Welcome to the practical on
Neoplasia
Department of Pathology
Faculty of Medicine, Colombo
Department of Pathology, MFC
Benign Tumors
Department of Pathology, MFC
Case 1
• Twenty-five-year-old Nelum noticed a lump measuring about 2cm in diameter, in her
left breast.
• She was worried but did not show it to a doctor because it was not painful. She ignored
the lump.
• Three years later the lump had increased in size. She finally consulted a doctor. The
lump was not attached to skin or underlying muscle.
• Fine needle aspiration of the lump was done and a diagnosis of fibroadenoma was
made.
• The lump was removed as it was large. It was well defined and easy to remove at
surgery
Department of Pathology, MFC
Let’s look at the
macroscopic
appearance of
Nelum’s
surgically
removed tumor
L61
Department of Pathology, MFC
Based on the history and the macroscopic
appearance, do you think this tumor is
benign or malignant?
Department of Pathology, MFC
This Photo by Unknown Author is licensed under CC BY-NC
The tumor is
likley to be
benign due to
the following
reasons
• Long history of 3 years.
• Well circumscribed lump which was
easy to remove at surgery.
• Not attached to skin or underlying
muscle.
• Cut surface does not show
hemorrhage or necrosis.
Department of Pathology, MFC
Microscopic appearance
of Fibroadenoma
• This is a benign tumor composed of
glandular (adenoma) and mesenchymal
(fibroma) elements.
Department of Pathology, MFC
Case 2
• 35 year old woman complains of heavy menstrual
bleeding for six months duration but no
dysmenorrhea. She has 28 day regular cycles with
excessive flow for 5 days. No abnormalities are
detected on examination.
• Her USS confirmed the diagnosis of leiomyoma of
the uterus.
Leiomyoma of the uterus
• This is a benign tumor derived from smooth muscle cells of
the uterus.
• Uterine fibroids may be symptomless or may cause:
• Heavy menstrual bleeding
• Pelvic pain
• Abdominal or pelvic mass
• Pressure symptoms on the renal system or the bowel
• Infertility
Leiomyoma of the Uterus
• A well circumscribed
tumor mass.
• Characteristic whorled
appearance on the cut
surface
• Absence of hemorrhage
and necrosis.
K75
Department of Pathology, MFC
Case 3
Notice smooth multilocular cysts
• A 30 year old woman with
one child complains of
abdominal discomfort and
lower abdominal distension.
On abdominal examination a
cystic mass was felt on the
right side of the abdomen.
• Transvaginal and
transabdominal USS was
performed. A diagnosis of
benign ovarian cyst was
made.
Department of Pathology, MFC
Mucinous cystadenoma
of the ovary
• In this specimen, the ovaries are distended due to
bilateral mucinous cystadenoma.
• This is an incidental finding.
• Why are they called mucinous cystadenoma?
• mucinous – epithelium is mucinous in type, similar
to the epithelium of the endocervix.
• Cyst – due to the macroscopic appearance being
cystic.
• Adeno – because it arises from a glandular
structure.
• Oma – because it is benign
• Though very large, this is a benign tumor.
Look for details at the VLE session.
K320
Department of Pathology, MFC
Case 4
• 40 year old Mrs. Malkanthi presented to the GP with
anterior neck lump for 2 month duration which has
progressively increased over the time. Other than the
concern about her appearance she didn’t have any
discomfort or change of voice.
• On examination, GP found a firm regular lump in the
anterior neck and she was clinically diagnosed to have
a solitary thyroid nodule.
• She underwent USS followed by USS guidance FNAC.
• Later she underwent total thyroidectomy.
Department of Pathology, MFC
Note encapsulated tumour within thyroid
tissue.
A
B
Follicular adenoma of
thyroid
A- Note the increased proliferation of the follicular cells
in the FNAC sample.
B- In the biopsy there’s no capsular invasion
Department of Pathology, MFC
Case 5
• 32 year old woman presented with a lump on
forehead for three years, she has not noticed any
change of the size of the lump and it was not painful
either.
• On examination the lump was soft in consistency
with well demarcated edges and lobulated surface.
It was freely mobile.
• The diagnosis of a lipoma was made.
• As she was concerned about her appearance surgery
was offered.
X41
Lipoma
• This is the commonest soft tissue tumor.
• It is a soft yellow, well circumscribed mass.
• Microscopically there is mature adipose tissue that
is indistinguishable from normal fat.
Macroscopic appearance of a lipoma
Microscopic appearance of a lipoma
Department of Pathology, MFC
Chondroma
• These arise from cartilage and occurs most
often in the small bones of the hand and
feet.
• They are well circumscribed lesions that
usually arise within the medullary cavity of
the bones.
• Microscopically there is mature hyaline
cartilage and normal looking
chondrocytes.
Microscopic
appearance
of a
Chondroma
Chondrocytes within lacunar
spaces (arrowed)
Neurofibroma
• This is a benign tumor
derived from nerve sheath
structures.
• Well circumscribed tumor
which has arisen from a
nerve.
• The cut surface does not
show hemorrhage or
necrosis.
Department of Pathology, MFC
Sometimes benign tumors
can cause serious
symptoms!!
Department of Pathology, MFC
This Photo by Unknown Author is licensed
Meningioma
Department of Pathology, MFC
• Meningioma (red arrow)
• The tumor has led to pressure
atrophy of brain. (blue arrow)
• This would have caused neurological
symptoms.
A59
Case 6
• 18 year old Aruna underwent a
colonoscopy after an episode of
passing blood in the stools. He
also had a family history of
colorectal carcinoma.
• Colonoscopy revealed a colonic
mucosa containing hundreds of
small polyps. He was diagnosed
of having familial adenomatous
polyposis coli.
