Neoplasia

Means a new growth Or "neoplasm".

In clinical practice, called a tumour.
This is not strictly correct, since the

term tumour refers to all swellings,

e.g. inflammation, haematoma etc.,
but it is so generally accepted .
Oncology (Greek oma = tumour) Is
the science of studying neoplasms

Definition
Neoplasm is an abnormal new growth,

of cells independent of physiologic

growth stimuli (autonomous).
Its presence serves no useful purpose
Its growth is uncoordinated with that
of the surrounding tissue
Its growth persists after cessation of
the stimuli which provoked its
formation

 In neoplasia

proliferation,
differentiation and organisation are
all disturbed

Proliferation:
a neoplasm is
characterized by partial or complete loss of
regulation of mitosis and cell maturation
Differentiation
reduction or deletion
of the specialized function of the cells
Organization
loss of the
morphologic tissue and organ
characteristics.

Classification of
neoplasms
According to their clinical behaviour into:
Benign tumours, which usually grow slowly
and do not interfere with the person's well
being or shorten his life, unless the tumour
encroaches on a vital organ e.g. the brain or
produces harmful substances e.g. excess
hormones.
Malignant tumours generally are more rapidly
growing, destroy and infiltrate the normal
structures and unless effectively treated
interfere with health and eventually cause
death.

 All tumours, benign and malignant are

formed of
two basic components:

1- Parenchymal neoplastic cells,

(proliferating neoplastic cells)

2- Supportive stroma of connective tissue

and blood vessels and possibly lymphatics

Classification of
tumours
1. Benign:
Epithelial
Mesenchymal
Germ cell tumours
2. Malignant:
Epithelial
Mesenchymal
Germ cell tumours

Classification of Tumours
A-Tumours of epithelial origin
1-Str. Sq. epithelium
carcinoma.
2-Glandular epithelium
3-Neuroectoderm

Squamous cell papilloma.

Squamous cell
Adenoma
Adenocarcinoma
Nevus
Malignant melanoma

B-Tumours of Mesenchymal
origin
Malignant=sarcoma

Benign=oma

Fibroma ( benign tumor of fibroblasts)

Lipoma ( benign tr of lipocytes)
Leiomyoma ( benign tr of smooth

muscle fibers)
Rhabdomyoma( benign tr of striated
muscle fibers)
Osteoma
( benign tr of osteoblasts)
Chondroma ( benign tr of chondrocytes)
Angioma
( benign tr of endothelium)

C- Tumours derived from more than one

germ layer
(from
totipotential cells)
Teratoma (mature)
Immature teratoma

Characterization of benign
and malignant tumours
1- Capsulation
Benign tumours grow by expansion leading

to pressure atrophy of the surrounding

tissue with formation of a fibrous capsule.
Though not all benign tumours are
encapsulated, but there is always a plane of
cleavage around the tumours.

 Malignant tumours grow by an

infiltrative manner that destroys and

penetrates the surrounding tissue;
they do not develop a capsule. The
infiltration tends to occur in
anatomic planes of cleavage

Comparison between a benign tumor of the myometrium

(leiomyoma) and a malignant tumor of similar origin
(leiomyosarcoma).

Benign
tumor

Capsule

Uterine leiomyoma

Malignant tumor

Malignant tumor

Differentiation and- 2
anaplasia
Differentiation refers to the
extent to which the tumour cells
resemble their normal counterpart,
both morphologically and
functionally

 Benign neoplasms are composed of

well-differentiated cells that

resemble very closely their normal
counterpart e.g. lipoma. Mitoses are
extremely scant in number and are
normal in configuration.

Follicular adenoma thyroid

 Malignant tumours are

characterized by a wide range of

parenchymal differentiation from
surprisingly well-differentiated
to those completely
undifferentiated.

Well differentiated
adenocarcinoma colon

Poorly differentiated
carcinoma

Anaplasia:
Definition
It implies dedifferentiation or
loss of structural and functional
differentiation of normal cells.
eg. Malignant tumours formed
of undifferentiated cells are
called anaplastic tumours,
anaplasia is a marker of cancer.

 The following cytologic features

characterize malignant cells:

Nuclear and cellular pleomorphism:

wide variation in the shape and size

of cells and nuclei.
Hyperchromatism: darkly-stained
nuclei that frequently contain
prominent nucleoli.

 Nucleo-cytoplasmic ratio:

approaches 1:1 instead of 1:4 or 1:6

reflecting enlargement of nuclei.
Abundant mitoses: reflect
proliferative activity. Mitotic figures
may be abnormal (atypical e.g.
tripolar, quadripolar or multipolar
spindles).
Tumour giant cells: containing a
single large polypoid nucleus or
multiple nuclei.

 Anaplastic tumours also demonstrate

a total loss of tissue architecture e.g.

in an anaplastic tumour of uterine
cervix, the normal orientation of
squamous epithelial cells with
respect to each other is lost (loss of
polarity).

 Well-differentiated tumours,

whether benign or malignant, tend

to retain the functional
characteristics of their counterparts
such as the production of hormones
in tumours of endocrine origin or
keratin in squamous epithelial
tumours. Anaplastic tumours have
no specialized functional activity.