回帖：Chapter 5 Neoplasm
§1. Definition and morphology of tumor
1. Concept: Tumor (neoplasm): under the stimulation of tumorigenic agents, a single cell of local tissue lost the controlling to its growth at the gene level, excessive hyperplasia to form neoplasm
2. Distinguish between neoplastic and nonneoplastic proliferation
Neoplastic proliferation Nonneoplastic proliferation
Proliferation Monoclonality Polyclonality
Morphology and functionAbnormal Normal
Differentiation Abnormal Matured
Growth Persistent, autonomy Limited
Influence Harmful Beneficial
3. Morphology and structure
(1)Macropathology: Number, Size, Shape, Color, Texture
(2)Histological structure
①Parenchyma: Neoplastic cell: determine the biologic feature and differentiation
②Stroma: Connective tissue, Blood vessel, Lymphocyte infiltration
§2. Neoplastic differentiation and atypia
1. Differentiation
(1)Definition: Refer to the extent to which neoplastic cells resemble comparable its originated normal cells, both morphologically and functionally
(2)Degree of differentiation: well differentiated, poorly differentiated, undifferentiated
2. Atypia: Neoplastic tissue has various extent of differences with its originated normal tissue, both cell morphologically and tissue architecturally
Anaplasia: Lack of differentiation of malignant neoplastic cell, with obvious atypia
Anaplastic neoplasm: Composed of undifferentiated cell, with obvious atypia
Pleomorphism: Obvious variation in size and shape, with obvious atypia
(1)Architectural atypia
Refer to difference between neoplastic tissue and its originated normal tissue on arrangement (polarization, organ-like structure, the relationship with stroma)
(2)Cellular atypia
①Pleomorphism of neoplastic cells
·Variation in size and shape
·Generally larger than normal cells (tumor giant cells)
②Pleomorphism of nucleus
·Increased nucleus: The nuclear-to-cytoplasmic ratio may approach 1:1 instead of the normal 1:4-1:6
·Variation in size, color and shape: Size: Huge, two or more nuclei, bizarre nuclei
Color: DNA↑, hyperchromasia
Shape: The chromatin is coarsely clumped and distributed along the nuclear membrane
Increased mitotic figures: atypical, bizarre, multipolar mitotic figures
③Changes of cytoplasm
·Basophilia → nucleoprotein increased
·Abnormal products or secretion: Mucus, glycogen, lipid → helpful to determine histogenesis of tumor
④Ultrastructural changes
Organelles: signs of histogenesis
·Neuroendocrine granules → neuroendocrine tumor
·Tonofilament and desmosomes → squamous cell carcinoma
·Myofilament and dense body → SMC
§3. Growth and spread of tumor
1. Biology of tumor growth
(1)Monoclonality: Tumor is formed by a transformed cell proliferation
(2)The natural history of most malignant tumors
①Malignant transformation in the target cell
②Clonal growth of the transformed cell
③Local invasion
④Distant metastasis
(3)The multiple factors that influence tumor growth:
①Kinetics of tumor cell growth
·Doubling time of tumor cells: In reality, cell cycle time for many tumors is equal to or longer than that of corresponding normal cells, growth of tumor is not associated with a shortening of cell doubling time
·Growth fraction: The proportion of cells within the tumor population that are in the proliferative pool (S + G2 phase)
·Tumor cell production and loss: Growth of tumors are determined by the excess of cell production over cell loss
②Tumor angiogenesis
Angiogenesis factors: tumor cells, infiltrated Macrophages → VEGF, FGF<