OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• tissue growth disorders
• oncology
• pathology
• neoplasia / cancer aetiologic factors
• neoplastic spread
• cytotoxic agents
• tumour markers
• cachexia
• specific tissue tumours:
  • oropharyngeal cancer
  • nasopharyngeal carcinoma
  • oesophageal cancer
  • stomach cancer
  • pancreatic cancer
  • hepatocellular carcinoma
  • colorectal cancer (bowel cancer)
  • renal malignancies
  • adrenal tumours
  • bladder cancer
  • breast cancer
  • lung cancer
  • mesothelioma
  • prostate cancer
  • ovarian tumours
  • testicular tumours
  • uterine cancer
  • cervical cancer
  • vulval cancer
  • skin cancer
  • thyroid cancer
  • primary brain tumours
  • lymphoma
  • leukaemia
  • multiple myeloma
  • myeloproliferative disorders:
    • polycythaemia rubra vera
    • myelofibrosis
    • essential thrombocytosis

• Papillomata (surface epithelia):
  • sessile
  • pedunculated (polyps)
  • villous
  • Squamous cell skin, tongue, larynx, anus (ie. where stratified sq. epith.)
    • acanthosis: incr. thickness of prickle cell layer
    • hyperkeratosis: incr. amt of adherent keratin
    • parakeratosis: retention of nuclei of desq. keratinised cells;
  • Transitional cell urinary passages, esp. bladder - usually villous;
    • usually regarded as malignant & reported as so (recur, etc);
  • Columnar cell colon (villous papilloma not the tubular adenoma), breast ducts;
  • onychopapilloma (usually affects multiple fingernails and is due to the rare BAP1 tumor predisposition syndrome, which is caused by mutations in the BAP1 gene and associated with other malignancies such as melanoma and mesothelioma) ¹⁾
• Adenomata (solid glandular tissue):
  • dense masses of acini (except endocrine - solid groups of cells only)
  • acini lined by either columnar or cuboidal shaped cells;
  • if in glands that open to surface → pedunculated polyps;
  • may secrete XS hormones (eg APUD-cell tumours, etc);
  • Cystadenoma variant with elaborate cystic spaces - esp. ovary;
  • Fibroadenoma variant with XS CT stroma (esp. breast)
    • hard pericanalicular CT type
    • soft intracanalicular CT type
    • cystosarcoma phyllodes - myxoid stroma (breast)

• Fibroma many sites eg. skin, stomach, ovary;
• Myxoma uncommon, resembling Wharton's jelly: atrium, jaw;
• Myoma
• Leiomyoma sm. muscle (uterus, arrector pili, b.v) - commonest tumours!
• Rhabdomyoma striated muscle (incl. heart) - v.uncommon, esp. tub.sclerosis;
• Nerve Sheath:
  • Neurofibroma
  • Schwannoma (also called neurinoma or neurilemmoma);
  • Meningioma
• Lipoma
• Giant-cell tumour of bone:
  • Chondroma/Synovioma
  • Osteoma
• Mesothelioma
• Carotid-body tumour

• Teratoma consists of multiple tissues foreign to part; ovary > testes;
• Hydatidiform mole trophoblastic;
• Ganglioneuroma

• usually indicated by pleomorphism, mitoses ± invasion b.memb;

• stroma well formed usually; early lymph. spread; esp → liver;
• Squamous-cell from strat.squam. epith. (or from epith. undergone sqam. metaplasia);
  • neo_dermal, oropharyngeal cancer, oesophageal cancer, anus, ectoCx, lung cancer, bladder cancer, GB, stomach cancer;
  • if differentiation good → epithelial pearls form;
• Basal cell actually of intermediate behaviour;
• Transitional cell urinary passages; well-diff. → anaplastic; +/- squamous change;
• Glandular
  • graded by:
    • tubule formationn; regularity size/shape/stain nuclei, mitoses;
    • stromal reactions alter appearance:
    • scirrhous - hard, fibrotic (most breast Ca & many GIT);
      • eg. linitus plastica; annular/purse-string of colon;
    • medullary/encephaloid - little stroma → soft
      • eg. breast Ca in lactation; cauliflower of caecum;
    • adenocarcinoma - best differentiated - has tubules;
    • carcinoma simplex - no attempt at central cavitation to produce acini (breast)
    • anaplastic carcinoma - sheet of loosely attached cells
    • giant cell carcinoma
    • squamous metaplasia of adenocarcinoma
    • signet-ring cell carcinoma - much mucus in cell

