Chapter 8 Neoplasia
8-1: A, Tubular adenoma (adenomatous polyp) of the colon. Note the fibrovascular stalk (arrow) lined by normal colonic mucosa and a branching head surfaced by dysplastic (blue-staining) epithelial glands. B, Lipoma showing a well-circumscribed yellow tumor. C, Cystic teratoma of the ovary, showing the cystic nature of the tumor. Hair is present, and a tooth is visible (arrow). D, Squamous cell carcinoma. The many well-differentiated foci of eosinophilic-staining neoplastic cells produce keratin in layers (keratin pearls). E, Adenocarcinoma. Irregular glands infiltrate the stroma. The nuclei lining the gland lumens are cuboidal and contain nuclei with hyperchromatic nuclear chromatin. Many of the gland lumens contain secretory material (arrow). F, Osteogenic sarcoma of the distal femur. The light-colored mass of tumor in the metaphysis abuts the epiphyseal plate (arrow) and has spread laterally out through the cortex and into the surrounding tissue.
(A from Kumar V, Fausto N, Abbas A: Robbins and Cotran’s Pathologic Basis of Disease, 7th ed. Philadelphia, WB Saunders, 2004, p 860, Fig. 17-57A; B and C from Damjanov I: Pathology for the Health-Related Professions, 2nd ed. Philadelphia, WB Saunders, 2000, pp 77, 79, Figs. 4-7, 4-11, respectively; D from Klatt E: Robbins and Cotran’s Atlas of Pathology. Philadelphia, WB Saunders, 2006, p 302, Fig. 13-35; E and F from Damjanov I, Linder J: Pathology: A Color Atlas. St. Louis, Mosby, 2000, pp 139, 369, Figs. 7-59, 17-35B, respectively.)
The monoclonal origin of neoplasms has been shown by studying glucose-6-phosphate dehydrogenase (G6PD) isoenzymes A and B in selected neoplasms (e.g., leiomyoma of the uterus). All the neoplastic smooth muscle cells in uterine leiomyomas have either the A or the B G6PD isoenzyme. Non-neoplastic smooth muscle proliferations in the uterus (e.g., pregnant uterus) have some cells with the A isoenzyme and others with the B isoenzyme, indicating their polyclonal origin.
Regional lymph nodes are the first line of defense against the spread of a carcinoma. However, if the nodal architecture is destroyed, malignant cells enter the efferent lymphatics, which empty into the bloodstream. In the bloodstream, malignant cells metastasize to distant organ sites (e.g., liver, lungs, bone).
Some carcinomas have both lymphatic and hematogenous spread. Renal cell carcinomas commonly invade the renal vein, where the tumor has the potential for extending into the vena cava to as far as the right side of the heart. Hepatocellular carcinomas invade the portal and hepatic veins. Tumor obstruction of either vein produces portal hypertension, splenomegaly, and ascites.
8-2: A, Radionuclide scan. Radionuclide uptake is increased throughout the skeleton, with a very heavy uptake in the vertebral column. The patient had a primary breast cancer, which is the most common cancer metastatic to bone. B, Prostate cancer metastatic to the vertebral column. Multiple white foci of metastatic prostate cancer produce an osteoblastic response in the bone. C, Radiograph showing osteoblastic metastases. Note the increased density of bone in the lower lumbar vertebra and pelvic bone in metastatic prostate cancer. D, Radiograph showing osteolytic lesions. Note the radiolucent areas in the midshaft of the femur (arrow) in metastatic breast cancer. E, Metastasis to the liver. The liver contains multiple nodules that have a depressed central area (“umbilicated”) and stellate-shaped borders.
(A from Bouloux P: Self-Assessment Picture Tests: Medicine, Vol. 1. London, Mosby-Wolfe, 1997, p 70, Fig. 140; B from Kumar V, Fausto N, Abbas A: Robbins and Cotran’s Pathologic Basis of Disease, 7th ed. Philadelphia, WB Saunders, 2004, p 1052, Fig. 21-35; C from Bouloux P: Self-Assessment Picture Tests: Medicine, Vol. 3. London, Mosby-Wolfe, 1997, p 11, Fig. 21; D from Rosai J, Ackerman LV: Surgical Pathology, 9th ed. St. Louis, Mosby, 2004, p 2187, Fig. 24-92; E from Damjanov I: Pathology for the Health-Related Professions, 2nd ed. Philadelphia, WB Saunders, 2000, p 303, Fig. 11-18.)
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