Neoplasms can be benign or malignant, with the key distinguishing characteristics including differentiation, growth rate, local invasion, and metastasis. Well-differentiated neoplasms with slow growth, encapsulation and no invasion or metastasis are typically benign, while poorly differentiated neoplasms with rapid uncontrolled growth, invasiveness and ability to metastasize are malignant. Nomenclature of neoplasms is based on the tissue of origin, structure, embryonic layer, and presence of multiple cell types.

1. NEOPLASMA I
Dr.Berti Nelwan,DFM,MSi,SpPA,SpF

2. NEOPLASMA I
 DEFINISI & NOMENKLATUR
 KARAKTERISTIK NEOPLASMA JINAK
& GANAS
• Diferensiasi & Anaplasia
• Kecepatan Pertumbuhan
• Invasi Lokal
• Metastasis

3. Introduction:
• Inflammatory, Degenerative & Neoplastic
• Growth – Increase in size due to
synthesis of tissue components.
• Proliferation- Cell division.
• Differentiation: functional and structural
maturity of cells.
• Tumor – Swelling / new growth / mass

5. Introduction
• Why we have to learn about cancer/ tumor?
• Cancer is the second leading cause of death
• In the year 2000,
–10 million new cases of cancer
–6 million cancer deaths worldwide.
• In the United States 2003,
–Cancer caused 556,000 death/year
–1500 cancer deaths per day.

6. Giant fibroadenoma mamma with malignant degeneration

7. DEFINISI NEOPLASMA
Pertumbuhan baru dimana terdapat diferensiasi sel, maturasi dan kontrol
pertumbuhan yang abnormal
Suatu massa jaringan abnormal yang tumbuh berlebihan dan tidak teratur di
sekitar jaringan normal yang akan berlangsung terus walaupun rangsangan
penyebab sudah hilang dan mengakibatkan timbulnya perubahan.(1954, Ruppert
Willis)

8. Characteristics of Neoplasia
Uncontrolled growth of Abnormal cells
• 1. Benign
• 2. Malignant
• 3. Borderline

9. “Root words”
• Neo- new
• Plasia- growth
• Plasm- substance
• Trophy- size
• +Oma- tumor
• Statis- location

10. “Root words”
• A- none
• Ana- lack
• Hyper- excessive
• Meta- change
• Dys- bad, deranged

11. Oncology defined
• Branch of medicine that
deals with the study,
detection, treatment and
management of cancer and
neoplasia

12. Non-Neoplastic Proliferation:
*Controlled & Reversible
• Hypertrophy – Size
• Hyperplasia – Number
• Metaplasia – Change
• Dysplasia – Disordered

13. Neoplastic Proliferation:
Uncontrolled & Irreversible*
• Benign
– Localized, non-invasive.
• Malignant (Cancer)
– Spreading, Invasive.

14. Neoplasia:
• Progressive, Purposeless, Pathologic,
Proliferation of cells characterized by loss of
control over cell division.
• DNA damage at growth control genes is central
to development of neoplasm.
• Carcinogens – Chemical, physical & genetic 
DNA damage  Neoplasm.

15. Pathogenesis of Neoplasia:
• Normal  Hyperplasia  Metaplasia (DNA damage) 
Dysplasia  (DNA damage)  (DNA damage) Anaplasia (DNA
damage) Infiltration  (DNA damage)  Metastasis….
• Progressive DNA Damage – features of neoplasia.

16. Pathogenesis of Neoplasia:
• Non lethal DNA Damage leading to uncontrolled
cell division.

17. Mechanism of Neoplams
Normal Adaptation Benign Malignant
Non-Neoplastic Neoplastic
(Polyclonal) (Monoclonal)

18. Loss of Normal Growth Control

24. Structure of Neoplasm:
• Neoplastic cells parenchyma.
• Non-neoplastic - stroma (Connective
tissue & BV)
• Fast growth  less stroma
• Less stroma  more necrosis

25. Biology of Neoplasm:
• Cell of origin • Lung cancer
• Rate of growth • Grade - low, high
• Differentiation • Well, Mod, P, Un.
• Local Invasion • Staging
• Metastasis • Staging
Lung cancer:
Squamus cell carcinoma.
Poorly differentiated, high grade, stage 4, Liver+

26. Benign Malignant:
• Slow growing, • Fast growing,
• capsulated, • non capsulated,
• Non-invasive • Invasive & Infiltrate
• do not metastasize, • Metastasize.
• well differentiated, • poorly differentiated,
• suffix “oma” eg. • Suffix “Carcinoma” or
Fibroma. “Sarcoma”

27. What makes a neoplasm “malignant” ?
• The ability to invade and/or metastasize.
• Examples: Basal cell carcinoma ( a skin
neoplasm) invades but rarely metastasizes.
• Malignant melanoma of the skin invades and
can widely metastasize.