Department of Pathology, MFC
Familial Adenomatous
Polyposis
• This is the specimen of his colon
after undergoing colectomy.
• Familial adenomatous polyposis coli
is an autosomal dominantly
inherited disorder.
• The polyps invariably become
malignant by middle age.
P23
Department of Pathology, MFC
Normal colonic epithelium
Department of Pathology, MFC
Dysplastic colonic epithelium
• Usually, malignant tumors are malignant from beginning
and benign tumors do not convert to become malignant.
Do benign
tumors
become
malignant?
• Ex:
lipoma vs liposarcoma
leiomyoma vs leiomyosarcoma
• But there are rare instances where benign tumors can
become malignant.
• Ex: colonic adenoma can convert to adenocarcinoma
• (adenoma to carcinoma sequence is due to accumulation
of genetic mutations and once the tumor invades the
muscularis mucosa it is considered as malignant)
You will learn more about this during the next practical
Department of Pathology, MFC
Malignant
tumors
Department of Pathology, MFC
Case 7
• Sixteen year old Amal presented with
pain, gradual swelling and redness
around his left knee joint for 3 moths.
• An X ray was done and it showed
features suggestive of Osteosarcoma.
Department of Pathology, MFC
x ray shows an
osteosarcoma in
the femur
• Note the formation of new
bone in the “sun burst” pattern.
Department of Pathology, MFC
Osteosarcoma
• This is the surgically
removed tumour.
• Note the large ill defined
lesion in the metaphyseal
region of the lower femur.
• There is extension
inwards into the marrow
cavity and outwards into
adjacent soft tissue.
• Microscopy confirmed
the diagnosis.
• Note the ill defined
ulcerated mass within the
medullary cavity
Department of Pathology, MFC
What do you think the reason
for Amal’s present condition?
• One year later, Amal complained of
cough and hemoptysis at a follow up
clinic visit.
• Chest X ray showed multiple round
opacities in both lung fields.
(Cannon ball appearance)
Department of Pathology, MFC
• Six months later he succumbed to his
illness. This is the appearance of his
lungs at postmortem examination.
• Note the multiple tumor deposits in
both lungs.
• These are due to haematogenous
spread of the osteosarcoma.
Some malignant tumours like Osteosarcoma
can metastasize very easily, hence a prompt
diagnosis is very important.
You will learn about osteosarcoma in detail in
MSK module.
Department of Pathology, MFC
D23
Case 8
• Mr. Piyadasa, a 52 year old farmer,
presented with an ulcerated lesion in the
sole of his right foot. It was clinically
suspected to be a malignant melanoma and
was surgically removed.
• The diagnosis was confirmed by histology.
• He also complained of right hypochondrial
pain, and hepatomegaly was found on
examination. He succumbed to his illness.
Department of Pathology, MFC
This is the asymmetrical,
irregular, and darkly
pigmented lesion found
on the sole of his foot.
Department of Pathology, MFC
Microscopic appearance of malignant melanoma
Large pleomorphic
melanocytes
Fine granules of brown
cytoplasmic pigments.
Department of Pathology, MFC
Case 9
• Sixty six year old Siripala presented with
fatigue and palpitations for a duration of 6
months. He also gave a history suggestive of
intestinal obstruction with intermittent
constipation, colicky abdominal pain and
abdominal distension.
• This is his surgically removed colon.
Department of Pathology, MFC
P107
Colonic Carcinoma
• The specimen is of the ileo-caecal
junction.
• Note:
• The ileum is distended due to the stricture
(narrowing) caused by the tumor at the
ascending colon.
• (the presence of the taenia coli helps in
the identification of the ascending colon)
Department of Pathology, MFC
Why do you think he had
fatigue and palpitations?
Colorectal
carcinoma
PR
Bleeding
Anemia
• Rapidly growing tumour
• Concomitant tissue necrosis
• Fragile blood vessels
• Easily gets eroded
• Due to blood loss
• Manifests as fatigue and
palpitations.
Microscopic
appearance of colonic
Adenocarcinoma
• Two and half years later, he presented
with severe anorexia (loss of appetite)
and right hypochondrial pain.
• A diagnosis of metastasis to the liver
was made.
Secondary deposits in the liver of Mr.
Siripala
Department of Pathology, MFC
• 57 year old Mr. Jayapala presented with
painless passing of blood in urine. (painless
haematuria)
Case 10
• He also had a dragging type of pain in his
right loin.
• CT scan was done and a large renal mass
was identified.
• He underwent nephrectomy.
Department of Pathology, MFC
H203
Nephrectomy specimen
of Mr. Jayapala
• Although the tumor appeared well
circumscribed, a lot of areas with
haemorrhage and necrosis can be identified.
Department of Pathology, MFC
Incidental
calculus
Laryngeal
Carcinoma
Department of Pathology, MFC
Carcinoma of
the oesophagus
Department of Pathology, MFC
Dermoid cyst (Mature
Teratoma)
• A cystic tumor of ovary which consists of tissues
derived from all three embryonic layers.
• The tumor is cystic, the contents being greasy
sebaceous material which is liquid at body
temperature. Masses of hair and endothelial debris
are seen within the tumor. At the lower left side two
teeth arising from the elevated plaque are seen.
Benign
Malignant and
benign
tumours in
summary
•
•
•
•
•
•
No local invasion
Well demarcated mass
No invasion or infiltration
May be encapsulated
Can be surgically enucleated
Exceptions
• Haemangioma are unencapsulated
Malignant
•
•
•
•
Invade or infiltrate surrounding tissue
Not well defined from the surrounding tissue.
So cannot be surgically enucleated.
Some malignancies arise from a pre invasive or
carcinoma in situ stage
Department of Pathology, MFC
Thank you !!
Department of Pathology
Faculty of Medicine, Colombo
Department of Pathology, MFC