Principles of Oncologic Surgical...

复旦大学上海医学院肿瘤学系

Fudan University Shanghai Cancer Center

《Basic Clinical Oncology》

Principles of Oncologic

Surgical PathologyFudan University Shanghai Cancer Center

Weiqi Sheng (associate professor)

Personal Information

• Name: Weiqi Sheng

• Speciality: Surgical Pathology

• Work: Department of Pathology Shanghai Cancer Center

• Contact: shengweiqi2006@163.com

Oncologic Surgical Pathology

• An important branch of surgical pathology• The core of oncologic pathology:

– etiology– pathogenesis– morphologic change– clinical significance

• The ultimate goal of oncologic surgical pathology is: – identifying the neoplasia– leading to successful therapy and prognosis estimation

Content• The definition and main features of neoplasia• The general features of neoplasms

– The main difference of benign and malignant tumors

• Nomenclature and classification • Grading and staging • Techniques and methods

Neoplasia

• Literally means the process of “new growth”• A genetic disease, in which the growth of

tumors is loss of responsiveness to normal growth control, and shows an excessive hyperplasia with abnormal differentiation

• The three important features:– Excessive hyperplasia– Abnormal differentiation – Persistent and progression

Based on the potential to invade and

metastasize, the tumors are classified into

• Benign

• Borderline

• malignant

Comparisons of benign and malignant tumors

General Features of Tumors

• Gross:– shape, size, colour, consistency, texture,

capsule, border…

• Microscopic:– parenchyma: neoplastic cells

– stroma: connective tissues and blood vessels

spherical / solidintra-abdominal fibromatosis

Spherical / cysticserous cystadenoma of ovary

solid / tough / whitecollagenous fibroma

ill-defined border with radiating arm Invasive ductal carcinoma of breast

minute lesionpapillary microcarcinoma of thyroid

huge massalveolar rhabdomyosarcoma of lower leg

Multiple lesion Von Recklinghausen’s

Disease

Thyroid

Folicular adenoma vs papillary carcinoma

Ovarymucinous cystadenoma vs

cystadenocarcinoma

Colontubular adenoma vs adenocarcinoma

parenchyma

stroma

Parenchyma and Stroma

rich of vessels / alveolar arrangement

alveolar rhabdomyosarcoma

scant stroma / diffuse type of arrangement

Burkitt lymphoma

spindle tumor cell / fish-bone like arrangementfibrosarcoma

spindle tumor cell / wavy arrangement

MPNST

pleomorphic tumor cells / pathologic mitosesMFH

colon adenoma, low grade vs high grade neoplasia

colon adenocarcinoma, moderate vs poorly differentiated

Nomenclature and classification

Nomenclature

Generally based on histogenesis and behavior

• Histogenesis:type of cell the tumor arising from• Behavior: benign, malignant or borderline

Nomenclature of Benign tumor

Histogenensis + morphologic characteristics+ -oma

• benign histiocytoma, lipoma, fibroma, angioma

• adenoma, squamous papilloma

• mucinous cystadenoma, serous cystadenoma

Lipoma

Vulva papilloma

Malignant tumor

different with origins

• Epithelial: Histogenensis + carcinoma– Squamous cell carcinoma

– Papillary adenocarcinoma

• Mesenchymal: Histogenensis+sarcoma– Liposarcoma, fibrosarcoma, angiosarcoma

• Lymphohematopoietic: lymphoma, leukemia

Special nomenclatureConventional or memorializedEwing sarcoma, Hodgkin lympomaWilm’s tumor, Kaposi sarcoma

Special nomenclature

• Carcinosarcoma: carcinoma + sarcoma• Teratoma: made up of a variety of

parenchymal cell types representative of more than one germ layer

• -blastoma: embryonic origin– most of them are malignant: neuroblastoma,

retinoblastoma, – some are benign: lipoblastoma, osteoblastoma

The World Health Organization (WHO) Classification on histological, immunohistochemical and genetic typing of human tumors is the most notable classification scheme.

Classification

Grading• a semiquantitative measurement of histologic

differentiation• based primarily on the degree of differentiation of the

malignant cells, nuclear features, and the growth rate(e.g. mitotic rate)

• Malignant tumors are usually classified as grade 1 to 3 or 4 with increasing anaplasia. – Well-differentiated tumors (grade 1)– Moderate-differentiated tumors (grade 2)– poorly differentiated tumors (grade 3)– Undifferentiated tumors (grade 4)

• The grading system is tumor-specific.

colon adenocarcinoma

the more poorly differentiated a tumor,

the more aggressive its behavior

well-differentiated moderate-differentiated

poorly-differentiated

Staging

To be of great value in,• estimating prognosis• indicating need for additional treatment• importance as an indicator of patient outcome

TNM system is widely used with three components to express the anatomic extent of disease

• T: the local extent of tumor spread• N: regional lymph nodes metastasis • M: metastatic spread to distant sites

Techniques and Methodsfor oncologic surgical pathology

Department of Pathology

Histopathology

Cytopathology

Immunohistochemistry

Ultrastructural Pathology

Molecular Pathology

Tissue Bank

Cytopathology

• Cytologic smears • Fine-needle aspiration (FNA) • Cell block

HistopathologySample types:• Biopsy• Frozen• ExcisionSlide processing:• Frozen section• Snap paraffin section• Conventional paraffin section

切片

dehydration

Grossingexamination

embedding

slicing staining

fixation

Processing of paraffin section

Intraoperative frozen section

• Giving an immediate answer to questions affecting proper patient therapy

• To be used only in the following due to limitations– Identification of the presence and nature of a lesion– Definition of the extent of disease and demonstration of

metastasis, to guide the type of the operation– Assessment of the adequacy of surgical margins– Identification of some small or suspicious tissues in operation– Confirmation that excised material is sufficient for diagnosis– Confirmation that the distributed fresh tissue is appropriate for

additional laboratory studies

Electronic microscope

Immunohistochemistry

CD20

AE1/3

Molecular Pathology

Summary1. The ultimate goal of oncologic surgical pathology is

to identify the neoplasia and lead to successful therapy and prognosis estimation.

2. Neoplasia is a genetic disease with three important features.

3. The first principle about tumors is to make a distinction between benign and malignant.

4. TNM system is a widely used cancer staging system to indicate the strategy of additional treatment and prognosis.

5. Many techniques and methods are used in oncologic surgical pathology.

复旦大学上海医学院肿瘤学系

Recommended Readings:

Juan Rosai. Rosai and Ackerman’s Surgical Pathology. Mosby, 2011

If you have any question, please contact me.

Teacher’s name：Weiqi Sheng

email: shengweiqi2006@163.com

Fudan University Shanghai Cancer Center