Chemical Physical Viruses Heritable genetic damage Viral-genetic Physico-chemical Dysontogenetic (result of embryonic primordia dytopia during embryogenesis Polyetiological Онкоген – Протоонкоген – нормальный ген, который ген стимулирующий при условиях мутации может злокачественный рост трансформироваться в онкоген Антионкоген – ген блокатор онкогена «De novo» Without previous damage Staging development of tumor Facultative Degeneration Atrophy Chronic inflammation Obligate Dysplasia Autonomous growth– lack of control over proliferation and differentiation of cells Macroscopical changes Microscopical changes Atypism Secondary changes in tumors Metastasis Infiltrative (invasive) Expansive Grows from itself, pushing the surrounding tissues Formation of pseudocapsule Mostly benign tumors Growth into surrounding tissues with destroing Fast growth Malignant tumors Apposition Neoplastic transformation of normal cells into the the tumor cells Desmoid tumors Depending from the lumen of organ Exophytic Expansive growth of tumor in the lumen of organ Unicentral Endophytic Infiltrative growth of tumor in the wall of organ Multycentral Depending from the amount of tumor primary foci Parenchyma of tumor Stroma of tumor Desmoplastic reaction Organoid tumors (look like organ due to presence of parenchyma and stroma) Hystioid tumors (undifferentiated tumors) – prevalence of parenchyma, stroma contain thin walls vessels and capillaries Morphological • tissue •cellular Histological investigation Biochemical Metabolic changes of cell Histochemical investigation Antigen Changes of surface active antigens IHC investigation Functional Changes of functional activity of tissue or organ Clinical diagnosis Polymorphism (different shape and size) or monomorphism of cells and nucleus Necrosis, hemorrhages, ulceration, petrification, sliming etc. The formation of secondary foci of tumor growth (metastasis) as a result of spreading neoplastic cells from primary tumor to other tissues Metastasis Hematogenous Intracanalicular Implantation Lymphogenous Mix Benign Tumors with local destructive growth (Bordeline tumors) Malignant Benign tumors=name of tissue in latin or greek + suffix “oma”. Excluding: lymphoma, seminoma, melanoma. Malignant epithelial tumors = name of tissue in latin or greek + «carcinoma». Malignant mesenchymal = name of tissue + «sarcoma». Tumor arising from the germ cells– «teratoma». Tumor arising from fetal tissue or their derivates– «blastoma» Small size incapsulated well demarcated formation compressing surrounding tissues Expansive slow growth without invasion Secondary changes rare, more often petrification, sliming Mature cells and very similar to normal tissue cells Organoid Tissue atypism Possible malignization Rare metastasis Do not recur Large size due to invasive growth with unclear borders Destructive fast growth Secondary changes are common, more often necrosis, bleeding The degree of differentiation of cells may be different, but the cells do not reach full maturity Cellular atypism Metastasis Recur Local Local effect of the primary tumor or metastases (compression, destruction of the surrounding tissues and organs) General Cachexia Paraneoplastic syndrom Nonspecific reactions from the various organs and systems, or ectopic production of biologically active substances by tumor Endocrinopathy (producing of different hormones by the tumor) Neurological manifestations Skin manifestations – acanthosis nigricans (hyperpigmentation of armpits, neck, anal area) Hematological apperances (hypercoagulation, anemia, thrombocytopenia) Epithelial tumors without specific localization (non-organic specific) Tumors of exo- and endocrine glands and epithelial integument Tumors of melaninproducing tumors Tumors of the nervous system and brain membranes Tumors of the blood system Mesenchymal tumors Teratomas The degree of malignancy G1 – low-grade tumors – usually well-differentiated tumors with minimally pronounced; G2 – intermediate grade tumors– moderately differentiated; G3 – high-grade– poorly differentiated tumors with pronounced signs of cellular atypism Stage of the tumors process Determined by: Degree of