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Lab 7: Neoplasia I
Robbins and Cotran Pathologic Basis of Disease 7th Ed.

Required Reading:
Cellular Adaptation, pp. 5 - 11
General Aspects, pp. 270 - 281

Suggested Reading:
Parathyroid Hyperfunction, pp. 1184 - 1188
Adrenal Hyperfunction, pp. 1207 - 1214
Colonic Polyps and Adenomas, pp. 858 - 862
Colonic Carcinoma, pp. 862 - 866
Cervical Cancer, pp. 1073 - 1079
Leiomyoma, pp. 1089 - 1090
Lipoma, Liposarcoma, pp. 1317 - 1318
Teratoma, pp. 1099 - 1100
Hamartom, pp. 765
 
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NEOPLASIA I


Slide 28 [WinLab] [Mac] [WinHome]

Parathyroid Gland: Adenoma

This section is dominated by a circumscribed nodule of epithelial cells. Just outside of this nodule are patches of normal parathyroid tissue, seemingly stretched or compressed by the nodule.

  • Note grossly that the nodule is far larger than any normal gland.

  • This nodule is composed of parathyroid cells, but differs from the adjacent, more normal gland. In what respects does it differ?

  • How do you go about concluding that this nodule is a neoplasm? How would you distinguish it from parathyroid hyperplasia?

  • What are the histologic features that suggest that the nodule is benign?

  • How would such a lesion of parathyroid present clinically? What tests would help establish the presence of an adenoma? How is the adenoma found?



Slide 29 [WinLab] [Mac] [WinHome]

Adrenal Gland: Cortical Adenoma

As you inspect this slide under scanning power, you'll note that the section includes part of a nodule attached to a segment of normal adrenal gland.

  • Review the architecture of the normal adrenal cortex. Identify medulla as well.

  • How does the architecture of the nodule differ from that of the normal cortex?

  • What are the features that suggest that the nodule is benign?

  • How does this condition differ from cortical hyperplasia?

  • How does this condition differ from cortical carcinoma?

  • How might an adrenal lesion of this sort present clinically? How could the adenoma be localized (i.e., right or left) pre-operatively?

  • What is the proper name of a benign neoplasm of the adrenal medulla?



Slide 30 [WinLab] [Mac] [WinHome]

Colon: Adenoma

Inspect this slide under scanning power, noting two sections of the lesion. On one section, the lesion is a thickened plaque, while on the other it projects as a broad-based polypoid mass.

  • Under the scanning power of the microscope, orient yourself to the various layers, noting that the lesion is entirely mucosal.

  • Contrast the arrangement and low-power appearance of the epithelium in the mass itself with the more normal mucosa. Then compare the high-power features of this adenomatous epithelium with the more normal.

  • This is a rather large adenoma growing as a "polyp," i.e., a bulbous projection from the surface. An adenoma such as this, which grows on a broad base, i.e., with no stalk, is designated as “sessile.” One with a stalk is designated as “pedunculated.”

  • Simply calling this lesion a “polyp" would not be specific enough, since some polyps are not neoplasms. Can you name a non-neoplastic polyp?

  • How does a colonic adenoma differ from a colonic carcinoma histologically? (See Slide 31 [WinLab] [Mac] [WinHome].)

  • How do colonic adenomas present clinically? What is their biological significance?



Slide 31 [WinLab] [Mac] [WinHome]

Colon: Invasive Adenocarcinoma

As you inspect this slide under scanning power, you'll note a sessile mass projecting from the surface.

  • Compare the epithelium in this mass with that of the normal colonic mucosa.

  • Compare it to the epithelium in the adenoma in Slide 30 [WinLab] [Mac] [WinHome].

  • What feature of this neoplasm identifies it as malignant and distinguishes it from the lesion in Slide 30?

  • Why is the designation "adenocarcinoma" appropriate?

  • How do lesions like this present clinically? What factors would influence prognosis?



Slide 32 [WinLab] [Mac] [WinHome]

Uterine Cervix: Invasive Squamous Cell Carcinoma

  • How can you identify tissue as cervix? (Hint: inspect the normal epithelium on either side of the section.)

  • Under the scanning power, note the masses of epithelium extending deep into the substance of the cervix, i.e., invading.

  • Compare the epithelium in the invading masses with that of the immediately adjacent mucosa and that of the more distant ectocervical squamous mucosa. Immediately adjacent to the neoplasm, the squamous epithelium is dysplastic. What are the features of dysplasia?

  • What features of the invasive epithelium enable you to identify it as squamous cell carcinoma?

  • How would such a lesion present clinically? What are the etiologic or "risk factors" in cervical squamous cell carcinoma? What are the risk factors in squamous cell carcinoma of oropharyngeal mucosa? Of lung?
 

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