28. Language of Oncology
• Neoplasm: (meaning new growth that is
“autonomous”); scientific term for a tumor.
• May be “malignant or benign”
• Other “plasias”:
– Hyperplasia: an increase in cell number
– Hypertrophy: an increase in cell size but not
number
– Metaplasia: a reversible process where one cell
type changes into another cell type

29. What Is Cancer?
CANCER is a complex of diseases which
occurs when normal cells mutate into
abnormal cells that take over normal
tissue, eventually harming and destroying
the host

30. WHAT IS CANCER
A large group of diseases characterized
by:
– Uncontrolled growth and spread of abnormal
cells
– Proliferation (rapid reproduction by cell division)
– Metastasis (spread or transfer of cancer cells
from one organ or part to another not directly
connected)

31. KARSINOGEN (PENYEBAB KANKER)
• Bahan kimia
• Nitrosamin kanker usus
• Virus
• HPV kanker serviks
• HCV, HBV kanker hati
• Epstein Barr kanker nasofaring
• Radiasi
• bom hiroshima kanker paru,
• Chernobil kanker tiroid
• Hormon
• Estrogen kanker payudara and
endometrium
• Dll

32. FAKTOR PREDISPOSISI
• Geografik/ Suku/ras
– Jepang banyak kanker lambung
– Negro jarang kanker kulit
• Usia
– >55 th
• Jenis kelamin
– Man : paru, kolon dan prostat
– Woman: paru, payudara dan kolon
• Hereditas
– Kanker Payudara dan ovarium
• Kelainan neoplastik didapat
– Hepatitis HCC (Hepatocellular carcinoma)

34. Nomenclature: Cell of origin + Suffix
Suffix - oma Carcinoma / Sarcoma
• Fibroma • Fibrosarcoma
• Osteoma • Osteosarcoma
• Adenoma • Adencarcinoma
• Papilloma • Squamous cell carcinoma
• Chondroma • Chondrosarcoma
Exceptions: Leukemia, Lymphoma, Glioma,

35. Grading & Staging of Tumor
• Grading – Cellular Differentiation
(Microscopic)
• Staging – Progression or Spread (clinical)

36. TNM: Staging of tumor:

37. Pathways of Spread:
• Direct Spread
• Body cavities
• Blood vessels
• Lymphatic vessels
• Lungs – Systemic Venous blood
• Liver – GIT venous return, nutrition.
• Brain – End arteries.

38. Tumor Diagnosis:
• History and Clinical examination
• Imaging - X-Ray, US, CT, MRI
• Tumor markers Laboratory analysis
• Cytology –Pap smear, FNAB
• Biopsy - Histopathology, markers.
• Molecular Tech – Gene detection.

39.  NOMENKLATUR
Tumor ada 2 komponen dasar:
1. Parenkhim
2. Stroma penunjang
parenchyma
supporting stroma

40. Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
• Hepatoma- liver
• Osteoma- bone
• Myoma- muscle

41. Nomenclature of Neoplasia
Tumor is named according to:
2. Pattern and Structure, either
GROSS or MICROSCOPIC
• Fluid-filled CYST
• Glandular ADENO
• Finger-like PAPILLO
• Stalk POLYP

42. Nomenclature of Neoplasia
Tumor is named according to:
3. Embryonic origin
• Ectoderm ( usually gives rise to
epithelium)
• Endoderm (usually gives rise to
glands)
• Mesoderm (usually gives rise to
Connective tissues)

43. BENIGN TUMORS
• Suffix- “OMA” is used
• Adipose tissue- LipOMA
• Bone- osteOMA
• Muscle- myOMA
• Blood vessels- angiOMA
• Fibrous tissue- fibrOMA

