Extent Of Local Tumour Spread
Lymphocytic reaction prominent sparse. Weight of chippings or length of cores and proportion ( ) or number involved. For a focal lesion give a maximum dimension (mm). Apex of gland, urethral limit, proximal bladder limit, capsule and margins, seminal vesicles. The TNM classification applies only to prostatic adenocarcinomas. Transitional cell carcinoma of the prostate is classified as a urethral tumour. pT1 clinically inapparent tumour not palpable or visible by...
Lobular carcinoma in situ
uniform cells populating the lobule. > 50 of the acini in the lobule expanded and filled. Pagetoid spread into ducts. potentially multifocal (70 ) and bilateral (30-40 ). epithelial proliferation of lesser extent (e.g. with preservation of lumina) is designated atypical lobular hyperplasia. Figure 22.2. Ductal carcinoma in-situ (DCIS) versus atypical ductal hyperplasia (ADH) versus florid hyperplasia without atypia (FHWA) cytology and histology. DCIS features smooth, punched-out luminal...
Other Pathology
Pleural plaques, subpleural fibrosis, asbestosis, bronchogenic carcinoma requiring increasing levels of asbestos exposure, respectively. Two to three percent of people with exposure to significant amounts of asbestos develop malignant mesothelioma. The consequences of asbestos exposure depend on the fibre type (amphiboles, e.g. crocidolite are particularly pathogenic) and can be both dose-related and idiosyncratic. Some individuals require less exposure to develop asbestos-related disease while...
Introduction
Histopathology reports on surgical cancer specimens are becoming increasingly complex for many reasons. With closer clinicopathological correlation and the use of novel immunocytochemical and molecular techniques, new entities and classifications of tumour emerge that are linked to prognosis and response to various treatment modalities. Increasingly the surgical oncologist wants tissue biopsy proof of cancer diagnoses so that patients may be recruited to suitable treatment protocols. No longer...
Specimen
fine needle aspirate needle core biopsy partial nephrectomy nephrectomy ureterectomy radical nephrectomy (kidney, pelvis, perirenal fat out to Gerota's fascia, adrenal gland, and a length of ureter) seg-mental ureterectomy. length (cm) of attached ureter. adrenal gland present absent. up to one-third of renal cancers are asymptomatic and an incidental finding on radiological examination. The classic triad of flank pain, mass and haematuria is infrequent and usually indicates advanced disease....
Breast Cancer
Spindle cell tumours of the breast practical approach to diagnosis. Histopathology 1999 35 1-13. Anderson TJ, Page DL. Risk assessment in breast cancer. In Anthony PP, MacSween RNM (eds). Recent advances in histopathology 17. Churchill Livingstone. Edinburgh 1997 69-91. Bloom HJG, Richardson WW. Histological grading and prognosis in breast carcinoma a study of 1049 cases of which 359 have been followed for 15 years. Br J Cancer 1957 11 359-377. Boecker W, Buerger H. Usual and...
Tumour
bilateral 1-3 of cases, synchronous or metachronous, similar or dissimilar types. Commonest is seminoma or spermatocytic seminoma but beware lymphoma in the older age group. testicular cancer usually presents with a painless lump or swelling of some duration. Investigation involves careful clinical examination and ultrasound assessment to detect hypoechoic areas of tumour. Tumour staging is by chest X-ray for pulmonary involvement and CT scan for abdominopelvic and mediastinal lymph node...
Small cell carcinoma
Small round fusiform nuclei (x2-3 lymphocyte size) with granular chromatin, moulding and an inconspicuous nucleolus, DNA crush and vessel artefact (Azzopardi effect), fir tree hyaline stroma, apoptosis, necrosis and mitoses. The nuclear features are the diagnostic characteristic of small cell carcinoma. Note that there can be a scattered population of large bizarre (polyploid) cells. intermediate larger nucleus more cytoplasm and most likely represents better preserved fixed oat...
Bone And Soft Tissue Cancer
Practical morphological approach to the diagnosis and differential diagnosis of soft tissue sarcomas. Curr Diagn Pathol 2002 8 395-411. Bullough PG. Orthopaedic Pathology, 4th edn. Mosby Wolfe. St Louis 1998. Coffin CM, Lowichik A, Zhou H. Treatment effects in paediatric soft tissue and bone tumors. Am J Clin Pathol 2005 123 75-90. Coindre J-M, Trojani M, Contesso G, David M, Rouesse J, Bui NB, Bodaert A, de Mascarel I, de Mascarel A, Goussot JF. Reproducibility of a...