• more rapid growth; mainly blood-borne spread → lungs esp.
• poorly formed stroma; more radioresistant than Ca;
• Fibrosarcoma
• Neurofibrosarcoma
• Liposarcoma
• Leiomyosarcoma
• Rhabdomyosarcoma
• Chondrosarcoma
• Osteosarcoma
• Malig. mesothelioma
• Angiosarcoma
• Malig. meningioma
• Malig. melanoma - cutan.; mucosal; uveal; meningeal; adrenal;

• Hodgkin's
• Non-Hogkin's
• Multiple myeloma
• Leukaemia

• Choriocarcinoma trophoblastic, secreting HCG;
• Nephroblastoma (Wilm's) infancy/childhood;
• Retinoblastoma definite hered. incidence; infants;
• Malignant Teratoma young-middle age adults;
• Seminoma/Dysgerminoma older age gp than teratomas;
• Medulloblastoma 4th ventricle; mainly young children;
• Neuroblastoma adrenal medull or symp. ganglia; infancy;
• Hepatoblastoma very rare;
• Chordoma/Craniopharyngioma - rare

• invasiveness (eg. through basement membrane)
• metastasise - see neoplastic spread
• rapid increase in size usually more than benign tumours;
• cell cycling time usually N. but incr. no. of cells in mitosis & may be incr. time spent in mitosis;
• irregularity of size, shape & staining of nuclei due to:
  • synthesis of DNA prior to division → nuclear enlargement & hyperchromatism;
  • formation of aneuploid & polypoid cells as abnormal mitoses;
• less similarity with normal tissue than benign tumours as abn. differentiation;
  • anaplasia is where little or no normal differentiation seen on microscopy;
• giant cells may be present in certain tumours, if anaplastic, or if adverse conditions;

• Mechanical pressure & obstruction
• Tissue Destruction:
  • usual mode of death; infiltrate tissues;
• Haemorrhage:
  • surface epith. Ca ulcerate; large arteries may be eroded;
• Secondary infection:
  • ulcerative Ca; obstructed lumens;
• Starvation:
  • direct by obstructing food intake; malabsorption;
• Pain:
  • usually late;
• Haematological disorders:
  • anaemia:
    • bleed; malabs.; marrow replacement;
  • neutrophil leukocytosis common;
• Cachexia:
  • starvation; infection; liver involvement; serous effusions;
• Immunologic effects:
  • esp. Hodgkin's, MM, CLL, & terminal cancers;
• Neuropathic effects:
  • esp. lung, stomach, breast & ovary (without metast. effect!)
• Myopathic effects:
  • esp. oat-cell lung; breast, colon; visceral → dermatomyositis;
• Dermatological effects:
  • acanthosis nigrans - stomach, pancreas, lung;
  • recurrent HZ - lymphoma due to decr. cell-med. immunity;
• Thrombotic complications:
  • thrombophlebitis migrans - pancreas, lung, stomach;
  • Afibrinoginaemia: rare: usually in prostate Ca;
• Hormonal:
  • own hormones APUD-cell, endocrine tumours
  • non-endo. tumour
    • ACTH (-like) - oat cell; islet-cell; med.thyr.; breast;
    • ADH - oat-cell
    • insulin - mesothelioma, liver;
    • TSH-like - hydat.mole, chorioCa,
    • erythropoietin-like - renal Ca;
• Hypercalcaemia:
  • extensive osteolytic mets; PGE2; PTH-like;
• Pulmonary osteoarthropathy:
  • lung, fibrous mesothelioma; (& in ch.supp.dis. lung)