1. borderline
1.1. 1. they are very rare 2. these are neoplasms that show nuclear features that suggest malignancy but not enough to be certain that the neoplasm will behave as a malignant neoplasm 3. most commonly are ovarian neoplasms 4. tumors of uncertain malignant potential 5. the histological assessment does not provide a definite indication of a benign or malignant behaviour 6. most commonly found in ovarian serous and mucinous tumors
2. malignant
2.1. definition
2.1.1. 1. primary (carcinoma, lymphoma and sarcomas) 2. secondary (metastasis) 3. they are capable of metastasis 4. metastasis is the essential feature that separates them from benign 5. surgery is not always curative and chemotherapy may be required
2.2. classification
2.2.1. carcinoma
2.2.1.1. definition
2.2.1.1.1. is the malignant tumor of epithelium
2.2.1.2. types
2.2.1.2.1. in situ carcinoma
2.2.1.2.2. invasive carcinoma
2.2.1.3. classification
2.2.1.3.1. squamous cell carcinoma
2.2.1.3.2. adenocarcinoma
2.2.1.3.3. small cell carcinoma
2.2.1.3.4. transitional cell carcinoma
2.2.1.3.5. basal cell carcinoma
2.2.1.3.6. anaplastic carcinoma
2.2.1.3.7. mixed carcinoma
2.2.2. lymphoma
2.2.3. leukemia
2.2.3.1. is the malignancy of the bone marrow
2.2.4. sarcoma
2.2.4.1. definition
2.2.4.1.1. they are malignant tumor of the connective tissue
2.2.4.2. classification
2.2.4.2.1. 1. Osteosarcoma (bone) 2. Chondrosarcoma (cartilage) 3. Angiosarcoma (vessel) 4. Neurofibrosarcoma (nerve) 5. Leiomyosarcoma (smooth muscle) 6. malignant schwnnoma (nerve) 7. liposarcoma (fat) 8. rhabdomyosarcoma (skeletal muscle) 9. kaposi’s sarcoma (herpes virus type 8)
2.2.4.3. causes
2.2.4.3.1. 1. radiotherapy < 1% post therapy 2. mean latency 10 years 3. chemicals, pesticides, asbestos and genetics
2.2.4.4. sites of sarcoma
2.2.4.4.1. limb, trunk, abdomen or anywhere
2.2.4.5. genetic association
2.2.4.5.1. 1. li fraumeni syndrome > p53 germline defect 2. von recklinghausen disease > neurofibrosarcomas
2.2.4.6. clinical presentation
2.2.4.6.1. lump or metastases
2.2.4.7. treatment
2.2.4.7.1. 1. wide local excision 2. radiotherapy 3. chemotherapy 4. targeted treatment imatinib for gastrointestinal stromal tumors
2.2.5. malignant melanoma
2.2.5.1. definition
2.2.5.1.1. 1. malignancy of melanocyte 2. new black nodule 3. change in mole asymmetry, border irregular, bleeding, colour, diameter and elevation 4. cells of differentiation are melanocytes
2.2.5.2. causes
2.2.5.2.1. sunlight
2.2.5.3. sites
2.2.5.3.1. skin, anal margin, eye (retina) and others
2.2.5.4. assessment
2.2.5.4.1. 1. breslow thickness and clarkes level of invasion assesses level into different parts of the dermis 2. >2mm then it is very poor prognosis 3. <0.76 mm is 98% curable
2.2.6. rare neoplasm
2.2.7. carcinosarcoma
2.2.8. embryonic neoplasm
2.2.8.1. 1. they occur in children 2. aggressive tumors 3. consist of one embryonal like cell 4. neuroblastoma >> neural tissue 5. nephroblastoma >> kideny 6. retinoblastoma >> retina 7. medullablastoma >> cerbellum
2.2.9. germ cell neoplasms
2.2.9.1. definition
2.2.9.1.1. 1. tumors arising from germ cell sites 2. testis, ovary, thymus, pineal and retroperitoneum 3. they are derived from cells which can recapitulate the 3 germ cell layers (endoderm, mesoderm and ectoderm) 4. it is changed with chmeotherapy 5. long term follow up is now available with regular analysis of serum tumor markers
2.2.9.2. clinical presentation
2.2.9.2.1. 1. primary >> mass or lump in testis 2. metastasis >> especially pulmonary
2.2.9.3. classification
2.2.9.3.1. seminoma for testes
2.2.9.3.2. dysgerminoma for ovary
2.2.9.3.3. teratoma
2.2.9.3.4. choriocarcinoma
2.2.9.3.5. yolk sac tumor
2.2.9.3.6. embryonal carcinoma
2.2.9.3.7. mixed tumor
2.2.10. glial neoplasms
2.2.10.1. 1. they are neoplasms of the CNS 2. astrocytoma 3. oligodendroglioma 4. these present due to the effects of a space- occupying lesion in the brain
2.2.11. multiple endocrine neoplasm
2.2.11.1. clustering of more than 1 neuroendocrine neoplasm in the one patient
2.2.12. neuroendocrine neoplasm
2.2.12.1. definition
2.2.12.1.1. 1. neoplasms with endocrine function and neural features 2. tumors showing differentiation of neural cells and endocrine cells 3. some are highly aggressive and lethal >> small cell carcinoma 4. some are low aggression >> carcinoid tumor 5. they are recognised by immunohistochemistry by identifying a specific neuroendocrine marker (chromogranin)
2.2.12.2. types
2.2.12.2.1. benign
2.2.12.2.2. malignant
