Cancer in the lymph nodes: signs of cancer, how it appears, diagnosis and treatment. Damage to the lymph nodes of the neck by metastases of malignant tumors Diagnosis and treatment of metastases to the lymph nodes

A tumor (tumor, blastoma, neoplasm, neoplasm) is a pathological process based on the unlimited and unregulated proliferation of cells with the loss of their ability to differentiate. The science that studies the causes, mechanisms of development, types, morphology and clinical picture of tumors, as well as their consequences, is called oncology. Unlike all other types of cell reproduction (during inflammation, reparative regeneration, hypertrophy, etc.), tumor growth does not have any adaptive or compensatory meaning. This is a purely pathological process that has existed for as long as life on Earth. Moreover, there is no living organism in which a tumor could not arise. It can develop in all animals, birds, fish, insects, and single-celled plants. However, tumors are most common in humans, being the second leading cause of death.

Epidemiology of tumors. At the same time, at least 6 million people in the world suffer from tumors, and about 2 million of them die every year. During the year, approximately 2 million new cases of tumor diseases are registered. An increase in morbidity and mortality from tumors is observed in all countries of the world and in all age groups, but especially after 50 years, with men getting sick 1.5 times more often than women. In the structure of morbidity in men since 1981, the leading place is occupied by cancer of the lung, stomach and colon, and in women - cancer of the breast, uterus and colon. Cancer incidence depends on various factors - geographical (it varies in different countries and regions), working conditions, living conditions, ecology, and nutrition of the population. To a certain extent, the increase in the incidence of neoplasms is associated with an increase in life expectancy, since tumors develop more often in older and older people. In Russia at the turn of the 20th and 21st centuries, the number of patients with malignant neoplasms was 303.3 per 100,000 people (i.e., about 1,500,000), and within a year, 36.2% of them died.

STRUCTURE OF TUMORS

Tumors are extremely diverse, they develop in all tissues and organs, and can be benign And malignant; in addition, there are tumors that occupy an intermediate position between benign and malignant - "borderline tumors" However, all tumors have common features.

Tumors can have a variety of shapes - either in the form of nodes of varying sizes and consistency, or diffusely, without visible boundaries, grow into surrounding tissues. Tumor tissue may undergo necrosis and hyalinosis. calcification. The tumor often destroys blood vessels, resulting in bleeding.

Any tumor consists of parenchyma (cells) and stroma (extracellular matrix, including stroma, microcirculation vessels and nerve endings). Depending on the predominance of parenchyma or stroma, the tumor can be soft or dense. The stroma and parenchyma of the neoplasm differ from the normal structures of the tissues from which it arose. This difference between the tumor and the original tissue is called atypia or anaplasia. There are morphological, biochemical, immunological and functional atypia.

Morphological atypia consists of two types: tissue and cellular.

Tissue atypia characterized by a violation of the relationships between various elements of the original tissue. For example, a benign skin tumor, papilloma (Fig. 33), differs from normal skin in the disruption of the relationship between the epidermis and dermis: in some areas the epidermis is deeply and unevenly immersed in the dermis, in others, fragments of the dermis are localized in the epidermis. The number of layers of epidermal cells in different areas of the tumor is different. However, the cells themselves have a normal structure.

Cellular atypia consists of pathological changes in tumor parenchyma cells, in which they lose the ability to mature and differentiate. The cell usually stops at the early stages of differentiation, often becoming similar to embryonic cells. This condition is called anaplasia: tumor cells have different sizes and shapes, the nuclei increase in size, have an ugly appearance, occupy most of the cytoplasm of the cell, the amount of chromatin and nucleoli increases in them, and irregular mitoses constantly occur. Intracellular structures also become atypical: mitochondria acquire an ugly shape, the number of cristae in them decreases, the endoplasmic reticulum expands unevenly, and the number of ribosomes, lysosomes, and various inclusions in the cytoplasm increases. The more pronounced the cellular atypia is, the more the tumor cells differ from the cells of normal tissue, the more malignant the tumor and the more severe its prognosis. And vice versa, the higher the degree of differentiation the tumor cells have reached, the more similar they are to the original tissue, the more benign the course of the tumor.

Biochemical atypia reflects changes in tumor metabolism, which underlies its uncontrolled growth.

All types of metabolism change, but the most characteristic are changes in carbohydrate and energy metabolism, the result of which is an increase in anaerobic glycolysis by 10-30 times and a weakening of tissue respiration. The resulting acidosis adversely affects the acid-base state of the blood and other tissues. In a tumor, the synthesis of protein and nucleic acids prevails over their breakdown. Tumor tissue actively absorbs amino acids, competing with normal tissues, both quantitative and qualitative changes in proteins occur in it, and lipid synthesis is disrupted. The tumor intensively absorbs water and accumulates potassium ions, which promote cell proliferation. At the same time, the concentration of calcium decreases, as a result of which intercellular connections are weakened, which promotes infiltrating growth and metastasis of the tumor.

Immunological atypia lies in the fact that tumor cells differ from normal ones in their antigenic structure. There is a point of view that the tumor process, especially tumor progression, occurs only when the body’s immune system is suppressed, which is almost always observed in cancer patients. However, this inhibition is largely mediated by tumor antigens.

