mesenchymal tumor2007

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Tumoros growthMesenchymal tumors

Associate Professor

Ph.D. I.A. Bechtereva



Connective tissue, vessels, mussels, bones,cartilages, serous membranes, haematogenic

system develop from mesenchyme. All thesetissues can be nidus of benign and malignanttumors.

Benign tumors

Fibroma is a benign tumor from connectivetissue. It consists of fibroblasts type cells,fibrocytes and collagen fibers. We can observe itson a skin, ovary e.t.c.

We distinguish: Hard fibroma consists of mainly fibrous collagen. Soft fibroma consists of mainly fibroblasts type

cells and soil connective tissue.



Dermatofibroma (histiocytoma)

Macroscopic picture: tumor localizes in the derma

and subcutaneous cellular tissue. It’s characterizedby presence of painless nodules (seldom diametercan be more 1 cm.). It has brown colors, at sectionit has bulging surface over surface of skin.

Microscopical picture: It consists of fibroblaststype cells, fibrocytes, histiocytes, macrophages,siderophages. It’s characterized by presence of

giants cells (multinucleated cells type of Touton).We can observe its on a skin of upper and lowerextremities. Cells and collagenous fibers are formedin short fascicles, directed in different direction and

tumor has “moire picture”.



Connective tissue tumor with locallydestructive growth or fibromatosis

They can be in fascia, aponeurosis and otherconnective tissue constitution.It has infiltrative growth, but they don’t metastasize.Macroscopic picture: fibromatosis can be nodoseor diffusive, they have different consistence.Microscopical picture: They have structureidentical to fibroma, but they don’t form capsule andinfiltrate circumflex tissues.Types of fibromatosis:Desmoid (aggressive fibromatosis)Palmar fibromatosPlantar fibromatos

fibromatosis of penis



Desmoid is the most frequent form of fibromatosis.It’s particular variety of fibromatosis. It’scharacterized by infiltrating growth. After surgicaloperation can be recur, very often can be malignanttransformation. We can observe at men and women.

It can be:

Abdominal (localization on musculo-aponeuroticstructure of abdomen front wall. More often it’sobserved at women of 20 to 40 years, often duringpregnancy and after labor. It’s recur often.

Intra-abdominal is localized in a mesentery, smallpelvis.Extra-abdominalis localized in a shoulder, chest wall,back, thigh.



Tumor-like conditions

(pseudosarcomatous reactive conditions)

They are characterized: It’s arise after trauma. It is grow fast. It’s consists of fibroblasts with numerous mitosis. Clinical and morphological it can imitate malignant

tumor (sarcoma). After ablation it can recur.

We distinguish:

1. Synovial giant cell tumor (giant cell tumor of tendon)

2. Myositis ossificans is characterized by proliferationof metaplastic ossification.



This sarcoma has

many mitoses. Avery large abnormal

mitotic figure.



Benign tumors from fatty tissue

Lipoma (adipoma) is constructed from

lipocytes. It can be solitary and plural. If lipoma has distinct fibrous stroma -f ibrol ipoma. If lipoma contains many vessels

- angiol ipoma. Special variant isintramuscular lipoma. It’s situated in musculartissue, it hasn’t capsule and it’s characterizedby infiltrating growth.

Hibernoma is developed from cells of brownadipose tissue. Usually it’s solitary and moreoften it’s localized in an interscapular space.



This large masslesion is aliposarcoma. This

one is yellowish, l ikeadipose tissue, and iswell-differentiated.

This liposarcoma has

enough differentiation to

determine the cell of origin, but there is still

significant pleomorphism

of the neoplastic cells.



Benign tumors from smooth muscle

Leiomyoma is tumor from smooth muscles. Itcan be in different organs. More often weobserved at women of 30-50 years in auterus. It can be plural in a uterus. It’ssensitive to estrogen: usually it increaseduring pregnancy and reduced in amenopause.Macroscopic picture: It’s nodules with clear-cut circuit (expansive growth), which gather

round connective tissue capsule, on a sectionit has whitish-rose color, fiberlike structure.



The leiomyomas of

uterus

It can located inmyometrium(intramural),

underendometrium

(submucous) andsubserous.



Microscopical picture: It consists of different thickness fascicles ripe smooth

muscular cells, which recumbent indifferent direction (tissue atipism). Fordifferential diagnostics we use colouring

by Van Gizon: connective tissue stromahas bright red color and smooth muscularcells has yellow color.

