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Special features of the

epithelial tumors in
different organs.

Benign tumors of epithelial origin


adenoma, papilloma.
Malignant tumors of epithelial origin carcinoma.

Epithelial tumors

The most often tumors

ectoderm -skin
mesoderm-kidney
endoderm - GIT

Structure

the parenchyma

neoplastic epithelial cells

Benign
malignant

non-neoplastic stroma

Epithelial tumors

Benign

Papilloma

from the surface epithelium

Gastro-intestinal tract

from the glandular epithelium

Malignant

Skin
Epithelial lining of glands
and ducts

Adenoma

Respiratory passages

carcinomas

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

Tumors of epithelial origin


Tissue of origin

Benign

Malignant

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

intact basement membrane in benign tumors

Carcinomas spread generally by lymphatics to lymph


nodes, then later via the blood stream to the liver, other
viscera and bones.
Treatment is by surgical resection

In carcinomas response to radiation and chemotherapy varies


with type.

Benign epithelial tumors

2 types according to the epithelium

Papilloma from the surface epithelium

Skin, urinary tract epithelium

Adenoma from the glandular epithelium

Papillomas

Tumors with finger-like


projections
Macroscopic features

Exophytic lesions
Rarely endophytic lesions

Inverted papilloma

Histology

Papillae

Epithelium lining

Squamous cell epithelium


Transitional epithelium

Preserved basement
membrane
Connective tissue core

Squamous cell papilloma

Verrucae

skin
viruses

Squamous cell papilloma

esophagus
larynx

children juvenile papillomatosis


trachea

precancerosis

Condylomata

genitals, anus

condyloma acuminatum

HPV (human papilloma virus -1,


2, 4, 7 type)

condyloma lata

syphilis

Urothelial papillomas

Transitional epithelium of
ureter, bladder, uretra

Precancerosis

Urothelial carcinoma with


low grade malignancy

Histology

Fragile papillae

Urine -cytology

Papilloma vesicae urinariae

Adenomas

Glandular epithelium

Endocrine glands

functional activity clinical syndromes


Pituitary
Thyroid gland
Suprarenal glands
Endocrine pancreas

Exocrine glands

Skin - oil and sweat glands


Salivary gland

Breast

Adenoma gl. Parotis


Fibroadenoma

Exocrine pancreas
Gastrointestinal tracts
Respiratory tract
Ovarium

Liver
Kidney

Adenomas

Macroscopy

nodules, capsulated
Mucosa surface
pedunculated and sessile
polyps
Single, multiple

familial polyposis coli

Gardners syndrome - +
osteomas, fibromas

Various size

< 1 cm
> 3 cm

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

Dysplasia

Normal gland

Moderate dysplasia

Mild dysplasia

Moderate dysplasia

Severe dysplasia

Adenomas

Histological types

acinar

Small glands lumen, endocrine


glands

trabecular

Tarbeculae, liver, suprarenal glands

tubule, GIT

Papillae, GIT

tubulovilous, GIT

Nests, bronchi

Papillary cystadenoma serous,


mucous, ovary

tubular
Villous
Mixed
Solid

Cystic

fibroadenoma

breast

Adenoma leomorphe glndulae


parotis

Tumor mixtus
Capsulated,
mucinous cut surface
Histology

Gland structures
Myoepithelial cells
Mucoid substance

Basophilic
Resemble
cartilagous

Fibroadenoma gl. mammae

Female, young age


Capsulated, firm
nodules
Histology

parenchyma

Gland structures
Loose connective tissue

pericanalicular
Intracanalicular

Fibrous stroma

Ovarian cystadenoma

Malignant epithelial tumors

= Carcinomas

Risk factors

Macroscopy

Preneoplastic syndromes chronic inflammation,


hyperplasia, regeneration
Benign epithelial tumors
Rapid growth necrosis, haemorrages
Noncapsulated
Infiltrative
Exophytic and endophytic growth

Histology

invasion through tissue layers -basement


membrane, muscularis mucosae
differentiation

Metastases

Grading - high-, moderate-, poor differentiation

Lymph nodes
Distant metastases
Seeding

TNM staging

Carcinomas

High morbidity and


mortality

may be due to:

pressure on and destruction


of adjacent tissue
metastases
blood loss from ulcerated
surfaces
obstruction of flow
(intestinal obstruction)
paraneoplastic effects
weight loss, cachexia

Carcinomas

From surface epithelium

Squamous cell carcinoma


Basal cell carcinoma
Transitional (urothelial)
carcinoma

From glandular epithelium

Adenocarcinoma

Hepatocellular carcinoma
Renal cell carcinoma
Seminoma
Choricarcinoma

Poorly differentiated carcinoma

Malignant tumors of surface


epithelium

Squamous cell carcinoma

skin

Face

Oral cavity

leukoplakia

Esophagus
Larynx
Bronchus

Metaplasia of stratified
squamous non-ketatinized
epithelium into keratinized

Squamous cell metaplasia

Cervix uteri, vagina

Squamous cell carcinoma

Histology

atypical cells at all


levels of the epidermis,
with nuclear crowding
and disorganization.
high grade dysplasia
Invasions of basement
membrane
variable differentiation

Keratinization

perls

Squamous cell carcinoma

High differentiation

With keratinization

Moderate differentiation

= carcinoma planocellulare keratodes

keratinization

Low differentiation

Without keratinization
= carcinoma planocellulare non-keratodes

WELL?
MODERATE?
POOR?
Grading for Squamous Cell Carcinoma

Basal cell carcinoma

=Ulcus rodens
Tumor cells resemble the normal epidermal basal cell layer from
which they are derived
2 patterns: superficial type or nodular lesions

palisading with separation from the stroma, creating a cleft

Slow growth, local invasion, no metastases

Malignant tumors of glandular


epithelium

= Adenocarcinoma

Breast
Salivary glands
Gastro-intestinal tract

Pancreas
Endocrine glands
Female genital system

esopagus Barrett esophagus


stomach H.pylori gastritis
colon adenomas

endometrium
ovarium

Male denital system

testis - seminoma

Adenocarcinomas

Histology

Gland structures

Various shape
cellular atypia
invasion through tissue
layers
basement membranes
muscularis mucosae

Adenocarcinomas

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

Adenocarcinoma ventriculi

Intestinal type

Diffuse type

Adenocarcinoma uteri

Seminoma Testis

Choriocarcinoma

Hepatocellular carcinoma

Renal cell carcinoma


3 types:
Clear Cell Carcinoma

the most often

Papillary Renal Cell


Carcinoma
Chromophobe Renal
Carcinomas

Poorly differentiated carcinomas

Undifferentiated
carcinomas
2 types

Scirousum

stroma firm
breast

medullare

stroma - soft