Functional atypia occurs as a result of the development of morphological, biochemical and immunological atypia in tumors. It is manifested by changes in functions characteristic of normal cells of the original tissue. In some cases, for example, with hormone-producing tumors of the endocrine glands, the specific function of their cells is increased in the absence of an increased need for hormones by the body. In other cases, due to stopping the maturation of tumor cells, they stop their specific activities. Thus, with tumors of the hematopoietic tissue, immature cells of the myeloid and monocytic series lose the function of phagocytosis and therefore do not participate in the formation of the body’s immune defense against the tumor. As a result, cancer patients usually develop immune deficiency, which contributes to the occurrence of infectious complications. Often, tumor cells begin to perform a perverted function that is not typical for them: for example, colloid stomach cancer cells produce mucus specific to the intestine, plasmacytoma cells (analogues of plasma cells) in multiple myeloma produce unusual proteins - paraproteins, etc.

The atypicality of tumors extends both to their cells and to the stroma, which occurs along with the atypical growth of tumor cells.

GROWTH OF TUMORS

The growth of tumors is a defining feature of a tumor, because it is characterized infinity and autonomy. This means that the tumor is not subject to the regulatory influences of the body and grows without stopping for as long as the life of the person in whom it originates.

TYPES OF TUMOR GROWTH

Expansive growth characterized by the fact that the tumor grows as if “from itself.” Its cells, while multiplying, do not go beyond the tumor, which, increasing in volume, pushes away the surrounding tissues, which undergo atrophy and are replaced by connective tissue. As a result, a capsule is formed around the tumor and the tumor node has clear boundaries. This growth is typical for benign neoplasms.

Infiltrating, or invasive, growth consists of diffuse infiltration, ingrowth of tumor cells into surrounding tissues and their destruction. In this case, it is very difficult to determine the boundaries of the tumor. It grows into blood and lymphatic vessels, its cells penetrate into the blood or lymph flow and are transferred to other organs and areas of the body. This growth characterizes malignant tumors.

Exophytic growth observed only in hollow organs (stomach, intestines, bronchus, etc.) and is characterized by the spread of the tumor mainly into the lumen of the organ.

Endophytic growth also occurs in hollow organs, but in this case the tumor grows mainly in the thickness of the wall.

Unicentric growth characterized by the occurrence of a tumor in one area of ​​​​tissue and, accordingly, one tumor node.

Mulycentric growth means the occurrence of tumors simultaneously in several areas of an organ or tissue.

TYPES OF TUMOR

There are benign and malignant tumors.

Benign tumors consist of mature differentiated cells and are therefore close to the original tissue. There is no cellular atypia in them, but there is tissue atypia. For example, a tumor of smooth muscle tissue - fibroids (Fig. 34) consists of muscle bundles of different thicknesses, running in different directions, forming numerous vortices, and in some areas there are more muscle cells, in others - stroma. The same changes are observed in the stroma itself. Often, foci of hyalinosis or calcification appear in the tumor, which indicates qualitative changes in its proteins. Benign tumors grow slowly and have expansive growth, pushing away surrounding tissue. They do not metastasize and do not have a general negative effect on the body.

However, at a certain location, morphologically benign tumors can clinically develop a malignant course. Thus, a benign tumor of the dura mater, increasing in size, compresses the brain, which leads to the death of the patient. In addition, benign tumors may become malignant or become malignant i.e., acquire the character of a malignant tumor.

Malignant tumors characterizes a number of signs: cellular and tissue atypia, infiltrating (invasive) growth, metastasis, recurrence and the general effect of the tumor on the body.

Rice. 34. Leiomyoma. Bundles of smooth muscle cells of varying thicknesses are unevenly distributed.

Cellular and tissue atypia is that the tumor consists of immature, poorly differentiated, anaplastic cells and atypical stroma. The degree of atypia can be different - from relatively low, when the cells resemble the original tissue, to pronounced, when the tumor cells are similar to embryonic ones and by their appearance it is impossible to recognize even the tissue from which the tumor arose. That's why according to the degree of morphological atypia malignant tumors can be:

• well differentiated (for example, squamous cell carcinoma, adenocarcinoma);
• poorly differentiated (for example, small cell carcinoma, mucinous carcinoma).

Infiltrating (invasive) growth does not allow accurately determining the boundaries of the tumor. Due to the invasion of tumor cells and the destruction of surrounding tissues, the tumor can grow into blood and lymphatic vessels, which is a condition for metastasis.

Metastasis- the process of transfer of tumor cells or their complexes with the flow of lymph or blood to other organs and the development of secondary tumor nodes in them. There are several ways to transfer tumor cells:

• lymphogenous metastasis characterized by the transfer of tumor cells through the lymphatic tract and develops mainly in cancer;
• hematogenous metastasis carried out through the bloodstream, and sarcomas predominantly metastasize this way;
• perineural metastasis observed mainly in tumors of the nervous system, when tumor cells spread throughout the perineural spaces;
• contact metastasis occurs when tumor cells spread across mucous or serous membranes in contact with each other (leaves of the pleura, lower and upper lips, etc.), while the tumor moves from one mucous or serous membrane to another;
• mixed metastasis characterized by the presence of several routes of tumor cell transfer. For example, with stomach cancer, lymphogenous metastasis first develops in regional lymph nodes, and as the tumor progresses, hematogenous metastases occur in the liver and other organs. Moreover, if the tumor grows into the wall of the stomach and begins to contact the peritoneum, contact metastases appear - peritoneal carcinomatosis.

Recurrence- re-development of the tumor in the place where it was removed surgically or using radiation therapy. The cause of relapse is the remaining tumor cells. Some benign tumors can sometimes recur after removal.

