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Benign Neoplasm and Teratoma – Neoplasia

by Carlo Raj, MD

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    00:01 Let's do benign first, neoplasia. What's happening? Well, we have increase proliferation of cells. Small size usually, but does'nt have to be.

    00:12 I'm giving you rule of thumb but there is an exception to everything.

    00:15 You can have a benign neoplasia that actually becomes larger and it may not then spread.

    00:23 Slow growing, usually. Encapsulated, as you see in this picture here. Encapsulated with well demarcated border.

    00:31 You will not find any of this in malignant.

    00:34 Malignant tend to be larger, they grow alot faster, difficult to differentiate and here with benign it is well differentiated. So might actually look like normal tissue.

    00:48 I will give you specific examples next, of benign neoplasia that you want to take a look at.

    00:53 In this picture here, you will notice that you have not lost the architecture.

    00:58 Everything is pretty much preserved. It's well encapsulated. So therefore you can make out the type of tissue you'd expect to see.

    01:08 Benign Epithelial and Benign Connective Tissues. Benign, is what we are looking at.

    01:13 Let me tell you exactly as to where we are. This is a tubular adenoma.

    01:18 Most likely would be in the colon How did you find this? You did a lower endoscopy. When i say lower endoscopy, remember, you'll never just do a sigmoidoscopy.

    01:30 Correct? You want to do a full endoscopy so that if perhaps this tubule was located where? In the ascending colon then you cannot do just a sigmoidoscopy and find a polyp on the right side. Never choose a sigmoidoscopy.

    01:46 Now beyond that, this is a stalk. And on top of the stalk, sitting on a pedestal, the reason i say that is tubular adenoma is also called pedunculated. You see that growth on top of this tubule? That arrow is pointing to the stalk. On top of the stalk is your neoplastic growth.

    02:06 Difficult for this proliferative cell to migrate down the stalk and then finally go into invasion.

    02:12 Remember, cancer in general and then for you, you will be focusing on staging much more so than grading.

    02:19 How come? Staging means invasion. And if more of this cancer then invades, then what are you doing? Moving towards the basement membrane. Oh my goodness. If this basement membrane ruptures, can you imagine this.

    02:31 Don't just look at me. You are absolutely invading through the mucosa. Invading.

    02:38 As you invade further, you will increase the stage.

    02:43 On your exam, I will tell you exactly what the stages would be that perhaps has a decent prognosis, and then a stage that all of a sudden, that prognosis drops like crazy.

    02:56 And those are kind of things that you will be paying attention to, as you go through different cancers, in various organ systems. Pulmonary, renal, so on and so forth.

    03:07 This is epithelial tissue, ectodermal and endodermal. Connective tissue, mesodermal in origin.

    03:15 Very common, unfortunately. These are fibroids. When we get into female reproductive pathology, when we talk about fibroids, we'll be talking about different locations of the leiomyoma.

    03:27 So, what is this? What are we looking at? Now, for you, the most common location would be the uterus.

    03:32 Is that clear? And what does a leiomyoma mean to you? It is a benign tumor which is the topic of the entire section here, in which you have well-encapsulated, you see that tumor that this arrow is pointing to.

    03:44 It's well-encapsulated. You could still make out the architecture of the uterus.

    03:48 Now there are multiple fibroid in your patient here. Most likely a young African American female but "Oh well, this is a young female who is having menorrhagia." And you know that there is fibroids as being a possibility, well yeah, more likely in African American but just as likely in a Caucasian female as well.

    04:14 I said menorrhagia. Yes, there is quite abit of bleeding that is involved, and when she is having her menses imagine this uterus that is contracting. And if it's contracting, sloughing off the endometrium during the end of your menstrual cycle. It hurts.

    04:30 I could only imagine, right? And so therefore it's a common cause of what's known as dysmenorrhoea.

    04:36 Okay? Well-encapsulated. Will this ever go on to a malignancy? Highly unlikely.

    04:42 This will not go on to leiomyosarcoma. Do not ever choose that.

    04:45 Leiomyomas? Yes, fibroids. Now we have a lipoma.

    04:50 Take a look at the colour of this. It's yellow.

    04:54 Take a look at the first three letters of the name of this tumor. LIP. LIPID. LIPOMA.

    05:01 A benign tumor of adipocyte origin.

    05:08 Continuing our discussion of benign, a teratoma. And where is this tumor originating from? And you must then divide this into genders. We will talk about this further when we get into specifically, our gonadal tumors. Then we will talk about reproductive pathology. We will take a look at testicular and ovarian tumors and when we do so, we will talk about teratoma in greater detail. At this point though you must know basics.

    05:34 You will have all three germ layers. Ectoderm, endoderm, mesoderm. What does that mean? When you take a look at the tumor, it might wink at you. You take a look at this tumor it might smile at you.

    05:45 And in addition, it might comb it's hair. What am I getting at? Point is, that tumor contain all tissue.

    05:52 It might have hair. It might have retina. It might have, what did i say? Teeth. Cartilage. Amazing, a teratoma.

    06:00 Now, a teratoma tends to be midline, whatever that means and the reason I say that is, well, the pineal gland, sure.

    06:07 That's midline. Mediastinum. That's midline. But as you know there is ovarian and testicular tumor.

    06:13 So you have an ovary over here. An ovary over here. Law of averages put you in the middle.

    06:18 You have a testicle over here. A testicle over here. Law of average put you in the middle.

    06:22 Midline. And if it's a young patient? If it's a young patient then you are thinking about the sacrococcygeal, lower back.

    06:31 Teratoma here, the arrow is pointing to. On X-ray, you find there to be calcification. In a female, yes, tends to be more benign. But in a male teratoma tends to be much more aggresive and malignant.

    06:47 More about teratoma to come including struma ovarii, so on and so forth that very much behaves like your primary hyperthyroidism. Yes you heard that here. And hear it again and again. And by the time we're done, all about reinforcement, this will be a permanent part of your learning.

    07:03 Teratoma. What we are seing here is a calcification. The white-ish area that we are seing on CT.

    07:13 Once again, a teratoma, you find this to be all kinds of particles. And what i mean by that is origin might be ectoderm, endoderm, mesoderm.


    About the Lecture

    The lecture Benign Neoplasm and Teratoma – Neoplasia by Carlo Raj, MD is from the course Cellular Pathology: Basic Principles.


    Included Quiz Questions

    1. Large size
    2. Well demarcated
    3. Slow growing
    4. Well differentiated
    5. Resembles normal tissue
    1. Well demarcated benign neoplasms.
    2. Benign neoplasms of adipocyte origin.
    3. Neoplasms with a connecting stalk.
    4. Benign neoplasms that are likely to become malignant.
    5. Benign neoplasms of the colon.
    1. Colon
    2. Towards the midline
    3. Pineal gland
    4. Anterior mediastinum
    5. Ovary/testes
    1. Teratoma
    2. Lipoma
    3. Leiomyoma
    4. Tubular adenoma
    5. Fibroma

    Author of lecture Benign Neoplasm and Teratoma – Neoplasia

     Carlo Raj, MD

    Carlo Raj, MD


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    Importance of knowledge with clinical application.
    By SULBHA S. on 15. September 2018 for Benign Neoplasm and Teratoma – Neoplasia

    I love the clinical application. It makes it so much more exciting to learn and remember because as Dr Carlos Raj points out it's not just memorising. I must say his way of speaking makes it even more exciting :) On a serious note though-mentioning how serious it is to act on dysplasia or when the BM is involved-we should be saying omg, and not looking at him. Looking forward to more lectures-wish he was lecturing the subjects to keep that interest and significance of the subject and our job.