OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• tissue growth disorders
• oncology
• pathology
• neoplasia / cancer aetiologic factors
• neoplastic spread
• cytotoxic agents
• tumour markers
• specific tissue tumours:
  • oropharyngeal cancer
  • 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
  • neo_testicular
  • uterine cancer
  • cervical cancer
  • vulval cancer
  • skin cancer
  • thyroid cancer
  • 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;
• 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)