General effect of the tumor on the body caused by metabolic disorders due to unusual reflex effects from the tumor, increased absorption of glucose, amino acids, vitamins, lipids from normal tissues, and inhibition of redox processes. Patients develop anemia, hypoxia, and quickly lose weight to the point of cachexia, or exhaustion. This can be facilitated by secondary changes in the tumor itself (necrosis of its tissue) and intoxication of the body with decay products.

PRE-TUMOR PROCESSES

Any tumor is preceded by some other diseases, usually associated with continuously repeating processes of tissue damage and constantly ongoing reparative reactions in connection with this. Probably, the continuous stress of regeneration, metabolism, synthesis of new cellular and extracellular structures leads to the hollow mechanisms of these processes, which is manifested in a number of their changes, which are, as it were, intermediate between normal and tumor. Precancerous diseases include:

• chronic inflammatory processes, such as chronic bronchitis, chronic colitis, chronic cholecystitis, etc.;
• metaplasia - changes in the structure and function of cells belonging to the same tissue germ. Metaplasia usually develops in the mucous membranes as a result of chronic inflammation. An example is the metaplasia of cells of the gastric mucosa, which lose their function and begin to secrete intestinal mucus, which indicates deep damage to the repair mechanisms;
• dysplasia is the loss of a physiological nature by the reparative process and the acquisition by cells of an ever-increasing number of signs of atypia. There are three degrees of dysplasia, the first two being reversible with intensive treatment; the third degree differs very slightly from tumor atypia, therefore in practice severe dysplasia is treated as the initial forms of cancer.

CAUSES AND MECHANISMS OF TUMOR Occurrence - ONCOGENESIS

At present, many facts have been discovered that make it possible to trace the conditions and mechanisms of the occurrence of tumors, and yet it cannot yet be assumed that the reasons for their development are precisely known. However, based on data, especially obtained in recent years thanks to advances in molecular pathology, we can speak with a high degree of probability about these reasons.

The cause of tumor development is changes in the DNA molecule in the cell genome under the influence of various carcinogens - factors that can cause genetic mutations. In this case, a condition facilitating the implementation of the action of carcinogens is a decrease in the effectiveness of antitumor protection, which is also carried out at the genetic level - with the help of antioncogenes P 53, Rb. There are 3 groups of carcinogens: chemical, physical and viral.

Chemical carcinogens. According to WHO. More than 75% of human malignant tumors are caused by exposure to chemical environmental factors. Tumors are caused mainly by combustion products of tobacco (about 40%): chemical agents included in food (25-30%), and compounds used in various areas of production (about 10%). More than 1,500 chemical compounds are known to have a carcinogenic effect. Of these, at least 20 are definitely the cause of tumors in humans. The most dangerous carcinogens belong to several classes of chemicals.

To organic chemical carcinogens relate:

• polycyclic aromatic carbons - 3,4-benzpyrene, 20-methylcholanthrene, dimethylbenzanthracene (hundreds of tons of these and similar substances are emitted into the atmosphere of industrial cities every year);
• heterocyclic aromatic hydrocarbons - dibenzacridine. dibenzcarbazole, etc.;
• aromatic amines and amides - 2-naphthylamine, benzidine, etc.;
• organic substances with carcinogenic activity - epoxides, plastics, urethane, carbon tetrachloride, chlorethylamines, etc.

Inorganic carcinogens can have exo- and endogenous origin.

Exogenous compounds enter the body from the environment - chromates, cobalt, beryllium oxide, arsenic, asbestos and a number of others.

Endogenous compounds are formed in the body as a result of modification of normal metabolic products. Such potentially carcinogenic substances are metabolites of bile acids, estrogens, some amino acids (tyrosine, tryptophan), lipoperoxide compounds.

Physical carcinogens. Physical carcinogens include:

• radioactive radiation of substances containing 32 P, 131 I, 90 Sr, etc.;
• x-ray radiation;
• ultraviolet radiation in excess dose.

Those exposed to radiation during accidents at nuclear reactors, as well as during the bombing of Hiroshima and Nagasaki, have a much higher incidence of cancer than in the general population.

STAGES OF CHEMICAL AND PHYSICAL CARCINOGENESIS

Carcinogenic substances themselves do not cause tumor growth, which is why they are called procarcinogens or precarcinogens. In the body they undergo physical and chemical transformations, as a result of which they become true, ultimate carcinogens. It is these carcinogens that cause changes in the genome of a normal cell, leading to its transformation into a tumor cell.

The stages of carcinogenesis consist of two interrelated processes: initiation and promotion.

At the initiation stage, the carcinogen interacts with DNA sections containing genes that control cell division and maturation. Such areas are called proto-oncogenic. The initiated cell becomes immortalized, i.e. immortal.

At the promotion stage, oncogene is expressed and a normal cell is transformed into a tumor cell and a neoplasm is formed.

Biological carcinogens.

Biological carcinogens include oncogenic viruses. Based on the type of viral nucleic acid, they are divided into DNA-containing and RNA-containing.

• DNA viruses. The genes of DNA oncoviruses are capable of directly inserting into the genome of the target cell. A section of DNA oncovirus (oncogene), integrated with the cellular genome, can carry out tumor transformation of the cell. DNA-containing oncoviruses include some adenoviruses, papovaviruses and herpesviruses. such as the Epstein-Barr virus (which causes the development of lymphomas), hepatitis B and C viruses.
• RNA viruses- retroviruses. Integration of viral RNA genes into the cellular genome does not occur directly, but after the formation of their DNA copies using the enzyme reversetase.

