Download MBBS Pathology Miscellanous Tumours

Lipoma
Miscellaneous tumors

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? MC soft tissue tumor
? Painless except ______
? Cytogenetics: Chr 6p, 12q and 13q
? Usually cured by simple excision

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Liposarcoma: Morphology
? Lipocytes with supernumerary rings & giant rod chromosomes -
12q (MDM2 oncogene)
? Lipoblasts: scalloping of nucleus

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Liposarcoma
? Most common sarcomas of adulthood
? MC: proximal extremities & retroperitoneum
? t(12;16): Myxoid/round cell variant of liposarcoma

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Fibromatoses:

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Superficial
Deep
? Palmar- Dupuytren
? Desmoid tumors-
Tumors & Tumor-like lesions

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contracture
? Locally aggressive
? Plantar
? Associated with Gardner
of fibrous origin

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? Penile: Peyronie disese
syndrome (APC)
? Recurs
? Rx- wide Excision

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Fibrosarcoma
? MC in extremities
? Herringbone pattern
? Aggressive

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? Recurs
? Metastasises
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Inflammatory myofibroblastic tumor

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? Benign spindle cell tumor along with scattered inflammatory cells
(lymphocyte and plasma cells)
? Occurs in viscera (lungs)and soft tissue of children and young adults
? ALK (2p23) gene mutation (hereditary hemorrhagic telangiectasia-1,
Adenocarcinoma lung, Neuroblastoma, Large, anaplastic large B cell lymphoma

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Rhabdomyosarcoma (RMS)
? Primitive mesodermal origin
? MC soft-tissue sarcoma of childhood & adolescence
Tumors of skeletal muscles
? Most common---head/neck; 2 nd Mc----genitourinary

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tract


Histology of RMS
Embryonal RMS (MC, 60%)

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? Rhabdomyoblast
? It includes sarcoma botryoides
? Stains --
? Occurs in children < 10 yrs of age
desmin, MYOD1 & myogenin.

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? Chr 11p involved
? Histologically sub-classified into:
? embryonal
? A submucosal zone of
? alveolar

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hypercellularity -> cambium layer.
? pleomorphic
Tadpole or strap cells

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Sarcoma Botryoides
Treatment and prognosis of RMS

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? At age < 5 yrs
? Rx: Surgery and chemotherapy with or without RT
? Grape like clusters in vagina
? Histologic type and location of tumor influence survival
? H/E: Tennis racket cells

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? Rx: surgery + Chemotherapy
Best prognosis: Botryoid subtype
Intermediate prognosis: Embryonal NOS
Poor prognosis: pleomorphic and alveolar

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Synovial Cell Sarcoma
? Only 10% intra-articular!!!
? MC around knee
Tumors of uncertain histogenesis

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? H/E: Biphasic- epithelial & mesenchymal (spindle cells)
? Stains: Keratin, vimentin, S-100 & EMA
? Cytogenetics: t(X;18)

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Squamous Cell Carcinoma (SCC)

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? 2nd most common tumor arising on sun-exposed sites
? Males>females (except on lower legs)
? Locally invasive; Metastasis uncommon
Tumors of Skin
? Risk factors: UV light, immunosuppression, HPV (5 & 8), tobacco

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? p53 mutation


Squamous cell carcinoma
Keratoacanthoma

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? A variant of well-differentiated squamous cell carcinoma
? After a period of rapid growth, it usually regresses spontaneously
Keratin pearls

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Basal Cell Carcinoma (Rodent ulcer)
Basal Cell Carcinoma

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? Most common invasive skin cancer
? Slow-growing tumors, rarely metastasize.
? Seen in immunosuppression & xeroderma pigmentosum
? NBCCS or Gorlin Syndrome ? AD, multiple sites,
Chr 9: PTCH gene receptor for product of SHH (Sonic Hedgehog)

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Pearly, telangiectatic
Tumor nests
Pallisading

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gene, p53 mutation
nodule
Separation artefact

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Melanoma
? 3 mutations:
? Predisposing factors are inherited genes and sun exposure (induced
? Cell cycle regulators(p16/INK4a, CDK4),
? Growth factor receptors e.g. BRAF, RAS,

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mutations)
? TERT- activate telomerase
Growth patterns:
? Prognosis: metastasis correlates with the depth of invasion, which by
? Radial growth- horizontal spread within epidermis/superficial dermis

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convention is the distance from the superficial epidermal granular cell layer
? lentigo maligna: indolent lesion on the face of older men
to the deepest intradermal tumor cells (Breslow thickness)
? Superficial spreading: (MC) sun-exposed skin
?

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?
Warning signs: ABCDE (1) asymmetry; (2) irregular borders; and (3)
Acral/mucosal lentiginous melanoma: unrelated to sun exposure
variegated color, (4) increasing diameter, and (5) evolution
? Vertical growth -appearance of a nodule & correlates with metastatic

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potential
? Marker- HMB-45 (Tendon clear cell sarcoma & Angiomyolipoma)

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Endocrine
system

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Colloid goitre
Thyroiditis: Inflammation of the thyroid gland
(1)Hashimoto thyroiditis: autoimmune disease that results in destruction of the
thyroid gland and gradual and progressive thyroid failure

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(2) Granulomatous (de Quervain) thyroiditis is a self-limited disease, probably
secondary to a viral infection, and is characterized by pain and the presence of a
granulomatous inflammation in the thyroid.
(3) Subacute lymphocytic thyroiditis often occurs after a pregnancy
(postpartum thyroiditis), typically is painless, and is characterized by lymphocytic

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inflammation in the thyroid.


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Hashimoto's thyroiditis
Hashimoto's thyroiditis

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? Most common cause of hypothyroidism in Iodine-sufficient areas
? Most common clinically apparent cause of chronic thyroiditis
? M:F 1 : 10-20
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? Genes involved: CTLA4 & PTPN22

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? C/F: Painless enlargement of thyroid + hypothyroidism
? HPE: Lymphocytic infiltration of the gland, well-developed germinal
centers, atrophic thyroid follicles, H?rthle cell metaplasia or oxyphil
change (Hallmark)

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Grave's disease


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Thyroid Ca

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Papillary Ca
Microscopic hallmarks
? Branching papillae with a fibrovascular stalk
? Nuclear features: Hallmark of diagnosis
? Orphan Annie eye nuclei (clear or empty appearing ground-glass appearance),

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? Pseudo-inclusions" ? invaginations in cytoplasm- appearance of intranuclear
inclusions or intranuclear grooves.
? Psammoma bodies (Absent in follicular and medullary Ca)
? Lymphatic invasion is common

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Follicular Ca Thyroid
Gross: Single well circumscribed or widely
infiltrative nodule
Microscopically:

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? Small follicles containing colloid, Hurthle
cell or oncocytic variant: cells with
abundant eosinophilic cytoplasm,
? Capsular &/or vascular invasion is the
sign of carcinoma & differentiates

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follicular adenoma ,
? Lymphatic spread is uncommon


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Medullary Ca Thyroid

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Pheochromocytoma
? Neuroendocrine neoplasm derived from the
parafollicular cells, or C cells, of thyroid
? MEN syndrome 2A or 2B or familial
medullary thyroid carcinoma,

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Microscopy
? Polygonal spindle-shaped cells form nests,
trabeculae and follicles
? Acellular amyloid deposits (A cal)
? Tumor Markers: Calcitonin, serotonin, ACTH,

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and vasoactive intestinal peptide (VIP)


Pheochromocytoma

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