Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
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: [email protected]
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: [email protected]
Fudan University Shanghai Cancer Center