STAGES OF VIRAL CARCINOGENESIS

• penetration of an oncogenic virus into a cell;
• inclusion of a viral oncogene into the cell genome;
• oncogene expression;
• transformation of a normal cell into a tumor cell;
• formation of a tumor node.

TUMOR TRANSFORMATION OF CELLS

The transformation of a normal genetic program into a program for the formation of tumor atypia occurs at the cellular level. Tumor transformation is based on persistent DNA changes. In this case, the tumor growth program becomes a cell program encoded in its genome. The single final result of the action of carcinogens of various natures (chemical, biological, physical) on cells and their tumor transformation is ensured by disruption of the interaction in the cellular genome of oncogenes and antioncogenes.

FEATURES OF TUMOR DEVELOPMENT

In the dynamics of oncogenesis of malignant tumors from cell to tumor tissue, several stages can be distinguished:

• cell proliferation on a limited area of ​​tissue; at this stage, morphological atypia does not yet appear;
• cell dysplasia, characterized by the gradual accumulation of signs of atypia:
• carcinoma in situ (cancer in place) - a cluster of atypical tumor cells that do not yet have tumor growth;
• infiltrating, or invasive, growth tumor tissue;
• tumor progression- increase in malignancy in the dynamics of oncogenesis. This phenomenon is due to the fact that as the tumor develops, various factors act on its cells to inhibit their growth. In this case, some of the cells die, but the most viable ones survive and continue to reproduce. It is they who turn out to be the most malignant and pass on their properties to their descendants, who in turn are subject to selection, becoming more and more malignant.

CLASSIFICATION OF TUMORS

Tumors are classified based on their belonging to a specific fabric. According to this principle, 7 groups of tumors are distinguished, each of which has benign and malignant forms.

1. Epithelial tumors without specific localization.
2. Tumors of exo- and endocrine glands and specific epithelial integuments.
3. Soft tissue tumors.
4. Tumors of melanin-forming tissue.
5. Tumors of the nervous system and meninges.
6. Hemoblastomas.
7. Teratomas (dysembryonic tumors).

The name of the tumor consists of two parts - the name of the tissue and the ending “oma”. For example, a tumor of bone - osteoma, adipose tissue - lipoma, vascular tissue - angioma, glandular tissue - adenoma. Malignant tumors from the epithelium are called cancer (cancer, carcinoma), and malignant tumors from the mesenchyme are called sarcomas, but the name indicates the type of mesenchymal tissue - osteosarcoma, myosarcoma, angiosarcoma, fibrosarcoma and so on.

EPITHELIAL TUMORS

Epithelial tumors can be benign or malignant.

BENIGN EPITHELIAL TUMORS

Benign epithelial tumors can arise from the surface epithelium and are called papillomas, and from the glandular epithelium - adenomas. Both have parenchyma and stroma and are characterized only by tissue atypia.

Papillomas(see Fig. 33) arise from flat or transitional epithelium - in the skin, mucous membranes of the pharynx, vocal cords, bladder, ureters and renal pelvis, etc.

They have the appearance of papillae or cauliflower, can be single or multiple, and sometimes have a stalk. Tissue atypism manifests itself in a violation of one of the main features of any epithelium - complexity, i.e., a certain arrangement of cells, as well as polarity, i.e., violation of the basal and apical edges of cells, but at the same time the basement membrane is preserved - the most important sign of expansive, and not invasive growth.

The course of papillomas from different types of integumentary epithelium is different. If skin papillomas (warts) grow slowly and do not cause much concern to a person, then papillomas of the vocal cords often recur after removal, and papillomas of the bladder often ulcerate, which leads to bleeding and the appearance of blood in the urine (hematuria). Any papilloma can malignize, turning into cancer.

Adenoma can occur wherever there is glandular epithelium - in the mammary, thyroid and other glands, in the mucous membranes of the stomach, intestines, bronchi, uterus, etc. It has expansive growth and has the appearance of a node, well demarcated from the surrounding tissue. A pedunculated mucosal adenoma is called adenomatous polyp Adenoma, in which parenchyma predominates, has a soft consistency and is called simple adenoma. If the stroma predominates. the tumor is dense and is called fibroadenoma. Fibroadenomas occur especially often in the mammary glands (Fig. 35).

Tissue atypia of adenomas is manifested in the fact that their glandular structures have different sizes and shapes; the epithelium can grow and branch in the form of papillae, sometimes in the form of trabeculae. Often, glandular formations in an adenoma do not have excretory ducts, so the secretion produced stretches the glands and the entire tumor turns out to consist of cavities - cysts, filled with liquid or mucous contents. Such an adenoma is called a cystadenoma. Most often they arise in the ovaries and sometimes reach enormous sizes. Adenomas of the endocrine glands usually have increased function, which is manifested by endocrine disorders. Adenomas can malignize, turning into cancer (adenocarcinoma).

MALIGNANT EPITHELIAL TUMORS

Cancer can develop in any organ where epithelial tissue is present and is the most common form of malignant tumors. It has all the signs of malignancy. Cancer, like other malignant neoplasms, is preceded by precancerous processes. At some stage of their development, the cells acquire signs of anaplasia and begin to multiply. Cellular atypia is clearly expressed in them. increased mitotic activity, many irregular mitoses. However, all this occurs within the epithelial layer and does not spread beyond the basement membrane, i.e., there is no invasive tumor growth yet. This very initial form of cancer is called “cancer in situ”, or carcinoma in situ (Fig. 36). Early diagnosis of pre-invasive cancer allows timely appropriate, usually surgical, treatment with a favorable prognosis.

