tumors of intestines. introduction overall, colorectal cancer ranks second only to bronchogenic...
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Tumors of IntestineTumors of Intestiness
IntroductionIntroduction
Overall, colorectal cancer ranks Overall, colorectal cancer ranks second only to bronchogenic second only to bronchogenic carcinoma among the cancer killers. carcinoma among the cancer killers.
Adenocarcinomas constitute the vast Adenocarcinomas constitute the vast majority of colorectal cancers and majority of colorectal cancers and represent 70% of all malignancies represent 70% of all malignancies arising in the gastrointestinal tract.arising in the gastrointestinal tract.
TTerminologyerminology ••A polyp is a tumorous mass that protrudes into A polyp is a tumorous mass that protrudes into
the lumen of the gut; traction on the mass may the lumen of the gut; traction on the mass may create a stalked or pedunculated polyp. create a stalked or pedunculated polyp. Alternatively the polyp may be sessile, without a Alternatively the polyp may be sessile, without a
definable stalk.definable stalk. ••NNon-neoplastic Polyps on-neoplastic Polyps
abnormal mucosal maturation, abnormal mucosal maturation, iinflammationnflammation do not have malignant potentialdo not have malignant potential (excl.Peutz-Jeghers) (excl.Peutz-Jeghers)
••NeoplasticNeoplastic PPolypsolyps:: adenomatous polyps, or adenomasadenomatous polyps, or adenomas,, precursors of carcinoma.precursors of carcinoma.
NNon-neoplastic on-neoplastic (benign) (benign) PolypsPolyps Hyperplastic polypsHyperplastic polyps Hamartomatous polypsHamartomatous polyps
Juvenile polypsJuvenile polyps Peutz-Jeghers polypsPeutz-Jeghers polyps
Inflammatory polypsInflammatory polyps Lymphoid polypsLymphoid polyps
Neoplastic epithelial lesionsNeoplastic epithelial lesions Benign lesions:Benign lesions:
Neoplastic polypNeoplastic polyp AdenomaAdenoma
Malignant lesions:Malignant lesions: AdenocarcinomaAdenocarcinoma Carcinoid tumorCarcinoid tumor Anal zone (anorectal) carcinomaAnal zone (anorectal) carcinoma
Mesenchymal lesions Mesenchymal lesions (benign/malignant)(benign/malignant)
Lymphoma Lymphoma
NNon-neoplastic on-neoplastic (benign) (benign) PolypsPolyps CommonCommon
Hyperplastic polypsHyperplastic polyps AdultsAdults RectosigmoidRectosigmoid MultipleMultiple Nipple-like, Nipple-like, Small protrusions (5 Small protrusions (5
mm)mm) Abundant crypts.Abundant crypts.
Juvenile polyps Juvenile polyps ChildrenChildren RectumRectum Single Single Round massRound mass 1-3 cm1-3 cm Dilated cystic glands.Dilated cystic glands.
Polyps
Hyperplastic polyp
Juvenile polyp
Sessile
Pedunculated
AdenomasAdenomas Small-pedunculated; Small-pedunculated;
large-sessilelarge-sessile ColonColon Familial Familial
predispositionpredisposition Risk of carcinomaRisk of carcinoma Subtypes:Subtypes:
TubularTubular VillousVillous TubulovillousTubulovillous
Malignancy:Malignancy: Rare: tubular Rare: tubular
adenoma less than adenoma less than 1 cm1 cm
High: sessile villous High: sessile villous adenomas more adenomas more than 4 cmthan 4 cm
Dysplasia: villous Dysplasia: villous adenomas. adenomas.
Tubular adenomas:Tubular adenomas: Colon (rectosigmoid)Colon (rectosigmoid) Small-sessile; large-Small-sessile; large-
pedunculatedpedunculated Stalk is covered by Stalk is covered by
normal mucosanormal mucosa Tumor is composed of Tumor is composed of
neoplastic epitheliumneoplastic epithelium Intramucosal Ca or Intramucosal Ca or
invasive Ca.invasive Ca.
Villous adenomas:Villous adenomas: Rectum/rectosigmoidRectum/rectosigmoid Larger than tubularLarger than tubular Sessile Sessile Cauliflower-likeCauliflower-like Dysplasia Dysplasia Ca. Ca.
Tubulovillous Tubulovillous adenomas:adenomas: Peduculated or sessilePeduculated or sessile Mix of tubular and Mix of tubular and
villous patternsvillous patterns DysplasiaDysplasia Malignancy.Malignancy.
Adenoma
Familial polyposis Familial polyposis syndromessyndromes Peutz-JeghersPeutz-Jeghers
SyndromeSyndrome Multiple polyps Multiple polyps
(polyposis coli)(polyposis coli) large, firm polyps with large, firm polyps with
a tree-like structure a tree-like structure distinctive freckles on distinctive freckles on
thethe lips, palms, and lips, palms, and genitalsgenitals
risk for colon cancerrisk for colon cancer.. Turcot's syndromeTurcot's syndrome
Multiple polypsMultiple polyps brain tumors.brain tumors.
Gardner's syndromeGardner's syndrome Multiple polypsMultiple polyps minor birth defects minor birth defects risk for other tumorsrisk for other tumors
((notably mesenchymalnotably mesenchymal).). CowdenCowden's syndrome's syndrome
Multiple polypsMultiple polyps Risk of tumors of:Risk of tumors of:
ThyroidThyroid BreastBreast UterusUterus Skin.Skin.
