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Histopath Lab 8:
Neoplasia II

INSTRUCTORS: First click here to
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Robbins and Cotran Pathologic Basis of Disease 9th Ed.

Suggested Reading:
Pages 265-275 – General Aspects
Pages 1101-1103 – Parathyroid Hyperfunction
Pages 1123-1127 – Adrenal Hyperfunction
Pages 807-810 – Colonic Adenoma
Pages 810-815 – Colonic Adenocarcinoma
Pages 1004-1006 – Cervical Cancer
Pages 1019-1021, 1223 – Leiomyoma, Leiomyosarcoma
Pages 1220-1221 – Lipoma, Liposarcoma


NEOPLASIA II


Slide 37 [WebScope][ImageScope]

Liver: This specimen came from a man who had a colon cancer resected three years earlier. At autopsy his liver was studded with multiple nodules.

  • At low magnification, you can see that there are nodular lesions replacing and compressing the normal hepatic parenchyma.
  • Higher magnification reveals the nodules to consist of proliferating epithelial cells. How are these cells arranged?
  • What cytological features identify the neoplasm as malignant?
  • Can you account for the pink and blue staining granular material in the center of some of the nodules?
  • What is your diagnosis?

 

Slide 38 [WebScope][ImageScope]

Lymph Node: These lymph nodes came from the neck of a 74-year-old man who had throat cancer. His surgeon removed these lymph nodes to see if there was metastatic cancer in them.

  • Examination of this section at low magnification will reveal one more or less normal node, and a second node partly replaced by a pink nodule.
  • Under a higher power, the nodule is rather easily identified as consisting of epithelial cells in a fibrous background. What are the cytological features that allow you to identify this epithelial population as malignant?
  • Is this an adenocarcinoma or squamous cell carcinoma? What is your overall diagnosis?
  • Where do you suppose the primary was and what might you guess about the clinical background of the patient?

 

Slide 33 [WebScope][ImageScope]

Uterus: This slide contains a portion of myometrium from a 48-year-old woman. Grossly, the myometrium was distorted by numerous circumscribed nodules ranging in size from 2 to 6 centimeters. As you inspect this slide at low magnification, you will note a roughly circular area that stains more deeply than the surrounding myometrium. This area is not really encapsulated, but it looks different, and seems to be separated from the adjacent myometrium along at least part of its circumference.

  • Note that this circumscribed area is more densely cellular, with a higher concentration of nuclei and a bluer color. This cellular area is the neoplasm. You will see that the neoplasm is also composed of interlacing bundles of spindle shaped cells. While not actually encapsulated, the nodule is easily distinguished from its surroundings by its denser cellularity and darker color. Note the structure of the normal myometrium -- interlacing bundles of spindle shaped cells that run in fascicles. Some of these fascicles are cut longitudinally, and others in cross-section.
  • What kind of cells make up this nodule?
  • Compare the nuclei in the nodule with those in the normal myometrium. Are they similar or dissimilar?
  • Do you think this nodule is benign or malignant? Why?
  • What is your diagnosis for this nodule?
  • How do these neoplasms present clinically? Where else might you find a neoplasm of this sort?

     

Slide 35 [WebScope][ImageScope]

Soft tissue of the scalp: This lesion actually came from an elderly male patient. The origin of the neoplasm was presumably a vascular wall (this was apparent in other sections of the neoplasm). A neoplasm such as this could have arisen in any other tissue containing smooth muscle, such as the myometrium.

  • Inspection of the section at low magnification reveals that it consists almost entirely of neoplasm with only a thin shell of overlying connective tissue (a “capsule”).
  • Closer inspection reveals that the neoplasm consists of interlacing bundles of spindle shaped cells. What kind of cells do you think these are derived from?
  • In comparison to the leiomyoma, however, this neoplasm has features that allow you to call it malignant. What are they? What’s your diagnosis?

 

Slide 34 [WebScope][ImageScope]

Colon: This lesion was found incidentally at autopsy of a 56-year-old man and had nothing whatsoever to do with his demise. The lesion was a large yellow nodule beneath an intact mucosa.

  • At low magnification, find the intact mucosa overlying the neoplasm. The muscle wall of the colon is distorted and attenuated (thinned) by the lesion.
  • What kind of cells make up the nodule?
  • Do you think this is benign or malignant neoplasm?
  • What is your diagnosis?
  • What would these neoplasms often occur? What is the biological significance?

 

Slide 36 [WebScope][ImageScope]

Liposarcoma of lower extremity: This section is from a bulky neoplasm in the thigh of a 49-year-old woman.

  • At low magnification, you can see part of a lightly staining nodular lesion that is bordered by more deeply pink-staining tissue. Close inspection reveals a rather cellular neoplasm, lobules of which extend into adjacent, distorted skeletal muscle. What does this extension of the neoplasm into surrounding tissue imply?
  • Note that despite its light-staining quality, the neoplasm itself is extremely cellular and has a finely vascular background. This is because the tumor cells have ample clear cytoplasm (as it is a tumor derived from fat).
  • This lesion is the malignant counterpart of the lesion seen in Slide 34 and a comparison of the two is useful. Some of the cells in this lesion can be identified as adipocytes (fat cells) of more or less the usual sort. Other cells are rather peculiar, with multiple cytoplasmic lipid droplets that characteristically indent their darkly-staining nuclei. Still others are rather nondescript-appearing, less well differentiated cells that have a more or less spindled shape. The cellularity, nuclear pleomorphism, and—importantly—invasiveness of this neoplasm identify it as malignant. If you had time to study this neoplasm for a while, you’d find that its mitotic rate is higher than that in the lipoma.
  • Where else might you expect to find a liposarcoma?

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