Most other forms of cancer are macroscopically shaped like a nodule with indistinct boundaries that blend into the surrounding tissue. Sometimes a cancerous tumor diffusely grows into an organ, which becomes denser, the walls of hollow organs become thicker, and the lumen of the cavity decreases. Often the cancerous tumor ulcerates, which may cause bleeding. Based on the degree of decline in signs of maturity, several forms of cancer are distinguished.

Squamous cell carcinoma develops in the skin and mucous membranes. covered with squamous epithelium: in the oral cavity, esophagus, vagina, cervix, etc. Depending on the type of squamous epithelium, there are two types of squamous cell carcinoma - keratinizing and non-keratinizing. These tumors belong to differentiated forms of cancer. Epithelial cells have all the signs of cellular atypia. Infiltrating growth is accompanied by disruption of cell polarity and complexity, as well as destruction of the basement membrane. The tumor consists of strands of squamous epithelium that infiltrate the underlying tissue, forming complexes and clusters. In squamous cell keratinizing cancer, atypical epidermal cells are located concentrically, retaining the ability to keratinize. These keratinized nests of cancer cells are called "cancer pearls"(Fig. 37).

Rice. 36. Carcinoma in situ of the cervix. a - the layer of the integumentary epithelium of the mucous membrane is thickened, its cells are polymorphic, atypical, the nuclei are hyperchromic, there are many mitoses; b - the basement membrane is preserved; c - underlying connective tissue; d - blood vessels.

Squamous cell carcinoma can also develop on mucous membranes covered with prismatic or columnar epithelium, but only if, as a result of a chronic pathological process, its metaplasia into stratified squamous epithelium has occurred. Squamous cell carcinoma grows relatively slowly and gives lymphogenous metastases quite late.

Adenokarinoma - glandular cancer that occurs in organs that have glands. Adenocarcinoma includes several morphological varieties, some of which are differentiated, and some are undifferentiated forms of cancer. Atypical tumor cells form glandular structures of various sizes and shapes without a basement membrane or excretory ducts. In the cells of the tumor parenchyma, hyperchromic nuclei are expressed, there are many irregular mitoses, and there is also stromal atypia (Fig. 38). Glandular complexes grow into the surrounding tissue, without being delimited by anything from it, destroy lymphatic vessels, the lumens of which are filled with cancer cells. This creates conditions for lymphogenous metastasis of adenocarcinoma, which develops relatively late.

Rice. 37. Squamous cell keratinizing lung cancer. RJ - “cancer pearls”.

Solid cancer. In this form of tumor, cancer cells form compact, randomly located groups, separated by layers of stroma. Solid cancer refers to undifferentiated forms of cancer; it exhibits cellular and tissue anaplasia. The tumor quickly infiltrates surrounding tissues and metastasizes early.

Small cell cancer - a form of extremely undifferentiated cancer consisting of small, round, hyperchromatic cells resembling lymphocytes. Often, only through the use of special research methods can it be established that these cells belong to epithelial cells. Sometimes the tumor cells become somewhat elongated and resemble grains of oats (oat cell carcinoma), sometimes they become large (large cell carcinoma). The tumor is extremely malignant, grows quickly and gives early extensive lymphatic and hematogenous metastases.

Rice. 38. Adenocarcinoma of the stomach. a - glandular formations of the tumor: b - mitoses in cancer cells.

MESENCHYMAL TUMORS

Connective, adipose, muscle tissue, blood and lymphatic vessels, synovial membranes, cartilage and bones develop from mesenchyme. Benign and malignant tumors can arise in each of these tissues (Fig. 39). Among mesenchymal tumors, the group of tumors of soft tissues, adipose tissue and the group of primary bone tumors, which occur most often, are important.

SOFT TISSUE TUMORS

Benign mesenchymal tumors. These include fibroma, myoma, hemangiomas, lipoma.

Fibroma develops from mature fibrous connective tissue. It is found wherever there is connective tissue, and therefore in any organs, but more often in the skin, mammary gland, and uterus. Fibroma is characterized by tissue atypia, which is manifested by an irregular, chaotic arrangement of connective tissue fibers and uneven distribution of blood vessels. The tumor grows expansively and has a capsule. Depending on the predominance of stroma or parenchyma, fibroma can be dense or soft. The significance of a fibroma depends on its location - a skin fibroma does not cause much concern to the patient, but a fibroma in the spinal canal can cause severe disturbances in nervous activity.

Myoma- tumor of muscle tissue. According to the two types of muscles, fibroids have two variants: those arising from smooth muscles are called leiomyomas, and those from striated muscles are called rhabdomyomas. Tissue atypia consists of unequal thickness of muscle bundles running in different directions and forming vortices. Tumors in which the stroma is highly developed are called fibromyomas. Leiomyomas are most often found in the uterus, where they sometimes reach significant sizes. Rhabdomyoma is a rarer tumor that can occur in the muscles of the tongue, in the myocardium, and in other organs containing striated muscle tissue.

Rice. 39. Mesenchymal tumors, a - solid fibroma of the subcutaneous tissue; b - soft skin fibroma; c - multiple uterine leiomyomas; d - fibrosarcoma of the soft tissues of the shoulder.

Rice. 40. Differentiated fibrosarcoma.