Comments On Adrenal Gland
Metastatic carcinoma in the adrenal gland, particularly from lung, breast and kidney, is commoner than a primary neoplasm and usually detected by follow-up CT scan. Sometimes CT-guided needle core biopsy or FNA is used to make this distinction and more often primary adrenal neoplasms present either as a symptomatic or incidental mass or are characterized by their endo-crinological symptoms and signs and resultant biochemical profiles. Phaeochromocytoma is a contraindication to biopsy due to the...
Tumour Report Protocols
Association of Directors of Anatomic and Surgical Pathology guidelines checklists cancer sites adrenal, ampullary, anus, bone, brain and spinal cord, breast, cervix, colon, endometrium, extrahepatic bile ducts, extra-adrenal paragangliomas, eye, and adnexa, fallopian tube, gall bladder, gestational trophoblastic disease, larynx, lip oral cavity oropharynx, liver, lung, lymphoma, nose and paranasal sinuses, oesophagus, ovary, pancreas, penis, pleural mesothelioma, prostate, renal pelvis and...
Gastric Carcinoma
gastric cancer can present with anaemia, weight loss or dyspeptic symptoms. Investigation is by endoscopy with biopsy. Staging for local and distant disease includes ELUS endoluminal ultrasound tumour depth and nodal spread , CT scan chest, abdomen and pelvis, PET scan and peritoneal laparoscopy with cytological washings and biopsy. Non-regional disease is an indicator for palliative treatment including chemotherapy, and surgery if there is anatomical dysfunction, e.g. extensive ulceration and...
Ophthalmic Cancer
Malignant melanocytic tumours of the eye a study of histo-logic types in 111 cases. Trans Am Acad Ophthalmol Otolaryngol 1931 36 131-142. Campbell RJ. Histological typing of tumours of the eye and its adnexa, 2nd edn. WHO International histological classification of tumours. Springer. Berlin Heidelberg New York 1998. Lee WR. Ophthalmic histopathology. Springer-Verlag. London 1993. McLean IW, Foster WD, Zimmerman LE. Uveal melanoma location, size, cell type and enucleation as risk...
Comments On Pelvic Exenteration
In general pelvic exenteration is considered for locally advanced or recurrent pelvic malignancy in the absence of extra-pelvic metastases. degree of disease spread is assessed by CT scan pelvic and retroperitoneal lymphadenopathy, extra-pelvic metastases. MRI scan local cancer spread. PET CT scan detects metabolic activity in malignant tumours and is useful in localizing recurrent or metastatic disease. Figure 7.5. Pelvic exenterations. QA Figure 7.5. Pelvic exenterations. QA relevant...
Kidney
Amin MB, Amin MB, Tamboli P, Javidan J, Stricker H, Venturina MD-P, Deshpande A, Menon M. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms. An experience of 405 cases. Am J Surg Pathol 2002 26 281-291. Bonsib SM. The renal sinus is the principal invasive pathway. A prospective study of 100 renal cell carcinomas. Am J Surg Pathol 2004 28 1594-1600. Davies DR. The reporting of renal cell tumours. CPD Bulletin Cellular Pathology 2000 2 40-45. Fleming S. Classification...
Respiratory And Mediastinal Cancer
Immunohistochemistry in the distinction between malignant mesothelioma and pulmonary adenocarcinoma a central evaluation of new antibodies. J Clin Pathol 2002 55 662-668. Attanoos RL. Management of small biopsies in pulmonary diseases. CPD Bulletin Cellular Pathology. 2000 2 138-141. Attanoos RL. Pitfalls in pulmonary pathology. Curr Diagn Pathol 2005 11 44-51. Attanoos RL, Gibbs AR. Asbestos-related deaths. Curr Diagn Pathol 2002 8 373-383. Attanoos RL, Gibbs...
Skin Cancer
Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Colt DG, Fleming ID, Gershenwald JE, Houghton A Jr, Kirkwood JK, McMasters KM, Mihn MF, Morton DL, Reintgen DS, Ross MI, Sober A, Thompson JA, Thompson JF. Final version of the American Joint Committee on cancer staging system for cutaneous melanoma. J Clin Oncol 2001 19 16 3635-3648. Banerjee SS, Harris M. Morphological and immunophenotypic variations in malignant melanoma. Histopathology 2000 36 387-402. Blessing K. Benign atypical naevi...