intergrowth (invasion) of the primary tumor node in the organ and the surrounding tissues; Severity of the metastatic process. Used classification TNM (tumor – опухоль, nodulus – узел, methastases – метастазы) Т – size and spreading; N – metastasis in regional lymphnodes; M – di8stant metastases Non-organospecific tumors Benign Papilloma Adenoma Malignant Carcinoma in situ Squamous cell carcinoma with keratinization or nonkeratinizing Adenocarcinoma Mucinous (colloid) Solid (trabecular) Smallcell (scirrous) Largecell Ringcell Medullar(adenogenic) Macro: round shape formation, hard or soft on consistency. Papillary surface located on wide or narrow base. Micro: constructed from cells, expanding cover epithelium, the number of its layers is increased. Tissue atypism - uneven development of the epithelium and stroma and excessive formation of small vessels. Cellular atypism is absent.. Location: skin and mucous membranes covered by transitional or squamous nonkeratinizing epithelium. Outcomes: inflammation, bleeding, malignization. Prognosis: favorable in case of adequate surgical removal. Macro: well demarcated nodule soft on consistency. On cut surface – white-pink, with formation of cyst in some cases. Micro: consists of cells prismatic or cubic epithelium, forming glandular formations, sometimes with papillary outgrowths. The relationship between glandular structures and the tumor stroma is different. There is no cellular atypism. Location: parenchymatous organs (liver, kidney, endocrine organs). Outcomes: inflammation, bleeding, malignization. Prognosis: favorable in case of adequate surgical removal. Fibroadenoma Adenomatous polyp Tubular adenoma Acinar adenoma Papillary adenoma Carcinoma in situ The form of cancer without invasive growth, but with marked atypism and cell proliferation with pathological mitoses Tumor growth within the epithelial bed without transition to the underlying tissue It consists of strands of atypical epithelial cells, growing into the underlying tissues, destroying them and forming clusters in them. It subdevided into keratinizing (formation of “carcinomatous pearls” and nonkeratinizing squamous-cell carcinoma. Location: skin and mucous membranes covered by transitional or squamous epithelium. Adenogenous tumor (tumor cells form a glandular formation, growing into surrounding tissues), but has a pronounced cellular atypism. Adenocarcinoma subdevided into three types: acinar (prevalence of acinar structures), tubular (tubular structures) and papillary. Location: prismatic epithelium of mucous membranes and glandular organs. Adenogenic carcinoma, whose cells have signs of morphological and functional atypism - perverted formation of mucus. The tumor has the slimy appearance or colloidal mass with single atypical cells Undifferentiated cancer Undifferentiated cancer or anaplastic tumor It consists of monomorphic lymphocyte-like cells that do not form any structures with a large number of pathological mitoses; stroma is extremely scarce. Common necrotic changes It is used IHC to determine immunophenotype of tumor Undifferentiated cancer which consist from polymorphous hyperchromic cells with numerous mitosis. High-grade tumor with early metastasis. Location: common in stomach, lungs. Undifferentiated carcinoma, which consist from cell containing mucus, and nucleus pushed to cellular membrane. Cytoplasm of these cells stain in crimson color in PAS-reaction. Undifferentiated cancer with extremely atypical hyperchromic cells located among strata and strands of coarse-fiber connective tissue. High-grade tumor with early metastasis. Undifferentiated cancer with a significant predominance of the parenchyma over the stroma. The tumor is soft, pale pink, resembles brain tissue (cerebral cancer) It consists of layers of atypical epithelial cells, contains numerous mitoses Location: mammary and thyroid glands. Follicular Papillary Anaplastic Medullary Anaplastic Small-cell carcinoma 13% Non-Small-cell carcinoma 87% Squamous cell carcinoma Carcinoid Adenocarcinoma Large-cell carcinoma Adeno-squamous carcinoma Cancer of bronchial glands Immunophenotype of metastase of adenocarcinoma of lungs