Intramural and submucous leiomyomascan result to bleeding from uterus(menometrorrhagia) and miscarriage(breaking of pregnancy).



Rhabdomyoma is extraordinarily rare atumor. We can observe it in children

nasopharynx, intramurally (in the heart)Macroscopic picture: it has appearance of nodule with clear-cut circuit. It has red color.

Microscopical picture: it consists of cellsremind of rhabdomyoblasts (embryonal cells).

Granular cell myoblastoma (granular

cell, Abrikosov's tumor). It has neurogenicbirth. It’s developed from Schwann cells(neurolemma). Localization in a tongue is more

often.



Benign tumors from vessels

Hemangioma is often occurred tumor from blood

vesells. It borrows intermediate position betweenhamartoma (abnormality) and veritable tumor.Hemangioma is classifed depending on type of vessels and other particulars such as:

CapillaryCavernous

From large vessels, hemangioma can be:

venousarteriovenous

Glomangioma

Benign hemangiopericytoma



Capillary hemangioma. More often it’s in skin of newborn.

Macroscopic picture: it’s characterized by eminent

high colour formation (“strawberry” nevus).Microscopically picture: this tumor consists of manycapillary type vessels. At aged people it canspontaneously regretion.

Cavernous hemangioma Morphological characteristics. It’s inborn formation.Often it’s in skin and liver (more often it’s primary tumorof liver) It’s increased with grows of organism. It can’t disappear spontaneously. It can accompanied by thrombosis, ulceration and

infection.



Macroscopic picture: it’s located on skinand has appearance murrey macules

(macules of “port”) or nodules red-cyanoticcolor with clear-cut border.

Microscopical picture: it consists of

multitude thin-walled vascular cavities,which line by endothelium cells withoutfeatures of cellular atypism. The cavitieshave different forms and sizes (this is tissue

atypism). Venous hemangioma consists of vessels,

which form cavity. This cavity contains

erythrocytes.



Kaposi's sarcoma at AIDS. The

lesions can start as small

reddish to red-purple plaques or patches. Over time, the lesions

become nodular and larger and

more numerous.

Kaposi's sarcoma

consists of

pleomorphic spindle

cells which line slit-likevascular spaces.

Areas of hemorrhage

are seen within the

neoplasm.



Glomangioma (glomus tumor,angioneuromyoma) is located on finger-tips

(regions of nail-bed)G\a: It’s sickly nodules purple color.

H\p: It consists of vessels, which around by

glomic cells.Benign hemangiopericytoma is located inskin, gastrointestinal tract and liver more

often.G\a: it consists of chaotic intertwinecapillaries, which round by muff from

pericytes.



Lymphangioma consists of lymphaticvessels, it has different forms and sizes,

which contains lymph.

Tumors from synovial membrane

Synovioma is developed from tendon. It hasalveolar structures, giant cells and xanthomecells.

Mesothelioma is developed frommesothelium.



Benign tumors from bone and cartilage

Osteoma is developed from bone. We distinguish

fungous and compact osteoma.Benign osteoblastoclastoma (brown tumors) isdeveloped from cells type of osteoblasts andosteoclasts. In this tumor vascular system developed

well, but vessels have primitive structure and lothemosiderins. More often it’s located in maxilla andmandible.

Chondroma is developed from confusedly locatedcells of hyaline cartilage.

Benign chondroblastoma is differ from chondromaso it contain chondroblasts.



Malignant tumors from boneand carti lage

Chondrosarcoma is characterizedpolymorphism atypical chondroid

cells, as well foci osteogenesis andsliming. It growth slowly and it ismetastased late.



Chondrosarcoma of thepelvis. Note theextensive nodules of

white to bluish-whitecartilagenous tumortissue eroding andextending outward from

the bone.

This is a computed

tomographic (CT) scan

demonstrating a

chondrosarcoma

involving the left pelvic

wing.



Osteosarcoma is a high-malignantmost often initial tumor of bones.Production of osteoid characteristicfor her.

3/4 tumors arise at persons of amale at children's or youthful age(10-20 years).



Pathogenesis connected withinactivation Rb suppressor gene

(antioncogene), located in 13-thchromosome.

The most typical localization is long bones:

areas of a knee joint are metaphysisfemoral bone or tibia.