Part OnePart One
Tumors ofTumors ofSmall IntestineSmall Intestine
Small Intestine tumors:Small Intestine tumors:
Small intestine -75% but tumors – 3-Small intestine -75% but tumors – 3-6%6%
BBenign tumors enign tumors (common)(common) Adenoma(25%), lipoma & leiomyoma.Adenoma(25%), lipoma & leiomyoma.
Malignant tumors Malignant tumors ((rarerare;; <1% <1%)) Adenocarcinoma of Duodenum or Adenocarcinoma of Duodenum or
Jejunum, Carcinoid, Lymphoma, SarcomaJejunum, Carcinoid, Lymphoma, Sarcoma Present at late stage, 70% 5 year Present at late stage, 70% 5 year
survival.survival.
ClassificationClassification Non neoplastic polypsNon neoplastic polyps
Hyperplastic, lymphoid & Hyperplastic, lymphoid & hhamartomatousamartomatous InflammatoryInflammatory
Neoplastic – epithelialNeoplastic – epithelial Benign – AdenomaBenign – Adenoma (ampulla of Vater)(ampulla of Vater) Malignant – Adenocarcinoma, carcinoidMalignant – Adenocarcinoma, carcinoid
Neoplastic – MesenchymalNeoplastic – Mesenchymal Benign - Lipoma, leiomyoma, neuroma, Benign - Lipoma, leiomyoma, neuroma,
angiomaangioma Malignant – Leiomyosarcoma, liposarcoma.Malignant – Leiomyosarcoma, liposarcoma.
LymphomaLymphoma
Benign tumors: LipomaBenign tumors: Lipoma
Most commonMost common Mature adipose Mature adipose
tissuetissue
Adenocarcinoma Adenocarcinoma
Napkin-ring or Napkin-ring or polypoidpolypoid
Duodenum (ampulla Duodenum (ampulla of Vater’s)of Vater’s)
Spreading:Spreading: Regional lymph nodesRegional lymph nodes LiverLiver
Obstructive jaundice.Obstructive jaundice.
Tumors ofTumors ofColon & Colon & RectumRectum
Colorectal carcinomaColorectal carcinoma Adenocarcinomas (98%)Adenocarcinomas (98%) often arises in one of the benign often arises in one of the benign
neoplastic colonic poneoplastic colonic polyplyp risk factorsrisk factors
(1) mild hereditary defects in anti-(1) mild hereditary defects in anti-oncogenes lost in colon cancer, oncogenes lost in colon cancer,
(2) years of eating the typical western diet(2) years of eating the typical western diet.. Low content of vegetablesLow content of vegetables High content of refined carbohydratesHigh content of refined carbohydrates High content of fat (animal)High content of fat (animal) Low content of micronutrients (vitamins A, C, E).Low content of micronutrients (vitamins A, C, E).
MorphologyMorphology Proximal colon tumors:Proximal colon tumors:
polypoidpolypoid Cecum and ascending Cecum and ascending
colon:colon: exophytic exophytic Distal colon:Distal colon: napkin-ring napkin-ring Progression: slow Progression: slow
(years)(years) Types:Types:
Gut: AdenocarcinomaGut: Adenocarcinoma Mucin productionMucin production
Anal zone: Squamous cell Anal zone: Squamous cell carcinomacarcinoma
Spreading:Spreading: Regional lymph nodesRegional lymph nodes LiverLiver
Carcinoid TumorsCarcinoid Tumors 2% of colorectal 2% of colorectal
malignancies.malignancies. Origin:Origin: Neuroendocrine Neuroendocrine
cellscells ( (paracrine, paracrine, Kulchitsky, Kulchitsky, enterochromaffin, enterochromaffin, neurosecretory, neurosecretory, chromaffinchromaffin))
Location:Location: gut gut (common in (common in appendixappendix)) pancreas or peripancreatic pancreas or peripancreatic
tissue, tissue, lungs, lungs, biliary treebiliary tree lliveriver..
Rectal and appendiceal Rectal and appendiceal carcinoidscarcinoids almost neveralmost never metastasizemetastasize
The classic carcinoid The classic carcinoid syndromesyndrome (serotonin) (serotonin) (1) wheezing(1) wheezing (asthmatic) (asthmatic); ; (2) flushing(2) flushing (vasomotor) (vasomotor); ; (3) fibrosis (3) fibrosis (cardiac, (cardiac,
pulmonic, pleural, pulmonic, pleural, pelvic);pelvic);
(4) intestinal (4) intestinal hypermotility.hypermotility.
Midgut carcinoidsMidgut carcinoids:: small intestinal, small intestinal, appendiceal, appendiceal, most colonic most colonic
carcinoids. carcinoids. These are usuallyThese are usually
argyrophil argyrophil ((hormonally activehormonally active).).
Foregut carcinoidsForegut carcinoids:: lung, lung, duodenal,duodenal, biliary carcinoids. biliary carcinoids. These These are almost are almost
never argyrophil never argyrophil (hormonally (hormonally ininactive)active)..
Gastrointestinal Gastrointestinal lymphomalymphoma LLess common than ess common than
carcinomascarcinomas WesternWestern lymphomaslymphomas
are usually familiar are usually familiar B-cell lymphomasB-cell lymphomas
Mediterranean Mediterranean lymphomaslymphomas usually usually feature plasmacytoid feature plasmacytoid differentiationdifferentiation (a (a subset is alpha-subset is alpha-heavy chain heavy chain diseasedisease).).
Sprue-associated Sprue-associated lymphomalymphoma exhibits T- exhibits T-cell markers cell markers
LymphomaLymphoma
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