44. NOMENKLATUR
Tumor Ganas
Mesenkhim Sarkoma
Neoplasma ganas asal
Epitelial Karsinoma
LIPOSARKOMA
FIBROSARKOMA
OSTEOSARKOMA
ADENOKARSINOMA
KARSINOMA SEL SKUAMOUS

45. MALIGNANT TUMOR
• Named according to embryonic cell
origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
• Use the suffix- “CARCINOMA”
– Pancreatic AdenoCarcinoma
– Squamos cell Carcinoma

46. MALIGNANT TUMOR
Named according to embryonic cell
origin
2. Mesodermal, connective tissue
origin
• Use the suffix “SARCOMA
– FibroSarcoma
– Myosarcoma
– AngioSarcoma

47. EXCEPTS
1. “OMA” but Malignant
– HepatOMA, lymphOMA, gliOMA, melanOMA
2. THREE germ layers
– “TERATOMA”
3. Non-neoplastic but “OMA”
– Choristoma
– Hamatoma

48. Characteristics of Neoplasia
BENIGN
• Well-differentiated
• Slow growth
• Encapsulated
• Non-invasive
• Does NOT metastasize

49. Characteristics of Neoplasia
MALIGNANT
• Undifferentiated
• Erratic and Uncontrolled Growth
• Expansive and Invasive
• Secretes abnormal proteins
• METASTASIZES

52. PAPILLOMA
Papilloma is benign epithelial neoplasm
Papilloma of the colon with finger-like projections into the lumen .

53. Benign tumor:Adenomatous polyp of the colon,
A, Gross appearance of several colonic polyps B, This benign glandular tumor
(adenoma) is projecting into the colonic lumen and is attached to the mucosa by
a distinct stalk

54. NOMENKLATUR
II. Lebih dari satu tipe sel neoplastik
(Mixed tumor)
Contoh: T. Kelenjar liur
III. Lebih satu tipe sel neoplastik dan merupakan
derivat dari lebih satu lapisan germinativum
(Teratogenous)
Sel totipoten dalam gonad/ sisa embrionik
berdiferensiasi kulit, otot, lemak, epitel usus, gigi
Contoh: Teratoma

55. Mixed Tumor/ Tumor Kelenjar Liur
This mixed tumor of the parotid gland contains epithelial cells forming
ducts and myxoid stroma that resembles cartilage

56. Teratoma
Gross appearance of an opened cystic teratoma of the ovary. Note the
presence of hair, sebaceous material, and tooth

58. KARATERISTIK TUMOR JINAK & GANAS
Kriteria membedakan Tumor jinak dan ganas
1. Diferensiasi & Anaplasi
2. Kecepatan Pertumbuhan
3. Invasi Lokal
4. Metastase
Diferensiasi & Anaplasi
Diferensiasi menunjukkan seberapa banyak kemiripan sel parenkhim
dibanding dengan sel normal (morfologi/ fungsional)
Baik Mirip sel matur normal asal jaringan neoplasma
Dif. Sedang
Jelek/ tidak berdif. Sel primitif/ sel tidak spesifik
T. Jinak umumnya berdiferensiasi baik
T. Ganas berdiferensiasi jelek

59. Leiomyoma uteri, benign smooth muscle tumor
Leiomyoma of the uterus. This benign, well-differentiated tumor
contains interlacing bundles of neoplastic smooth muscle cells
that are virtually identical in appearance to normal smooth
muscle cells in the myometrium

60. Benign tumor of thyroid gland
Normal thyroid
Benign tumor (adenoma) of the thyroid. Note the normal-looking (well-
differentiated), colloid-filled thyroid follicles.

61. KARATERISTIK TUMOR JINAK & GANAS
Anaplasi : Neoplasma ganas yang tidak berdiferensiasi
Karakteristik :
Sel dan inti pleomorfik,
Inti hiperkromatik,
tumor sel raksasa
Gambaran mitosis, T. ganas atipik dan aneh
Sel bentuk spindel dengan tripolar, kwadripolar/ multipolar
Displasia : Proliferasi yang tidak beraturan, tetapi bukan
neoplasma (pleomorfik, hiperkromatik, mitosis)
Ringan
Displasia Sedang
Berat = Ca. in situ/ Ka. Primitif

62. Anaplastic tumor of the skeletal muscle (rhabdomyosarcoma).
Note the marked cellular and nuclear pleomorphism,
hyperchromatic nuclei, and tumor giant cells.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 11 November 2005 02:05 PM)
© 2005 Elsevier

63. Anaplastic tumor showing cellular and nuclear variation in size and shape.
The prominent cell in the center field has an abnormal mitotic tripolar
spindle (arrow).