Hemangiomas- a group of tumors from blood vessels. Depending on which vessels tumor growth arises from, capillary, venous and cavernous hemangiomas are distinguished.Capillary hemangiomaIt is usually congenital and localized in the skin in the form of purple spots with an uneven surface.Venous angiomaconsists of vascular cavities. resembling veins.Cavernous hemangiomaalso consists of vascular cavities of different sizes and shapes, with unequal wallsthickness. Blood clots often form in vascular cavities. When injured, cavernous hemangioma can cause profuse bleeding. Venous and cavernous angiomas occur most often in the liver, muscles, and sometimes in the bones and brain.

Lupoma - a tumor of adipose tissue, grows expansively in the form of one or multiple nodes, usually has a capsule. It is most often located in the subcutaneous fatty tissue, but can occur anywhere there is adipose tissue. Sometimes the lipoma reaches very large sizes.

Malignant mesenchymal tumors. These tumors have the general name of sarcoma and, when cut, resemble fish meat. They develop from the same tissues (mesenchyme derivatives) as benign mesenchymal tumors. They are characterized by pronounced cellular and tissue atypia, as well as hematogenous metastasis, as a result of which metastases appear quite quickly and are widespread. Therefore, sarcomas are very malignant. There are several types of soft tissue sarcomas: fibrosarcoma, liposarcoma, myosarcoma, angiosarcoma.

Fibrosarcoma arises from fibrous connective tissue, has the appearance of a node with unclear boundaries, and infiltrates the surrounding tissues. It consists of atypical fibroblast-like round or polymorphic cells and immature collagen fibers (Fig. 40). Fibrosarcoma usually occurs in the shoulder, hip, and soft tissue of other parts of the body. It is characterized by pronounced malignancy.

Liposarcoma develops from immature fat cells (lipocytes) and lipoblasts. It can reach large sizes and not metastasize for a long time. The tumor is relatively rare.

Myosarcota Depending on the type of muscle tissue, they are divided into leiomyosarcoma and rhabdomyosarcoma. The cells of these tumors are extremely atypical and polymorphic, often completely losing their resemblance to muscle tissue, and therefore identification of the original tissue is only possible using an electron microscope.

Angiosarcoma- malignant tumor of vascular origin. Consists of atypical endothelial cells and pericytes. It is highly malignant and gives early hematogenous metastases.

PRIMARY BONE TUMORS

Benign bone tumors.

Chondroma- a tumor of hyaline cartilage that grows in the form of a dense node or nodes in the area of ​​​​the joints of the hands, feet, vertebrae, and pelvis. Histologically, it consists of a random arrangement of hyaline cartilage cells enclosed in a ground substance.

Osteoma occurs in the bones, most often in the bones of the skull. Histologically, it consists of randomly located bone beams, between which connective tissue grows. Among osteomas, a special place occupies “giant cell tumor” (benign osteoblastoma), which consists of multinucleated giant cells. Its peculiarity is this. that it destroys bone, but does not metastasize.

Malignant bone tumors.

Osteosarcoma occurs in the bones, often after injury. Consists of atypical osteoblasts with a large number of irregular mitoses. The tumor quickly destroys bone, grows into surrounding tissues, and gives multiple hematogenous metastases, especially to the liver and lungs. The lung affected by metastases has the appearance of a “cobblestone street”.

Chondrosarcoma consists of atypical cartilaginous cells; its tissue is often slimy and necrotic. Chondrosarcoma grows relatively slowly and metastasizes later than other sarcomas.

TUMORS OF MELANIN-FORMING TISSUE

Melanin-forming tissue is a type of nervous tissue and includes melanoblast cells and melanocytes containing the pigment melanin. These cells form tumor-like benign formations - nevi (Fig. 41).

Rice. 41. Pigmented nevus. Melanin-synthesizing cells form islands (a), separated by layers of connective tissue (b). Melanin grains in the cytoplasm of connective tissue cells (c).

Their traumatization often causes the transformation of a nevus into a malignant tumor - melanoma. Melanoma develops not only from nevi, but also from other tissues containing melanin-forming cells - the pigment membrane of the eyes, meninges, and adrenal medulla. Externally, melanoma is a nodule or plaque of black or brown color with black inclusions. Histologically - a cluster of polymorphic, ugly cells containing inclusions of brown melanin, with many mitoses, sometimes with areas of hemorrhage and necrosis. Melanoma is difficult to treat.

Lymph nodes of the abdominal cavity and retroperitoneal space and pelvis - treatment of advanced cancer

If the tumor was not detected at an early stage, it begins to spread to other parts of the body. One of the most common “targets” of metastasis are lymph nodes. Moreover, most malignant tumors of the abdominal organs give metastases to nearby parts of the lymphatic system.

This means that with a high degree of probability the patient, simultaneously with treatment of the primary tumor, will have to treat metastases in lymph nodes of the abdominal cavity, retroperitoneum and pelvis. In modern conditions, treatment tactics include simultaneous treatment of the primary tumor and metastases to the lymph nodes CyberKnife (radiosurgery), or surgical removal affected lymph nodes (if the primary tumor was carried out), as well as radiation therapy affected lymph nodes, or those to which the tumor process could have spread with a high degree of probability. It is also widely used as a treatment for metastases (including to lymph nodes). chemotherapy.