Headand Neck Cancer
My approach to oncocytic tumours of the thyroid. J Clin Pathol 2004 57 225-232. Anderson CE, McLaren KM. Best practice in thyroid pathology. J Clin Pathol 2004 56 401-405. Baloch ZW, Livolsi VA. Newly described tumours of the thyroid. Curr Diagn Pathol 2000 6 151-164. Barnest L, Eveson J, Reichart P, Sidransky D eds . World Health Organisation Classification of Tumours. Pathology and Genetics. Tumours of the Head and Neck. IARC Press. Lyon 2005. Barrett AW, Speight PM. Diagnostic...
Lip and Oral Cavity Carcinoma
fine needle aspirate diagnostic or wedge excision biopsy resection, e.g. glossectomy neck dissection. pathological lesions present either as a lump, ulcer, red or white mucosal patch and require biopsy to determine their nature. preoperative investigation of a mass will include plain X-ray, MRI and CT scan to assess local spread, bone destruction and or cervical nodal metastases. Local wedge excision shave excision of adjacent mucosa is used for small tumours of the lip and tip lateral border...
Oesophageal Carcinoma
oesophageal cancer usually presents with progressive dysphagia initially for solids and ultimately liquids. Investigation is by endoscopy and biopsy, and chest X-ray to detect any enlargement of the heart, mediastinal lymph nodes or lung lesion that may be causing extrinsic compression. For biopsy-proven cancer, staging for local and distant disease includes endoluminal ultrasound tumour depth and nodal spread , computed tomographic CT scan chest and abdomen and positron emission tomographic...
Salivary Gland Tumours
oral . conservative superficial radical parotidectomy, submandibulectomy, excision of oral tumour sublingual glands, or minor salivary glands of mucosal origin , neck dissection. salivary gland tumours present as persistent unilateral enlargement the majority of which are in the parotid gland and are benign. There is a higher incidence of carcinoma arising in the submandibular glands, sublingual and minor glands of the oral cavity. Investigation is plain X-ray for calculus , ultrasound scan...
Laryngeal Carcinoma
biopsy hemi- partial or total laryngectomy neck dissection. Typically presenting with hoarseness, investigation is by indirect laryn-goscopy with biopsy. Chest X-ray and endoscopy of the upper aerodi-gestive tract are done to exclude a concurrent cancer elsewhere. CT and MRI are used to stage the tumour and cervical lymph node enlargement necessitates FNA to establish if there are metastases. Tumour stage and fitness of the patient determine the appropriate choice of treatment, i.e....
Nasal Cavity and Paranasal Sinus Carcinoma
fine needle aspirate biopsy resection, e.g. rhinectomy, maxillectomy, ethmoidectomy, craniofacial resection neck dissection. weight g and size cm , number of fragments. Clinical presentation is with nasal obstruction, rhinorrhoea, epistaxis or facial pain. Investigation is by endonasal endoscopy with biopsy. Plain X-ray, CT and MRI scan can demonstrate and stage a soft tissue mass and any bone destruction. Tumour can be removed piece-meal by fibre-optic endoscopic sinus surgery FE S S or more...
Other Malignancy
The TNM classification is targeted primarily at carcinoma but also includes malignant mesothelioma, malignant melanoma, gestational tro-phoblastic tumours, germ cell tumours and retinoblastoma. This section notes the commoner non-carcinomatous cancers such as uterine and gastrointestinal smooth muscle stromal tumours, lymphoma leukaemia and sarcoma. Summary diagnostic and prognostic criteria are given, where relevant. Various ancillary techniques can be useful in the histopathology of surgical...
Oropharyngeal Carcinoma with comments on nasopharynx and hypopharynx
fine needle laryngectomy neck dissection. weight g and size cm , number of fragments. Depending on the anatomical site of the lesion, patients can present with dysphagia, hoarseness, deafness, cranial nerve palsy or cervical lym-phadenopathy. Investigation is by endoscopy with biopsy and cervical node FNA to obtain a diagnosis. CT and MRI scan are used to assess local tumour spread and metastasis to the neck and elsewhere. Chest X-ray can detect concurrent lung cancer. Extent of resection...
Lymphovascular Invasion
LVI usually relates to microscopic tumour emboli within small thin-walled channels in which distinction between post-capillary venule and lymphatic channel is not possible hence the general term LVI is used. It is important to identify an endothelial lining to differentiate from retraction space artefact, which often comprises a rounded aggregate of tumour sited centrally and free within a tissue space. Other helpful features of LVI are red blood cells, thrombosis, a point of attachment to the...