64. Gambaran skematik lesi prakanker/displasia
dan karsinoma in situ pada serviks uteri.
I. Displasia Derajat 1 Derajat 2 Derajat 3
Sangat
Normal
I II III IV V
Ringan
II. Displasia
Ringan
III. Displasia
Sedang
IV. Displasia
Berat
Membrana basalis
V. Karsinoma
In Situ
Karsinoma mikroinvasif

65. Carcinoma In situ
• A preinvasive stage of cancer referred to as carcinoma in situ.
• Occurs in tumors of the skin, breast, uterine cervix
• In situ epithelial cancers display the cytologic features of malignancy
(marked nuclear and cellular pleomorphism, and numerous mitotic
figures extending toward the surface) without invasion of the
basement membrane.

66. KARATERISTIK TUMOR JINAK & GANAS
Kecepatan Pertumbuhan
T. Jinak tumbuh lambat, gambaran mitotik : jarang dan normal
T. Ganas tumbuh lebih cepat, mitotik: banyak dan abnormal
Invasi Lokal
T. Jinak : biasanya kohesif & ekspansif,
massa berbatas tegas karena tidak ada invasi dan
infiltrasi ke jaringan normal sekitarnya.
T. Ganas : invasi lokal dan infiltrasi ke jaringan normal
sekitarnya,
kadang-kadang kohesif & ekspansif dan
mendesak kedalam struktur sekitarnya yang
normal.

67. FIBROUS CAPSULE in BENIGN
TUMOR
A. Fibroadenoma of the
breast. The tan-colored,
encapsulated small tumor
is sharply demarcated
from the whiter breast
tissue.
B. Microscopic view of
fibroadenoma of the
breast. The fibrous
capsule (right) delimits
the tumor from the
surrounding tissue.

68. LOCAL INVASION
A. Cut section of an invasive
ductal carcinoma of the breast.
The lesion is retracted,
infiltrating the surrounding
breast substance, and would be
stony hard on palpation.
B. The microscopic view of the
breast carcinoma seen in A
illustrates the invasion of
breast stroma and fat by nests
and cords of tumor cells. Note
the absence of a well-defined
capsule.

69. KARATERISTIK TUMOR JINAK & GANAS
Metastasis
Metastasis adalah suatu perpindahan tumor yang terpisah
dengan tumor primernya T. ganas.
P. Darah
Kanker invasif penetrasi P. Limfe menyebar
ke Organ tubuh
Cara Metastasis
Penyebaran kanker terjadi melalui
1. Langsung rongga tubuh dan permukaan
2. P. Limfe
3. Hematogen

70. KARATERISTIK TUMOR JINAK & GANAS
Melalui Rongga Tubuh dan Permukaan
Terjadi pada neoplasma ganas yang menembus ke dalam
tempat yang terbuka / rongga kavum peritonium, pleura,
perikardial, subarachnoid dan rongga sendi
Contoh: Ka. Ovarium pseudomiksoma peritonei
Melalui Pembuluh Limfe
Transportasi melalui limfatik cara utama penyebaran
karsinoma.
Contoh: Ka. Mammae
Penyebaran Hematogen
Cara ini spesifik untuk sarkoma.
Arteri dengan dinding lebih tebal kurang cepat penetrasi dari
pada vena

71. Metastasis
Liver metastatic cancer from pancreatic adenocarcinoma

72. Comparison between a benign tumor of the myometrium (leiomyoma)
and a malignant tumor of similar origin (leiomyosarcoma).

73.  Benign and Malignant Tumor
Characteristic Benign Malignant
Differentiation Well differentiation, structure Lack of differentiation/
may be typical of tissue origin anaplasia
Structure is often
atypical
Rate of growth Usually progressive and slow Erratic, may be slow to
growth, rapid,
Mitotic figures are rare and Abnormal and
normal Numerous mitotic figure
Local invasion Usually well demarcated and Locally invasive,
no infiltration to the infiltration to the
surrounding tissue surrounding tissue
Metastasis Absent Frequently present

74. TERIMA KASIH