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Introduction to Neoplasia


Abnormal mass of tissue, growth of which exceeds and proliferates and is un-coord-inated with normal tissue & persists in same excessive manner after removal of stimulus.

  1. Components of a neoplasm – are -
    1. Parenchyma - proliferative neoplastic
    2. Stroma -supporting connective tissue & blood supply 
  2. Benign: Suffixed by - oma eg,
    1. Epithileal –  i. Adenoma,  ii. Papilloma
    2. Mesenchymal – i. Fibroma ii. Chondroma 
  3. Malignant         
    1. Epithelium - Carcinoma
    2. Mesenchyme - Sarcoma (Sar - fleshy)
    3. Epith + Mesench. → Carcino sarcoma
    4. Teratoma Derivatives of all 3germ layer
    5. Pleomorphic adenoma - Has ectodermal and mesodermal components


  1. Choristoma: Ectopic rest of normal tissueQ (eg. Adrenals - in kidney caps; Pancreatic - in small intestinal   mucosa)
  2. Hamartoma: aberrant Differentiation ~ disorganized but mature specialized tissue indigenous to particular site
  1. Characteristics of Neoplasia: Q
    1. Differentiation & Anaplasia (to form backwards) :­
      1. Benign neoplasms are usually well differentiated Q
      2. Anaplasia is a hallmark of malignant tumor Q

Features of malignant cells ­

  1. Pleomorphism                           
  2. Hyperchromasia
  3. High N/C ratio (normal 1:4 - 1:6)Q    
  4. Bizarre Morphology             
  5. Disturbed orientation

Rate of growth-

Growth rate correlates with level of differentiation

  1. Local Invasion,
    1. Benign: Slow growing, cohesive, expansile, capsule +
    2. Malignant: Infiltration, Invasion, Destruction: metastasis
      1. Most reliable feature of malignancy → Metastasis Q
      2. 2nd most reliable feature Invasiveness Q 
  2. Metastasis: Tumor implants discontinuous with primary tumor.
    30% newly diagnosed malignancy presents with metastasis 
  1. Pathways of spread
    1. Direct seeding of body cavities on surfaces: peritoneum: Pseudomyxoma peritonei 
    2. Lymphatic spread: Natural route, skip lesions;  
      1. Carcinoma: Lymphatic                 
      2. Sarcoma: hematogenous
      3. LN enlargement - seen in –spread of Ca, also Known as Reactive hyperplasia. 
    3. Hematogenous spread
      1. Arterial - (less common): seen in pulmonary capillary beds
      2. Venous: - More common 
  2. Liver & lung
Table: Comparisons Between benign and malignant tumors
  Benign Tumors
Malignant Tumors
Similar to cell of origin
(well differentiated)
Dissimilar from cell of
Origin differentiated
Tumor edges move outward in a smooth manner (encapsulated) grows by expansion and compresses and displaces surrounding tissues
Tumor cells stay attached to the clone or mass of cells and do not break away and start new growths elsewhere in the body
The tumor edges move outward in an irregular fashion (usually no capsule) and can infiltrate, invade, and destroy surrounding tissues
Tumor cells can break away from the cloned mass, live independently, move to other area of the body and start new clones or growths
Rate of growth Slow growth rate Rapid growth rate
Degree of Vascularity Slight vascularity Moderate-marked
Recurrence After surgical Ulceration Seldom recurs after
Frequently recurs
After removal
Degree of Necrosis and Ulceration Necrosis and
Ulceration unusual
Necrosis and ulceration common
Likelihood or of Causing Systemic effects Systemic effects are
Unusual unless the
Tumor is a secreting
Endocrine neoplasm
Systemic effects are
Common and usually

Inherited Cancer Syndromes

  1. Inherited predisposition indicated by strong family h/o & of associated marker:
  1. Retinoblastoma - 40% are familial       
  2. Familial APC Q
  3. MEN syndrome Q                         
  4. NF I & II Q           
  5. VHL syndrome Q 
  1. Familial cancers: Familial clustering but role of inherited predisposition not clear
    1. Breast cancer Q BRCA - 1 & BRCA – 2
    2. Ovarian cancer Q    
    3. Colon cancer other than FAP Q
  2. AR syndrome of defective DNA repair
    1. Xeroderma pigmentation Q  
    2. Ataxia Telangiectasia Q
    3. Bloom syndrome Q              
    4. Fanconi Anemia Q 
  3. Preneoplastic diseases
  1. Endometrial HP Q        
  2. Cirrhosis of Liver Q              
  3. Chronic gastritis Q
  4. Ulcerative colitis Q               
  5. Solar keratosis Q         
  6. Leukoplakia Q

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