Histopathology lecture 1

Histology is a science dealing with the structure of cells and their formation into tissues and
organs.

What Is Cancer?
Throughout our lives, healthy cells in our bodies divide and replace themselves in a controlled
fashion. Cancer starts when a cell is somehow altered so that it multiplies out of control.
A tumor is a mass composed of a cluster of such abnormal cells.
Most cancers form tumors, but not all tumors are cancerous.
Benign, or noncancerous, tumors do not spread to other parts of the body, and do not create
new tumors. Malignant, or cancerous, tumors crowd out healthy cells, interfere with body
functions, and draw nutrients from body tissues.
Cancers continue to grow and spread by direct extension or through a process called metastasis,
whereby the malignant cells travel through the lymphatic or blood vessels -- eventually forming
new tumors in other parts of the body.
Which factors causes cancer:
1. Chemical Carcinogens: Responsible for 80% of the cancers
Life style: Cigarette contains benzopyrenes and other harmful substances like
nicotine, carbon monoxide, nitrogen dioxide etc.
Therapeutic drugs: E.g. Diethylstilbestrol
Contaminated food: Fungus and Aspergillus flavus which produce aflatoxin B are
carcinogenic.
2. Radiation: X ray, UV rays or gamma rays can cause mutation causing cancer.
UV light: Formspyrimidine diamers in DNA
X ray: Produces free radicals
Superoxide: Breaks DNA causing cellular mutation.
3. Occupation: Exposure to aniline, asbestos or benzene which covalently bind to DNA
causing irreparable damage to the DNA causing mutation
Characteristics of Growing Tumour:
▪ General and Morphological:
o Tumour cells appear much rounder than the normal cells.
o Normal cells have contact inhibition while cancer cells don’t.
o Loss of dependence on anchorage in cancer cells
o Changes in permeability property.
Staging:
Determining stage of cancer
o Stages of Cancer: I to IV
Stage determined with the help of:
• Tumour size and extent of its penetration
• Invasion to adjacent organs
• Metastasis to the no. of lymph nodes
• Metastasis to distant organs
TNM Staging:
o T: Tumour size and its invaded nearby tissues
o N: If regional lymph nodes are involved
o M: Metastasis
Eg. For invasive colon cancer:
o Stage I and II: Curable by surgery
o Stage III (Spread to lymph): 73% cases cured by Sx and chemotherapy.
o For rectal cancer: Radiation
Tumour Marker:
A substance present in or produced by a tumour or by the tumour’s host response to the
presence of tumour that can be used to differentiate a tumour from normal tissue or to
determine the presence of a tumour based on measurement in the blood or secretions
E.g. enzymes, isoenzymes, hormones, onco-foetal antigens, carbohydrate epitopes
o Specific tumour marker indicate towards specific type of cancer.
o ALP(Alkaline Phosphatase Enzyme): Metastatic cancer of bone or liver.
o CK1(Creatinine Kinase): Isoenzyme of CK: Prostrate and small cell carcinoma of the
lung and also malignancy in breast, colon, ovary and stomach
o LDH (Lactase Dehydrogenase): cancer of liver, acute leukaemia, breast, colon,
stomach and lung. LDH isoenzyme in CSF indicates metastasis to CNS.
o AFP (Fetoprotein): hepatocellular or liver cancer or germ cell carcinoma. Normal: <
10 μg/l, Indicating Cancer: AFP> 1000 μg/l
o CEA (Carcinoembryonic antigen): colorectal, gastrointestinal, lung and breast
carcinoma
o
 PSA
(Prostrate Specific Antigen): early prostrate cancer detection and for monitoring
treatment.
In hyperplasia, there is an increase in the number of cells in an organ or tissue that appear
normal under a microscope. In dysplasia, the cells look abnormal under a microscope but
are not cancer.

Types of Cancer :
Carcinoma:

Carcinomas are the most common type of cancer. They are formed by epithelial cells, which
are the cells that cover the inside and outside surfaces of the body

Adenocarcinoma is a cancer that forms in epithelial cells that produce fluids or mucus.
Tissues with this type of epithelial cell are sometimes called glandular tissues. Most cancers
of the breast, colon, and prostate are adenocarcinomas.

Basal cell carcinoma is a cancer that begins in the lower or basal (base) layer of the
epidermis, which is a person’s outer layer of skin.

Squamous cell carcinoma is a cancer that forms in squamous cells, which are epithelial cells
that lie just beneath the outer surface of the skin. Squamous cells also line many other
organs, including the stomach, intestines, lungs, bladder, and kidneys. Squamous cells look
flat, like fish scales, when viewed under a microscope. Squamous cell carcinomas are
sometimes called epidermoid carcinomas.

Transitional cell carcinoma is a cancer that forms in a type of epithelial tissue called
transitional epithelium, or urothelium. This tissue, which is made up of many layers of
epithelial cells that can get bigger and smaller, is found in the linings of the bladder, ureters,
and part of the kidneys (renal pelvis), and a few other organs. Some cancers of the bladder,
ureters, and kidneys are transitional cell carcinomas.