It observe also in various bones at persons

of advanced age on background bonepathology (Paget's disease, an irradiation of bones).



Microscopic picture: the tumor isconstructed from atypical cells osteoblast

type with a plenty mitosis and a primitivebone tissue.

The typical radiological attribute: in the field

of a tumor occurs moving and thickening of periosteum with formation of Korman'striangle.

Prognosis is unfavourable: the 5-yearspostoperative survival rate makes 5 - 20 %(to the moment of diagnostics many patientsalready have metastasizes).).



This femur has a largeeccentric tumor massarising in the

metaphyseal region.This is anosteosarcoma (avariant known as

parosteal osteogenicsarcoma) of bone.

This radiograph

demonstrates a"pathologic fracture"

that has occurred as a

consequence of

weakening of the lower

tibial metaphysis by a

lytic osteosarcoma.



The neoplastic spindle

cells of osteosarcoma are

seen to be making pink

osteoid here. Osteoid

production by a sarcoma

is diagnostic of

osteosarcoma.

The osteosarcoma. Sarcomas

have very pleomorphic cells.

One large cell with very largenuclei is seen near the center.

There are islands of reactive

new bone.



2 . Ewing's sarcoma. It’s traditionally considered in group of mesenchymal

tissues (a tumor of bones indeterminate genesis)though specified recently histogenesis allows toattribute its to neuroectodermal tumors.

The second on frequency (after osteosarcoma ) an initialtumor of bones.

The characteristic attribute is chromosomal translocation

11 - 22. It’s typical for children (till 15 years). Long bones, edges, caxal bone and scapula are

damaged.

The tumor growth long in the marrowy channel, furtherbeing distributed to cortical layer. It’s accompanied by jet multilayered growths of periosteum, giving acharacteristic radiological attribute such as "an onionspeel».



This is Ewing'ssarcoma. Thisprimary bone tumor

mainly occurs inthe diaphysis oflong bones ofchildren and young

adults.

Ewing's sarcoma is

one of the "small

round blue cell" tumorshistologically.



Microscopic picture: the tumor issubmitted by undifferentiated

monomorphous cells in cytoplasm of them atSchick test find out glycogen (it’s adiagnostic attribute).

Current extremely malignant with earlydevelopment of metastasizes.

Prognosis is considerably improved at

chemotherapy.



Tumors of melanin constitutive tissue

Melanocytes arise from Schwann membrane of peripheral nerves. Tumor-like formations issubmitted by nevus, true tumors is submittedby melanoma.

1 . Freckles are focal hyperpigmentation,connected to the increased synthesis of melanin by melanocytes under influence of

insolation.2. Lentigo is a pigmentary stain, connectedwith hyperplasia of melanocytes in epidermis.



3. Nevocellular nevus is congenital ormore often acquired pigmentary

formation (appears in the age of 2 - 6years more often and it has tends tospontaneous regress with age) which

occupies intermediate position betweenabnormality and benign melanotictumor.

4. Melanoma is a malignant tumorfrom melanocytes.



Nevus

Frequently we observed them in skin. We distinguish:

1.Junction nevus, which grows on border of epidermis and derma;

2.Intradermal nevus is located in derma;

3.Mixed nevus, which has features of junction and

intradermal nevus;4.Epithelioid nevus. More often we observed it inchildhood (juvenile nevus). There are multinuclearhuge cells in this nevus.

5. Blue nevus. More often we observed it at a personsof 30-40 years in derma in the field of buttocks andextremity. It’s look like as blue nodule with a bluishshade. It has cellular polymorphism. It’s recur rare.



The benign nevus

(pigmented mole) of the skin



Melanoma

• It makes up 1,2 % of all malignant tumors and 4 %of skin tumors.

• In overwhelming majority of cases melanoma islocated in a skin, less often in membranes of aneye (in 20 times less often), even less often in piamater.

• More often it arises at women of 30 - 50 years inskin of a lower extremities, head, neck.

• It’s traced connection melanoma of skin with

insolation (ultra-violet radiation).• Majority of melanomas arise de novo, is the

extremely rare on a background of pigmentaryformations.



To pigmentary formations with high probabilityof development of melanoma we attribute:

Lentigo maligna is a pigmentary formationarising more often on a skin of the older

person. At microscopy it’s characterized byproliferation of atypical melanocytes in basallayers of epidermis, atrophy epidermis,

elastosis of a top layers of derma. There is anopinion, that lentigo maligna is malignantformation such as melanoma in situ.



