PATHOLOGY OF TUMOURS PART 3

1
PATHOLOGY OF TUMOURS PART 3

1. GRADING AND STAGING
2. PROGNOSIS

2
PROGNOSIS
THE PREDICTION OF FUTURE PROGRESS OF A
DISEASE OR TUMOUR
3
PROGNOSIS

• BENIGN TUMOURS GENERALLY GOOD..
• BUT DEPENDS ON SITE, TYPE ETC
• MALIGNANT TUMOURS
• SITE
• e.g. visceral versus superficial
• 2. INHERENT NATURE OF THE TUMOUR
• PROGNOSIS ACCORDING TO THESE TWO
• FACTORS DEPENDS ON-
• PAST EXPERIENCE OF
• EACH TYPE OF TUMOUR

4
MENINGIOMA A FAIRLY BENIGN TUMOUR ARISING FROM
THE DURA. PRODUCES SYMPTOMS ACCORDING TO THE
REGION OF THE BRAIN IN WHICH IT ARISES. CAN BE
FATAL AS IT IS A SOL
5
BENIGN MENINGIOMA DIAGRAM TO ILLUSTRATE HOW THE
TUMOUR ERODES BONE BY PRESSURE ATROPHY AND
COMPRESSES THE UNDRELYING BRAIN ? RAISED
INTRA-CRANIAL PRESSURE
6
BENIGN HAEMANGIOMA OF THE LIVER THE COMMONEST
BENIGN TUMOUR OF THE LIVER CAN BLEED SEVERELY
DUE TO MINOR TRAUMA TO THE ABDOMEN
7
BENIGN LEIOMYOMA OF THE SMALL BOWEL CAN CAUSE
INTESTINAL OBSTRUCTION AND OFTEN BECOMES
MALIGNANT ( c.f. UTERINE FIBROID)
8
BENIGN ADENOMA OF THE PARATHYROID GLAND.
CAUSES SEVERE METABOLIC DERANGEMENTS WHICH CAN
BE FATAL
PARATHYOID ADENOMA
NORMAL PARATHYROID GLAND
9
CALCIUM DEPOSITED IN THE INTERSTITIUM OF THE
KIDNEY
NEPHROCALCINOSIS
10
PROGNOSIS

• OVERALL PROGNOSIS DEPENDS ON 3 FACTORS-
• GROWTH -
• RAPID GROWTH BAD PROGNOSIS
• 2. EXTENT
• THIS FORMS THE BASIS OF
• THE TNM CLINICAL STAGING
• OF TUMOURS
• a. SIZE OF PRIMARY TUMOUR T0-4
• WHERE T0 IN SITU MALIGNANCY
• b. LYMPH NODE SPREAD N0-3
• c. DISTANT METASTASES M0-4
• 3. DIFFERENTIATION HISTOLOGICAL GRADE

11
PROGNOSIS
THE CLINICAL STAGING OF TUMOURS a. SIZE
OF PRIMARY TUMOUR - T0-4 WHERE T0 IN
SITU MALIGNANCY b. PRESENCE/ABSENCE OF
LYMPH NODE INVOLVEMENT
N0-3 c. PRESENCE/ABSENCE OF METASTASES
M0-4

12

• HISTOLOGICAL GRADE
• OF THE TUMOUR REFERS TO THE
• TISSUE AND CELLULAR DIFFERENTIATION
• WELL DIFERENTIATED
• 2. MODERATELY DIFFERENTIATED
• 3. POORLY DIFFERENTIATED

13
3) Tumour Grading

• Measure of prognosis
• Example of breast cancer
• A) Glandular differentiation
• B) Cellular pleomorphism
• C) Mitotic activity (per 10 HPF)
• Scored as 3 9
• (modified) Bloom Richardson grading