Combined treatment of lymph node metastases

Traditionally, local spread of primary tumor cells into nearby lymph nodes is quite common. If the choice of radical treatment method was chosen surgery, the patient is recommended removal of nearby lymph nodes. If the lymph nodes are affected by distant metastases (lymphogenous metastasis), their surgical treatment (second surgery) may be difficult due to the severity of the patient's condition or the large volume of intervention required.

In the case of multiple metastases, the patient is indicated for chemotherapy, and for the treatment of single metastases, high-precision radiation therapy IMRT is widely used in world practice. Also, radiation therapy is combined with surgical treatment of the primary tumor, after which most world protocols provide for irradiation of the removed tumor bed and lymph nodes.

Metastases to the lymph nodes of the abdominal cavity and retroperitoneum, plan for IMRT radiation therapy on a modern linear accelerator at the Spizhenko Clinic in Kyiv

Treatment of metastases in the lymphatic system with CyberKnife

The CyberKnife radiosurgical system is the most effective method of combating cancer metastases

In many cases, in order to treat metastases to the lymph nodes, it is not necessary to use surgical intervention, which is associated with the need for anesthesia, damage to healthy tissue during access to the metastasis, as well as a recovery period during healing. Such a bloodless alternative to traditional surgery is stereotactic radiosurgery, implemented using the CyberKnife system.

There is no clear recommendation that any lymph node metastasis should be treated with CyberKnife. In some cases, treatment of metastases in the lymph nodes of the abdominal cavity, retroperitoneal space and pelvis, greater effectiveness can be achieved by radical treatment using a high-precision linear accelerator (IMRT). Therefore, like any other treatment, radiosurgery on CyberKnife for lymph node metastases is prescribed after an interdisciplinary consultation, at which doctors of various specializations consider all aspects of a particular case in order to determine the most effective treatment regimen.

If the patient is indicated for radiosurgery on the CyberKnife, preliminary planning is carried out, during which, based on CT and MRI diagnostic data, a three-dimensional model of the relative position of the affected lymph node, surrounding healthy tissues will be created, and also the nearby body structures into which it is unacceptable will be taken into account. supply of ionizing radiation.

During each of the treatment sessions (fractions), CyberKnife, based on the treatment plan, will deliver many single beams of ionizing radiation, at the intersection of which a high-dose zone will be formed, corresponding to the shape and volume of metastasis in the lymph node. In addition, treatment of metastases using CyberKnife may be included in a fraction (session) for the treatment of the primary tumor or other metastases.

As a rule, the cost of treatment with CyberKnife is lower than with surgery, because there is no need for anesthesia or recovery period.

Cost of treatment

The cost of treatment of metastases to the lymph nodes at the Spizhenko Clinic for each patient is determined individually after consultation with a clinic specialist.

However, you can find out the preliminary cost of treatment in our oncology center by filling out a simple form using the button below.

After filling out the form, specialists from the Spizhenko Clinic will contact you and advise you on the cost of treatment.

Diagnostics

CT scan (CT) does not always allow to differentiate metastases and unchanged tissue of lymph nodes. Magnetic resonance imaging (MRI) has a slight advantage over CT, because MRI allows you to more accurately determine the stage of the tumor process in the pelvic organs.

What are metastases and where do they come from?

In a significant number of patients, when a tumor grows and has not received sufficient or timely treatment, metastases—secondary tumor nodes—appear in nearby and distant organs. Treatment of metastases is easier when they have small volumes, but micrometastases and circulating tumor cells are often not detected by available diagnostic methods.

Metastases can occur in the form of single nodes (single metastases), but can also be multiple. This depends on the characteristics of the tumor itself and the stage of its development.

There are the following ways of metastasis of cancer tumors: lymphogenous, hematogenous And mixed.

• lymphogenous- when tumor cells, having penetrated a lymph node, pass through the lymph flow to the nearest (regional) or distant lymph nodes. Cancerous tumors of internal organs: esophagus, stomach, colon, larynx, cervix often send tumor cells through this route to the lymph nodes.
• hematogenous- when cancer cells, penetrating a blood vessel, pass through the bloodstream to other organs (lungs, liver, skeletal bones, etc.). In this way, metastases appear from cancerous tumors of lymphatic and hematopoietic tissue, sarcoma, hypernephroma, chorionepithelioma.

Lymph nodes of the abdominal cavity divided into parietal and internal:

• parietal (parietal) nodes concentrated in the lumbar region. Among them are the left lumbar lymph nodes, which include the lateral aortic, pre-aortic and post-aortic nodes, intermediate lumbar nodes located between the portal and inferior vena cava; and the right lumbar nodes, which include the lateral caval, precaval and postcaval lymph nodes.
• visceral (visceral) nodes arranged in several rows. Some of them are located on the path of lymph from the organs along the large splanchnic vessels and their branches, the rest are collected in the area of ​​the gates of the parenchymal organs and near the hollow organs.

Lymph from the stomach enters the left gastric nodes located in the area of ​​the lesser curvature of the stomach; left and right gastroepiploic nodes located in the area of ​​the greater curvature of the stomach; hepatic nodes following along the hepatic vessels; pancreatic and splenic nodes located at the hilum of the spleen; pyloric nodes running along the gastroduodenal artery; and into the cardiac nodes that form the lymphatic ring of the cardia.

For cancerous tumors in abdominal cavity(stomach) and pelvic cavity(ovary), dissemination of the process occurs throughout the peritoneum in the form of small “dust” metastases with the development of hemorrhagic effusion - ascites.

