Neoplasia V

Dr Iram Khurshid
FCPS Histopathology
Assistant Prof CKMC
Clinical Aspects of Neoplasia
Although malignant tumors are more threatening than
benign,
Both can cause problems becauseof:
1. Location and impingementon adjacent structures
2. Functional activity such as hormone production s or
the developmentof paraneoplasticsyndromes
3. Bleeding and infection when the tumor ulcerates
through adjacent surfaces
4. Symptoms from tumor rupture or infarction
5. Cachexiaor (wasting)
Local and Hormonal Effects
1. Location: Location is crucial in both
benign and malignant tumors.
a) Intracranial tumors (e.g., pituitary
adenoma small 1-cm) can expand and
destroy the remaining pituitary gland,
giving rise to hypopituitarism;
b) Tumors of the gastrointestinal tract may
cause obstruction of the bowel or may
ulcerate and cause bleeding
c) A comparably small carcinoma within the
common bile duct may induce fatal
biliary tract obstruction.
2. Hormone production: (Paraneoplastic
syndromes)
These are tumor-associated syndromes where the
symptoms are not directly related to the spread of the
tumor or to the elaboration of hormones indigenous to
the tumor tissue. They appear in 10% to 15% of patients
with cancer.
Paraneoplasticsyndromes may be the earliestclinical
manifestations of a neoplasm and can mimic distant
spread. The most common syndromes include:
•Endocrinopathies: Some non-endocrine cancers
produce hormones or hormone-likefactors (ectopic
hormone production). Thus small-cell lung cancer
causes Cushing syndrome byelaborating ACTH.
• Hypercalcemia is the most common
paraneoplastic syndrome. It is caused by bone
resorption resulting from the elaboration of
parathyroid hormone (PTH)-like peptides.
• Neuropathic paraneoplastic syndromes:
include peripheral neuropathies, cortical
cerebellar degeneration, and myasthenic
syndromes.
In most cases, the mechanisms are thought to
involve autoantibodies against tumor antigens
that cross-react with normal host tissues.
• Thrombotic diatheses result from
production of thromboplastic
substances by tumor cells and manifest
as disseminated intravascular
coagulation, or valvular vegetations
(nonbacterial thrombotic
endocarditis).
3. Cancer Cachexia:
Many cancer patients suffer loss of body fat, lean
body mass, and profound weakness, referred to as
cancer cachexia.
Its multifactorial, but is largely driven by TNF and
other cytokines by inflammatory cells in response to
tumors:
i. Loss of appetite
ii. Metabolic changes causing reduced synthesis
and storage of fat and increased mobilization
of fatty acids from adipocytes
iii. Increase catabolism of muscle and adipose tissue
by ubiquitin proteasome pathways
Grading and Staging of Tumor
These methods are used to quantify the clinical
aggressiveness of a given neoplasm with help of
level of differentiation (or grade), and extent of
spread of a cancer within the patient (or stage).
(Clinical aggressivenessof a tumor)
Both histologic grading and clinical staging are
valuable for prognostication and for planning
therapy, although staging has proved to be of
greater clinical value.
Grading
•Grading is based primarily on the
degree of differentiation (how well
the tumor resembles its normal
counterpart), and, occasionally,
architectural features or number of
mitoses.
⚫In general, higher-grade
tumors (more poorly
differentiated) are more
aggressive than lower-grade
tumors.
Staging
Staging is based on the size of the primary
tumor and the extent of local and distant
spread.
The major system currently used is the
American Joint Committee on Cancer (AJCC)
staging; the classification involves a TNM
designation—
1. T for primary tumor (i.e., size and local
invasion),
2. N for regional lymph node involvement,
3. M for distant metastases.
FNAC of Thyroid lumps
Pap (cytologic) Smear
Cytologic (Papanicolaou) smears
provide another method for the
detection of cancer.
This approach has been used widely for
discovery of carcinoma of the cervix at
an early stage.
Histology of Stomach
GASTRIC CARCINOMA
Membrane staining
Nuclear staining
Tumor markers
⚫Proteins released by tumors
into the serum, such as PSA, can
be used to screen populations
for cancer and to monitor for
recurrence after treatment
Flow cytometry
Used routinely in the classification of
leukemias and lymphomas.
In this method, fluorescently labeled
antibodies against cell surface molecules
and differentiation antigens are used to
obtain the phenotype of malignant cells

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Dr Iram Khurshid

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