14
DIFFERENTIATION IN A SQUAMOUS CARCINOMA LIES
IN THE TUMOURS ABILITY OR FAILURE TO FORM KERATIN
15
SQUAMOUS METAPLASIA IN BRONCHIAL MUCOSA
16
Mild dysplasia
17
Moderate dysplasia
18
Severe dysplasia / carcinoma in situ
19
CIN III/SEVERE DYSPLASIA ? CA-IN-SITU
20
SQUAMOUS CARCINOMA IN SITU i.e. CONFINED BY
THE BASEMENT MEMBRANE
21
WHEN THE TUMOUR CELLS BREAK THROUGH THE
BASEMENTMEMBRANE THEY FORM CORDS OF CELLS
INFILTRATING THE UNDERLYING STROMA
22
Text
IN WELL-DIFFERENTIATED TUMOURS THE CELLS ARE ABLE
TO PRODUCE KERATIN SEEN HERE AS PINK MATERIAL
WITHIN A SPIRAL ARRANGEMENT CALLED A KERATIN
PEARL
23
CONCENTRIC LAYERS OF KERATIN-CINTAINING CELLS IN
A WELL- DIFFERENTIATED SQUAMOUS CARCINOMA
24
AS THE TUMOUR BECOMES LESS WELL DIFFERENTIATED
ONLY SOME OF
THE CELLS SHOW KERATIN FORMATION
AND-INTER-CELLULAR BRIDGE FORMATION
25
POORLY OR UNDIFFERENTIATED TUMOURS, WHETHER
SQUAMOUS OR GLANDULAR IN ORIGIN CONSIST OF
SHEETS OF UNDIFFERENTIATED CELLS WITH NUMEROUS
AND OFTEN ABNORMAL MITOTIC FIGURES
26
IN ADENO-CARCINOMAS THE DEGREE OF GLANDULAR
STRUCTURE FORMATION WILL DETERMINE THE DEGREE OF
DIFFERENTIATION
27
ADENOCARCINOMA THE GLANDULAR ACINI ARE WELL-
FORMED IN THIS WELL DIFFERENTIATED TUMOUR
28
ANAPLASTIC CARCINOMA i.e. POORLY OR
UNDIFFERENTIATED TUMOUR WITH NUMEROUS MITOTIC
FIGURES (?)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
BREAST MASS EXCISED AT SURGERY. THE CUT SURFACE
SHOWS THE TYPICAL YELLOWISH-WHITE TUMOUR TISSUE
INFILTRATING THE SURROUNDING FIBRO-FATTY BREAST
TISSUE
33
NORMAL BREAST TISSUE
INFILTRATING CARCINOMA
34
FAIRLY SOLID SHEET OF TUMOUR CELLS WITH SOME
DUCTAL DIFFERENTIATION
35
Tumour Grading
Grade Score 5-year survival () 7-year survival ()
1 3 5 95 90
2 6 7 75 65
3 8 - 9 50 45
36
Staging

• A uniform TNM system for staging cancer according
  to its anatomic extent at the time of diagnosis
  is extremely useful for many reasons, chiefly for
  comparing treatment results from different centres

37
4) Tumour Staging

• Measure of prognosis
• TNM classfication T(umour size) N(ode
  numbers) M(etastasis)
• Dukes and Astler-Coller Large intestine
  see later

38
STAGE Definition 5-year survival 7-year survival
I lt 2cm without nodal or regional mets 96 92
II gt 2 lt 5 cm with ve nodes OR gt 5 cm without nodes 81 71
III Any size but with fixation to skin, chest wall, etc 52 39
IV Tumour any size but distant metastases 18 11
39
5) Prognosis

• Depends on grade and stage
• Also tumour type NB breast, lung, melanoma
  (very unpredictable)
• Site VIP (superficial vs. deep visceral)
• Immune status, nutrition, pain threshold, etc
• (No evidence that positive thinking, homeopathy
  and miracles can cure cancer!!)
• General principle, earlier/smaller tumours have
  better prognosis therefore
• Importance of surveillance programs PAP smears,
  mammography, PSA, colonoscopy

40
Spread of Tumours

• Local invasion
• Lymphatic spread
• Haematogenous
• Transcoelomic
• Implantation

• Fascial planes, ducts,
• Carcinoma. Permeation and embolisation.
  Retrograde spread
• Sarcomas. Early to lung
• Pleura, peritoneum, meninges. Example is
  Krukenberg tumour
• Rare due to good surgical practice

41
CARCINOMA

• Majority (90) of malignant tumours
• Prevalence increases with age (cf sarcoma)
• Variable geographic differences (cf sarcoma)
• ENVIRONMENTAL (cf sarcoma)
• NB. All epithelia have a basement membrane
  therefore
• Always a defined pre-malignant phase
• DYSPLASIA (mild, moderate, severe)

42
PROGNOSIS OF A MALIGNANT TUMOUR
43
(No Transcript)
44
(No Transcript)
45
Text
46
ADENO-CARCINOMA SHOWING GLAND FORMATION
47
(No Transcript)
48
CIN III/SEVERE DYSPLASIA ? CA-IN-SITU