – the extent of spread of tumor
TNM classification
Benign and malignant epithelial tumors
Spreading
• lympfatic (carcinomas)
• hematogenous (sarcomas)
• transcoelomic
• implantation
• Physical
• Chemical
• Biological
Benign and malignant epithelial tumors
Reasons of the tumor development
• Physical – Ultraviolet radiation (UV)
• Mostly UVB 280 – 320 nm
– Infrared
– Ionizing radiation • Rtg, α, β, γ radiation
– diagnostical methods, radon, industry
• Chemical – cancerogenic substances (mutagens)
– procancerogenic substances – need of metabolic activation
Benign and malignant epithelial tumors
Reasons of the tumor development
Benign and malignant epithelial tumors
Reasons of the tumor development
• Biological – Viral cancerogenesis
• Retrovirus HTLV-I(T-cell leukaemia/lymphoma)
• Human DNA papillomavirus (epidermoid carcinoma)
• DNA virus hepatitis B (hepatocellular carcinoma)
• RNA virus hepatitis C (hepatocellular carcinoma)
• EBV (Epstein-Barr virus) (Burkitt´s lymphoma)
• HHV-8 (Kaposi´s sarcoma)
– Oncogenes – part of the DNA responsible for the tissue growth - without the regulations
– Metaplasia – change of one type of differentiated tissue to the other type
Tumor classification
1. Tumors from one type of cells
epithelial
squamous epithelium
glandular epithelium
transitional epithelium
mesenchymal (non-epithelial, „soft tissue“)
neuroectodermal
placental (trofoblast)
Tumor classification
mesenchymal (non-epithelial, „soft tissue“)
adipose tissue
fibrous tissue (adult, embryonic), cartilage, bone
synovium
smooth and skeletal muscle
mesothelium
blood and lymph vessels
glomus
meninges, nerve sheath, nerve cells
haematopoietic cells
lymphoid tissue
Tumor classification
2. Special categories of tumors:
mixed tumors – two types of tumors in the same tumor
adenosquamous carcinoma, adenoacanthoma,
carcinosarcoma
Tumors derived from the three germ cell layers – ectoderm, mesoderm,
endoderm – mature, immature teratoma
Blastomas – from embryonal or partially differentiated cells
Hamartoma – from mature but disorganised cells of tissues indigenous to
the particular organ
Choristoma – not a true tumor, ectopic islands of normal tissue
Benign and malignant epithelial tumors
• From squamous epithelium
- benign: papiloma
- malignant: carcinoma
• From glandular epithelium
- benign: adenoma
- malignant: adenocarcinoma
Benign and malignant epithelial tumors
Tumors from the squamous epithelium
Papiloma (43)
• benign tumor of the skin or mucosa with the squamous epithelium, or of the tissues with transitional epithelium
• exophytic or inverted; isolated or multiple
• during the development the infection by HPV – Human Papiloma Virus can play an important role
Benign and malignant epithelial tumors
Tumors from the squamous epithelium
Squamous cell carcinoma (45) (Spinocellular carcinoma, epidermoid carcinoma)
• malignant transformation and proliferation of the stratum spinosum
• solid isles and stripes growing deeply into the tissue, penetrating the lymphatic and vascular vessels
• loss of the stratification, differentiation to the stratum granulosum, keratinization - the depositions of keratin in the cells
• keratinization depends on the differentiation level
• tissues with the primary keratinizating epithelium or the metaplastic epithelium (e. g. in esophagus)
– screening: cervical carcinoma, bronchogenic carcinoma
Benign and malignant epithelial tumors
Tumors from the squamous epithelium
Basal cell carcinoma (46) (Basalioma)
• skin tumor (predominantly on the face) – proliferation of the cells similar to the immature cells of the basal layer of the epidermis (but arises from hair follicule)
• variable histological features
• grows predominantly endophytic, with the dermis infiltration, and surface exulceration (ulcus rodens)
• without metastasis (semimalignant), locally destructive, with relapses – the adequate surgical extirpation with the histopathological examination of the borders is necessary
Benign and malignant epithelial tumors
Tumors from the glandular epithelium
Adenomatous polyp (44)
• benign, exophytic growth, polypous (adenoma polyposum)
Benign and malignant epithelial tumors
Tumors from the glandular epithelium
Adenocarcinoma (Carcinoma adenomatosum)
• the most frequent malignant tumor
• transformation and proliferation of the exocrine and endocrine
glands epithelium or cylindric epithelium of mucous membranes,
„de novo“ or secondary (malignant transformation of adenoma,
abnormal or dysplastic epithelial proliferation)
Benign and malignant epithelial tumors
Tumors from the glandular epithelium
Adenocarcinoma (Carcinoma adenomatosum)
• classification: in parenchymatous organ
» irregular nodular structure, often without the capsule
» trabecular – equal proportion of stroma and
parenchyma
» scirrhotic – stroma predominance
» medullary – parenchyma predominance
» gelatinous – mucus
» cystic – cystic cavities
Benign and malignant epithelial tumors
Tumors from the glandular epithelium
Adenocarcinoma (Carcinoma adenomatosum)
• classification: on the surface of organ with lumen
» Exophytic or endophytic growth
» Endophytic has forms as described before
» Exophytic can be according to the apperance:
papilar, polypous, villous, disciform (central
necrosis)
Benign and malignant epithelial tumors
Tumors from the glandular epithelium
Adenocarcinoma (Carcinoma adenomatosum)
• classification: according to the source:
– Adenocarcinoma of trabecular glands (liver, cortex of adrenal gland,
hypophysis) are solid with trabecular form
– Adenocarcinoma of tubular, acinar and alveolar glands and of cylindric
epithelium
– Both types resemble original tissue according to the differentiaton
• classification: according to mucus production:
– Carcinomas of signet-ring cells – mucus in cytoplasm
– Mucinous carcinomas – mucus in stroma
Medullary type of adenocarcinoma (49)
Scirrhotic type of adenocarcinoma (50)
Benign and malignant epithelial tumors
Tumors from the glandular epithelium
Ductal mammary carcinoma (304)
• malignant proliferation of the ducts (the terminal ducts
predominantly)
• scirrhotic carcinoma, solid or tubular growth
Benign and malignant epithelial tumors
Tumors from the glandular epithelium
Lobular mammary carcinoma (294)
• the cells form structures – strands („Indian filing“) or target-like
structures around the small preserved ducts
• stroma rich tumor