Upload
mirza-rusyda-hidayat
View
44
Download
3
Embed Size (px)
Citation preview
Neoplasia
Introduction
Neoplasia Dental
• Contoh kasus: Ameloblastoma
Ameloblastomaa tumor of the jaw derived from remnants ofthe embryonic rudiment of tooth enamel—called also adamantinoma
Berdasarkan gambaran ro.foto kedua kasus ini apakah sudah bisa ditentukandiagnosa untuk neoplasma ?
Diagnosis Cycle
ClinicalRadiograph Histopathology
Clinicalexamination
Radiograph Histopathology
Contoh kasus: Pengangkatan tumor
Pengambilan jaringan
Implantasi bridge
Nomenclature
Neoplasia literally means “new growth”
Definition:
"an abnormal mass of tissue the growth of"an abnormal mass of tissue the growth ofwhich exceeds and is uncoordinated with thatof the normal tissues and persists in the sameexcessive manner after the cessation of thestimuli which evoked the change."
Characteristic
• Heritable (genetic) changes
– Allow excessive and unregulated proliferation that isindependent of physiologic growth-regulatory stimuli
• To be transformed and continue to replicate
• Have certain degree of autonomy• Have certain degree of autonomy
– Depend on their local environment and the nutritionalstatus of the host ??
– Not completely: because some still require endocrinesupport
Tumors
a neoplasm is often referred to as a tumor
Study: oncology: (from oncos, "tumor," andlogos, "study of")
benign
tumor
benign
malignant
Klasifikasi
• remain localized
• amenable to local surgical removal
• the patient generally survivesbenign
• collectively referred to as cancers
• invade and destroy adjacentstructures
• spread to distant sites (metastasize)to cause death
malignant
Basic ComponentAll tumors, benign and malignant, have twobasic components:
parenchyma
• the essential and distinctive tissue of an organ• the essential and distinctive tissue of an organor an abnormal growth as distinguished fromits supportive framework / neoplastic cells
stroma
• made up of connective tissue, blood vessels,and host-derived inflammatory cells
Benign Tumors
Nomenclature:designated by attaching the suffix -oma to the celltype from which the tumor arises– Ex: fibroma fibrous tissue– Ex: chondroma cartilago tissue– Ex: chondroma cartilago tissue– Ex: Adenoma glands like
How to Classified:– Microscopic pattern– Macroscopic pattern– Cells of originEx: papillomas finger-likes fronds
Polyps
Malignant TumorsThere are two type:
• Malignant neoplasms arising in mesenchymal tissue or itsderivatives
• designated by their histogenesis (i.e., the cell type ofwhich they are composed)
• Ex: fibrosarcoma, chondrosarcoma
sarcomas• Ex: fibrosarcoma, chondrosarcoma
• Malignant neoplasms of epithelial cell origin
• three germ-cell layers: mesoderm, ectoderm, endoderm
• Sometimes the tumor shows little or no differentiationand must be called poorly differentiated orundifferentiated carcinoma
• Ex: adenocarcinomas, squamous cell carcinomas
carcinomas
CARCINOMAS
• Mesoderm sel epitel tubulus ginjal
• Ektoderm kulit
• Endoderm sel epitel pelapis usus
– ex: Squamous Cell Carsinoma
– ex: Adenocarsinoma
Mixed Tumor
• Causa: konvergen differentiation
– ex: adenoma pleomorfik salivary gland
Comparison between a benign tumor of the myometrium (leiomyoma) and a malignant tumorof similar origin (leiomyosarcoma)
Example
Tissue of Origin Benign Malignant
Composed of One Parenchymal Cell Type
Connective tissue andderivatives
Fibroma Fibrosarcoma
Lipoma Liposarcoma
Chondroma Chondrosarcoma
Osteoma Osteogenic sarcoma
Example
Endothelial and relatedtissues
Benign Malignant
Blood vessels Hemangioma Angiosarcoma
Lymph vessels Lymphangioma LymphangiosarcomaLymph vessels Lymphangioma Lymphangiosarcoma
Synovium Synovial sarcoma
Mesothelium Mesothelioma
Brain coverings Meningioma Invasive meningioma
Characteristic of Benign and MalignantNeoplasm
Fundamental features:
• differentiation and anaplasia,
• rate of growth,• rate of growth,
• local invasion,
• metastasis
Differentiation & Anaplasia (1)
Differentiation:
• The differentiation of parenchymal cells refersto the extent to which they resemble theirnormal forebears morphologically andnormal forebears morphologically andfunctionally
– Normal cell ?
– Benign and Maligna ?
• Squamous cell carcinoma (well differentiated)
Anaplasia:• Malignant neoplasms that are composed of
undifferentiated cells are said to be anaplastic• Anaplastic cells display marked pleomorphism (i.e., marked
variation in size and shape)• the nuclei are extremely hyperchromatic (darkly stained)
Differentiation & Anaplasia (2)
• the nuclei are extremely hyperchromatic (darkly stained)and large.
• The nuclear-to-cytoplasmic ratio may approach 1 : 1instead of the normal 1 : 4 or 1 : 6.
• Giant cells that are considerably larger• Anaplastic nuclei are variable and bizarre in size and shape.
• Anaplasia
Rate of Growth
The rate of growth of malignant tumors correlates ingeneral with their level of differentiation
Recently research:
• Cancer stem cells, sometimes called tumor-initiating• Cancer stem cells, sometimes called tumor-initiatingcells, were identified in breast cancer, glioblastomamultiforme (a brain tumor), and acute myeloidleukemia.
• These findings have important implications for cancertreatment Therapies kill the progeny of cancerstem cells capable of regenerating the tumor.
• Fibroadenoma of the breast
The tan-colored, encapsulated small tumor is sharply demarcated from thewhiter breast tissue
Local Invasion (1)
Benign
• Remains localized at its site of origin.
• It does not have the capacity to infiltrate,invade, or metastasize to distant sitesinvade, or metastasize to distant sites
– most develop an enclosing fibrous capsuleseparate from host tissue
– not all benign neoplasms are encapsulated
• Ex: leiomioma
Local Invasion (2)
Malignant
• Cancers grow by progressive infiltration,invasion, destruction, and penetration of thesurrounding tissuesurrounding tissue
– local invasiveness is the most reliable feature thatdistinguishes malignant from benign tumors.
Downloaded from: StudentConsult (on 2 December 2010 09:25 AM)
© 2005 Elsevier
Downloaded from: StudentConsult (on 2 December 2010 09:25 AM)
© 2005 Elsevier
Benign or Malignant ?
Metastasis
• The term metastasis connotes thedevelopment of secondary implants(metastases) discontinuous with the primarytumor, in remote tissues
• Malignant neoplasms disseminate by one ofthree pathways:(1) seeding within body cavities
(2) lymphatic spread
(3) hematogenous spread
• A liver studded with metastatic cancer