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Updated: Dec 15 2019

Principles of Neoplasia

  • Overview
    • Acquired abilities of neoplastic tissue
      • apoptotic evasion
      • self-sustained monoclonal growth
        • all cells in a neoplasm are derived from a single progenitor cell
          • can be measured by the presence of single G6PD isoform or Ig heavy and light chain
      • resistance to anti-growth signals
      • angiogenesis
        • must supply nutrients to rapidly growing neoplasm
      • limitless replicative potential
      • invasion
      • metastasis
        • key difference between benign and malignant neoplasms
          • benign remain localized
    • Systemic effects of neoplasia
      • cachexia
        • muscle wasting leading to increased autophagic vacuole formation
  • Steps of neoplastic progression
    • Normal
      • histological characteristics
        • basal to apical differentiation
        • small nucleus:cytoplasm (N:C) ratio
        • intercellular adhesion
    • Hyperplasia
      • histological characteristics
        • increased cell number
        • otherwise normal histology
      • reversible
    • Dysplasia
      • histological characteristics
        • increased cell number
        • loss of cellular orientation
        • increased cell size
      • reversible
    • Carcinoma in situ (preinvasive)
      • histological characteristics
        • increased N:C ratio
        • nuclear changes (chromatin clumping)
        • basement membrane remains intact
      • non-reversible
    • Invasive carcinoma
      • histological characteristics
        • a neoplasm that has breached the basement membrane but is still localized to tissue of origin
      • requirements
        • reduced intercellular adhesions (↓ cadherin)
        • increased attachment to ECM proteins (↑ laminin and integrin receptors)
        • upregulated matrix metalloproteinases to pass through basement membrane
      • non-reversible
    • Metastasis
  • Other Types of Cellular Growth Alterations
    • Metaplasia
      • histological characteristics
        • replacement of 1 adult cell type by another
          • e.g., Barrett's esophagus
            • stratified squamous replaced by simple columnar
      • often a response by a tissue to a change in tissue environment
        • e.g., irritation by smoke, gastric acid, etc.
      • reversible
    • Anaplasia
      • histological characteristics
        • dramatic change in tissue morphology with no resemblance to original tissue
        • most often a malignant neoplasm
      • irreversible
    • Desmoplasia
      • histological characteristics
        • fibrous response to neoplastic growth
      • irreversible
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