2.3. clinical presentation
2.3.1. effects of primary
2.3.1.1. 1. mass (cancer of the breast) 2. obstruction (colon) 3. bleeding (like benign + malaena) 4. loss of function (fracture of the bone)
2.3.2. effects of metastasis
2.3.2.1. 1. metastasis is the malignant neoplasm that has spread from primary site to distant site 2. Lump/Mass (Axillary nodal mass) 3. Obstruction (bronchus due to a metastasis) 4. Bleeding (haemoptysis due to lung metastasis) 5. Loss of function (Stroke due to metastasis in brain) 6. Ascites
2.3.3. effects of hormone secretion
2.3.3.1. 1. ACTH from small cell carcinoma of lung >> Cushing’s syndrome (ectopic, homotropic, inappropriate) 2. oestrogen from a testicular tumor >> gynaecomastia 3. excess ADH 4. hypercalcaemia >> squamous cell carcinoma lung 5. common clinical emergency causes of hypercalcaemia in malignant neoplasm - bone metastases (bone destruction by the tumor causes the release of calcium into the blood) - excess PTH or similar type hormone
2.3.4. paraneoplastic syndrome effects
2.3.4.1. 1. peripheral neuropathy 2. dermatomyositis 3. effects which cannot be explained due to local deposition of neoplasm or to hormonal effect 4. examples >> peripheral neuropathy, myopathy, dermatomyositis, cerebellar degeneration, PUO and night sweats 5. most likely cause is an immune or cytokine mediated response (anti cerebellar antibodies have been secreted by some tumors)
2.3.5. general effects of malignant disease
2.3.5.1. 1. weight loss 2. fatigue 3. anorexia 4. lassitude (lack of energy)
2.3.6. haematological effects
2.3.6.1. 1. iron deficiency anaemia (commonest) >> blood loss 2. megaloblastic anaemia >> cytotoxic drugs interfering with DNA synthesis 3. hypoplastic anaemia >> marrow infiltration by tumor, chemotherapy destruction and radiotherapy destruction 4. haemolytic anaemia >> immune mediated destruction of RBC 5. increased clotting (DVT) >> tumor activated clotting factors, platelets and endothelial cells or tumor inhibits fibrinolysis 6. polycythaemia (increased haemoglobin) due to an increase in the number of RBC 7. erythropoietin production >> renal cell carcinoma
2.4. diagnosis
2.4.1. 1. history 2. clinical examination 3. radiology CT, MRI, PET 4. pathology FNA, Bx, aspirate and resection
3. benign
3.1. definition
3.1.1. 1. they are neoplastic 2. Cannot metastasize, therefore can be surgically resected and almost always cured 3. Different macroscopically and microscopical features from malignant neoplasms 4. Sometimes benign neoplasms can become malignant over time such as adenoma of colon to carcinoma of the colon 5. pathologists can tell the difference between normal cells and benign by microscopical assessment
3.2. microscopical features
3.2.1. nuclear features
3.2.1.1. 1. pleomorphism 2. hyperchromasia 3. increased mitotic activity 4. nuclear/ cytoplasmic ratio
3.2.2. architecture of the cells
3.2.2.1. 1. disruption of architecture 2. loss of maturation
3.2.3. assessment of maturation of the epithelium
3.2.4. altered genetic profile
3.2.5. altered function
3.3. macroscopical features
3.3.1. well circumcised
3.3.2. often encapsulated
3.3.3. rarely hemorrhage
3.3.4. rarely necrosis
3.4. examples
3.4.1. epithelial neoplasms
3.4.1.1. squamous epithelium (papilloma)
3.4.1.1.1. skin
3.4.1.2. glandular epithelium (adenoma)
3.4.1.2.1. 1. GIT 2. thyroid 3. ovary and breast
3.4.1.3. transitional epithelium (transitional / urothelial papilloma)
3.4.1.3.1. bladder
3.4.2. connective tissue (mesenchymal) neoplams
3.4.2.1. 1. lipoma > fat 2. neuroma > nerve 3. angioma > vessel 4. chondroma > cartilage 5. leiomyoma > muscle (known as fibroid)
3.5. clinical presentation
3.5.1. lump
3.5.2. bleeding
3.5.2.1. 1. Haematemasis (Vomiting blood) 2. Haemoptysis (Coughing of blood) 3. Malaena (Black Stools) 4. Per vaginum 5. Fe Deficiency Anaemia
3.5.3. mass effect
3.5.3.1. 1. Cerebral Stroke 2. Git Obstruction 3. Prostatic Outflow 4. Obstruction
3.5.4. pain
3.6. behaviour
3.6.1. 1. benign neoplasms will grow but not metastasize 2. they may cause death if they are associated with severe blood loss 3. they will spread locally into adjacent tissues
3.7. management
3.7.1. 1. surgery is usually curative 2. they can kill the patient if there is an inoperable site such as the brain
3.8. notes
3.8.1. hamartoma 1. excess of tissue which is normal to the site but haphazardly arranged 2. it is malformation rather than neoplasm 3. example > capillary angioma
3.8.2. there is no such thing called as benign lymphoid neoplasms