Dysplastic nevus, characteristic forseldom meeting hereditary syndrome

(dysplastic-nevus syndrome), described byClark.

There are usually numerous, more 1 cm in

diameter, there are located on a closed sitesof a body.

At microscopy it’s defined proliferation of

atypical melanocytes. Occasionally melanoma arises in connection

with congenital bathing trunk nevus.



Growth phases of melanoma1. A phase of radial (horizontal) growth.• A tumor grows inside of epidermis, not in derma.

• Lymphocytic infiltration defined frequently inpapillary layer of derma.• This stage can be considered as a tumor in situ astumor not metastasize, excision of it results in full

treatment.2. A phase of vertical growth (late stage)• A tumor is spread in derma and subcutaneous fat.• Lymphogenic and hematogenous metastasizes are

characteristic.•Melanoma has better prognosis if it was accompaniedby the long period of radial growth, than variant withearly vertical growth.



Clinico-pathologic classification of melanoma

1.Superficially extending (such as malignant lentigo)2.Nodular.

1. Malignant lentigo-melanoma.

• It arises on the sites of a skin exposed of insolation.

• It has a long phase of radial growth.

• Frequently develops from previous Lentigo maligna;differs from the last invasion in derma atypical,

polymorphic, frequently spindle cell melanocytes; hasa low degree of malignancy.



2. Superficially extending melanoma

• It’s the most often variant; typical localization onan extremity and a trunk.

• Looks like as a macula or plate without the preciseborders painted in various colors from pink-brownup to dark brown.

Microscopic picture: noninvasive tumor, it issubmitted monomorphous atypical melanocytes,forming jacks from pagetoid cell (large cells withvacuolated light cytoplasm). Growth is horizontal.The centers invasion in derma, frequently

surrounded by cellular infiltration and fibrous tissueare defined. Growth is vertical.

• Prevails the radial form of growth (in situ) whichcan last till 10 years.



3. Nodular melanoma

• Begins with a vertical growth phase.

• Has the worst prognosis.

• Arises at earlier age on any site of a

skin.

Macroscopical picture: it looks like

as blue-black plaque or pigmentednode (black, brown), frequently withulceration.



Here is amelanoma

excised with awide margin.

Large polygonal cells

have very pleomorphic

nuclei with prominentnucleoli. The neoplasm

is making brown

melanin pigment.



G\a: it consists from polymorphic (frequentlymultinuclear) cells which contain granules of a

black - brown pigment - melanin; irregular-shaped nucleus with coarse-dispersiblechromatin and large nucleolus, numerousmitosises are visible. It infiltrates derma and

adjacent cellular tissue. Intraepidermal spreadof a tumor to its extremity isn’t expressed.

• Lymphogenic and hematogenous metastasiseswhich are looking like plural tumoral nodes of dark brown (black) color with precise bordersarise early.



4. Acranial lentiginouse melanoma

• most typical localization is palms and soles,

mucosal epidermal zones of an oral cavity, anose and anus.

• More often arises at negros.

H\p: intraepidermal proliferation of large, thefreakish form melanocytes, containing a plentyof a pigment, and invasion them in derma are

characteristic; papillary layer of derma isexpanded, inflammatory infiltrate is present.



The prognosis of melanoma is defined:

а) stage of a tumor:

I stage - local defeat; II stage - regional skin metastasises(satellites) or metastasizes in regional lymph

nodes; III stage - presence of a remotemetastasizes;

Cl ifi i f f f l (Cl k)



Classification of forms of melanoma (Clark)

b) A level of invasion:

1 - Intraepidermal tumor (in situ);2 - spread in papillary layer of derma;

3 - defeat of all papillary layer of derma up to

reticular layer;4 - germination of reticular layer of derma;

5 – germination of subcutaneous fat.

At 1 - 2 levels of invasion 5-years survival rateof 100 %,

At З level 5-years survival - 88 %, 4 - 66 %, 5 -15 %;

) Thi k f t



c) Thickness of a tumor:

at thickness less than 0,76 mm - survival

rate almost 100 %;More than 1,5 mm - 44-60 %;

0,76-1,5 mm - intermediate figures of

survival rate.