Sarcoma :
Sarcomas are cancers that form in bone and soft tissues, including muscle, fat, blood
vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments).

Osteosarcoma is the most common cancer of bone.

Leukemia
Cancers that begin in the blood-forming tissue of the bone marrow are called leukemias.
These cancers do not form solid tumors. Instead, large numbers of abnormal white blood
cells (leukemia cells and leukemic blast cells) build up in the blood and bone marrow,
crowding out normal blood cells.

Lymphoma
Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are disease-
fighting white blood cells that are part of the immune system. In lymphoma, abnormal
lymphocytes build up in lymph nodes and lymph vessels, as well as in other organs of the
body.

There are two main types of lymphoma:

Hodgkin lymphoma – People with this disease have abnormal lymphocytes that are called
Reed-Sternberg cells. These cells usually form from B cells.
Non-Hodgkin lymphoma – This is a large group of cancers that start in lymphocytes. The
cancers can grow quickly or slowly and can form from B cells or T cells.

Multiple Myeloma
Multiple myeloma is cancer that begins in plasma cells, another type of immune cell. The
abnormal plasma cells, called myeloma cells, build up in the bone marrow and form tumors
in bones all through the body. Multiple myeloma is also called plasma cell myeloma and
Kahler disease.

Melanoma
Melanoma is cancer that begins in cells that become melanocytes, which are specialized
cells that make melanin (the pigment that gives skin its color). Most melanomas form on the
skin, but melanomas can also form in other pigmented tissues, such as the eye.

Astrocytic tumor begins in star-shaped brain cells called astrocytes, which help keep nerve
cells healthy. Brain tumors can be benign (not cancer) or malignant (cancer).

Germ Cell Tumors

Lump:
A mass usually refers to a lump which is at least 20 mm (0.787 inches) in diameter at its
widest point
Nodule:
a nodule is mass usually refers is less than 20 mm at its widest point.
Malignant tumor:
it is abnormal and uncontrollable growth of cell. Generally refers to cancerous condition.
Pre - Malignant tumor:

It is one that is not yet malignant, but is about to become so.

Benign tumor:

It is an abnormal but controllable growth of cells. It is non-cancerous tumor.

Adenoma:
Adenomas are tumors that arise from glandular epithelial tissue
examples include pituitary adenoma, adrenocortical adenoma, basal cell adenoma, bile duct
adenoma, chromophobe adenoma, follicular adenoma, hepatocellular adenoma, and nipple
adenoma (there are many more).
Fibromas:
They are benign tumors that grow on fibrous or connective tissue of any organ in the body.
Uterine fibroids are common. Uterine fibroids can cause vaginal bleeding, pelvic pain or
discomfort, and urinary incontinence.
Hemangiomas:
They are benign tumors which consists of a collection of too many blood cells. They can
sometimes be seen on the surface of the skin and are colloquially called strawberry marks.
Lipomas:
They are the most common form of soft-tissue tumor. Lipomas consist of adipose tissue (fat
cells). Most of them are very small, painless, soft to the touch, and generally movable. They
are more common among people aged 40+ years
Metaplasia of the lung:
It is the growths occur in the bronchi, tubes that carry air from the windpipe into the
lung. The bronchi are lined with glandular cells, which can change and become squamous
cells. Metaplasia of the lung is most commonly caused by smoking.
Leukoplakia:

It is thick, white patches form on the gums, bottom of the mouth, insides of the cheeks,
and less commonly on the tongue. They cannot be scraped off easily. Experts believe
tobacco smoking and/or chewing is the main cause. Many mouth cancers occur next to
areas of leukoplakia.

Fig: Leukoplakia
Metastasis:
Cancer can spread from its original site by local spread, lymphatic spread to regional
lymph nodes or by blood (haematogenous spread) to distant sites, known as metastasis
Biopsy:
It is a removal of tissue from living body.
Blastoma:

Cancers derived from immature "precursor" cells or embryonic tissue.

How are tumor grades classified?

Grading systems differ depending on the type of cancer. In general, tumors are graded as 1,
2, 3, or 4, depending on the amount of abnormality. In Grade 1 tumors, the tumor cells and
the organization of the tumor tissue appear close to normal. These tumors tend to grow and
spread slowly. In contrast, the cells and tissue of Grade 3 and Grade 4 tumors do not look
like normal cells and tissue. Grade 3 and Grade 4 tumors tend to grow rapidly and spread
faster than tumors with a lower grade.

If a grading system for a tumor type is not specified, the following system is generally used
(1):
• GX: Grade cannot be assessed (undetermined grade)
• G1: Well differentiated (low grade)
• G2: Moderately differentiated (intermediate grade)
• G3: Poorly differentiated (high grade)
• G4: Undifferentiated (high grade)