Tumors of nervous system and meanings

Tumors occur from the central, vegetative, peripheralnervous system. They are benign and malignant. Atlocalization of tumors in the CNS without dependencefrom a structure course of all tumors is malignant andthey metastasize within the limits of brain and spinal

cord.Tumors of the CNS

They are divided on neuroectodermal andmeningovascular.

Neuroectodermal tumors develop from elementsof glia and are submitted benign and malignantglioma.



Glial tumors

Astrocytoma is benign tumor. It develops from

astroglia cells. We allocate:1. Fibrillary astrocytoma

2. Protoplasmatic astrocytoma

3. Fibrillaryprotoplasmatic astrocytoma.Astroblastoma is malignant analogue of astrocytoma. It’s differs by cellular atypism, fastgrowth,necrosis and metastasizes in limits CNS.

Oligodendroglioma is a benign tumor fromoligodendroglia with calcified focus and cysts in it.



Oligodendroglioblastoma is a malignant tumorwith expressed cellular atypism, presence of thenecrosis centers. It’s grow quickly.

Epidermal tumors and tumors

of choroid epithelium

Ependymoma is benign glial tumor, develops from

ventricle of brain ependyma and forms pseudo-sockets around of vessels.

Ependymoblastoma is a malignant tumor. It

reminds glioblastoma. Grows quickly.Choroid papilloma is a benign tumor, developsfrom epithelium of chorioid plexus of brain, consistsof epithelial villous.



Chorioid carcinoma (malignant choroidspapil loma) is located in ventricle of brain,

it’s constructed from atypicalchoroidepithelium.

Neuronal tumors

Ganglioneuroma is a benign tumor frommature ganglious cells.

Ganglioneuroblastoma is a very malignant

tumor. It’s malignant analogue of ganglioneuroma.

Neuroblastoma. It’s constructed from

neuroblast. There are many mitosis.



Low-differentiated and embryonal tumors

Medulloblastoma is very malignant tumorconstructed from medulloblast. We observed its ininfancy. It’s located usually in vermis cerebelli.

Glioblastoma is one of often malignant tumors of abrain. It’s characteristic cellular atypism, necrosis and

haemorrhages. The tumor growth quickly and givesmetastasises early.

Meningovascular tumors

They arise from meninges.Meningioma is benign tumor from pia mater,constructed from endothelio-like cells. Psammouscorpuscle are formed.



meningioma

This is an MRI scan

demonstrating a discreet

mass along the lateralconvexity and extending

from a dural base

impinging upon the

cerebral hemisphere.

i li t l



Meningeal sarcoma is a malignant analogueof meningioma. On a structure reminds

fibrosarcoma.Tumors of vegetative nervous system

They develop from sympathetic ganglion and

cells of nonchromaffin paraganglia.Benign nonchromaffin paraganglioma develops from cells of APUD-system,

synthesizes serotonin, less oftenadrenocorticotropic hormone (ACTH). Its namestill is apudoma. It contains a plenty of vesselssinusoidal type.



Malignant nonchromaffinparaganglioma. It has cellular

polymorphism. It’s characterized by infiltratinggrowth and lymphogenic metastasizes.

Sympathoblastoma is a malignant tumor on

a structure reminds neuroblastoma. The tumorgrowth quickly, gives metastasizes early. Weobserved it in infancy.



Tumors of peripheral nervous system

Develop from nerve sheath.

Benign tumors:Neurilemoma (schwannoma) isconstructed from fusiform cells formingrhythmic structures (palisades), named"Verokaj corpuscles".

Neurofibroma. Consists of nervous fibresand a connective tissue. If at a patient system

neurofibromatosis is present the question isRecklinghausen's disease.

Malignant neuri lemoma is characterized byexpressed cellular atypism.



Teratoma

It develops at detaching one of blastomere of

egg. Consist of one or several kinds of tissue. Can have organoid structure. It can hasbig sizes. Most frequently we observed

sacrococcygeal teratoma, teratoma of ovary,testis, fauces, lung, retroperitoneal andmesenteric teratoma.

Teratoblastoma is malignant tumorcharacterized by expressed cellular atypismand polymorphism, growth quickly andmetastasizes.

Th "d id t" hi h



At medium power, this

meningioma is composedof whorled nests of cells.

A variety of patterns are

possible.

The "dermoid cyst" which

contains two of the germ

cell layers (ectodermal and

mesodermal). The hair andsebaceous material seen

here came from a dermoid

cyst of the cerebellum.

mesenchymal tumor2007

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