Metastatic ovarian cancer can arise from any organ affected by cancer, but is most often observed when tumor cells are carried either by the bloodstream or retrogradely through the lymphatic tract (). Metastatic ovarian cancer has rapid growth and a more malignant course. Most often, both ovaries are affected. The tumor early spreads to the pelvic peritoneum, forming multiple tuberous tumor nodes.

With metastasis ovarian cancer in various organs in the first place are metastases to the peritoneum, in second place - to the retroperitoneal lymph nodes, then - the greater omentum, iliac lymph nodes, liver, lesser omentum, second ovary, pleura and diaphragm, mesenteric lymph nodes, mesentery of the intestine, parametrial fiber, inguinal lymph nodes, lungs, spleen, uterus, cervical lymph nodes, kidneys, adrenal glands, navel.

In the skin, the tumor node is delimited by a pink connective tissue capsule. Bundles of tumor cells are located chaotically. At higher magnification, rod-shaped hyperchromatic cell nuclei are determined.

Essential Elements: 1. tumor smooth muscle cells

2. connective tissue capsule

No. 127. Myxoma

The tumor consists of rare, loosely lying cells. At higher magnification, the branched nature of the cells is noted. The cells lie in a basophilic mucus-like homogeneous substance.

Essential Elements: 1. process cells

2. basophilic substance

No. 128. Lymphangioma of the tongue

A microslide shows a section of the tongue. Multilayered squamous non-keratinizing epithelium is visible from the surface, the papillae are clearly expressed. The epithelial layer is thickened, with acanthosis (submerged growth of the epithelium). Under the epithelium in the muscle tissue, a formation of lymphatic vessels is determined. The vessels are located chaotically, collapsed, dilated and filled with lymph. The stroma is fibrous, with round cell infiltrates. The tumor has an infiltrative growth pattern.

Essential Elements: 1. tumor vessels

2. round cell infiltrates

3. epithelial acanthosis

No. 129. Hemangioma of the tongue

The specimen shows a section of the tongue with a squamous epithelial lining and papillae. A round-shaped tumor nodule is detected in the subepithelial muscle tissue. The structure of the tumor in different areas is not the same. In the center there are compactly lying polygonal cells that form small capillary-type vessels. At the periphery of the node, cavernous vessels with a wide, irregularly shaped lumen containing single red blood cells are visible.

Essential Elements: 1. capillary tumor vessels

2. cavernous tumor vessels

No. 130. Capillary angioma of the skin

The microscopic structure of the skin is changed. In multilayered squamous epithelium, the stratum corneum is wide (hyperkeratosis), the epithelial layer and interpapillary processes of the epidermis are thickened (acanthosis), and there are horny cysts and plugs. In the dermis, numerous and full-blooded capillaries are located chaotically, in some places in the form of plexuses. At higher magnification, forming capillaries and cellular infiltrates are noted.

Essential Elements: 1. tumor capillaries

2. altered epithelium

3. cellular infiltrates

No. 131. Cavernous and liver angioma

In the liver there are full-blooded vascular formations of the cavernous type. At higher magnification, thin vessel walls are visible, the stroma is fibrous and in places hyalinized. The surrounding liver cells are without pronounced changes.

Essential Elements: 1. tumor vessels

2. liver cells

No. 132. Chondroma

The structure of the tumor resembles hyaline cartilage, in which the cells are unevenly distributed, and there is mosaic basophilia in the interstitial substance. At higher magnification, blurred cellular polymorphism is noted, individual cells without capsules, and some capsules have two or more nuclei.

Essential Elements: 1. tumor cartilage-like cells

2. basophilic foci in the cartilaginous substance

No. 133. Fibrosarcoma

A tumor of cellular (histoid) structure. Cellular cords and bundles are chaotically intertwined, forming fan-shaped and ring-shaped structures. At higher magnification, cellular and, especially, nuclear polymorphism is noted; various figures of nuclear division are often found.

Essential Elements: 1. cell strands

2. cell polymorphism

3. nuclear polymorphism

4. nuclear fission figures

No. 134 Angiosarcoma

At low magnification, the tumor is determined in the form of individual cell clusters located in a structureless pink mass. At higher magnification, in the center of the tumor complexes, an undifferentiated blood vessel is visible, around which the tumor cells are arranged in a muff-like manner. Structureless pink masses around the tumor are necrotic tumor tissue.

Essential Elements

2. vessel in the center of the complex

3. zone of necrosis in tumor tissue

No. 135 Myxosarcoma

The tumor is represented by soft fibrous cellular tissue, forming randomly directed strands and containing a large number of small vessels. At higher magnification, polymorphic tumor cells are visible, some elongated, some stellate. The cell nuclei are hyperchromic, and pathological mitoses are found in a few of them.

Essential Elements: 1. bundles of tumor tissue

2. cellular polymorphism

No. 136. Myosarcoma

Muscle tumor cells form bundles of unequal size, arranged randomly. At higher magnification, a pronounced polymorphism of tumor cells is visible - they are of different shapes, their nuclei are of different sizes, and in some of them there are figures of pathological mitoses. Multinucleated cells are also found. The vessels in the tumor are dilated, full of blood, and there are hemorrhages along their periphery.

Essential Elements: 1. bundles of tumor cells

2. cellular polymorphism

No. 137. Chondrosarcoma

The tumor somewhat resembles hyaline cartilage in structure. The tumor exhibits tissue and cellular atypia. The cells are unevenly distributed. The intermediate substance is spotted lilac-pink, and in places where lime salts are deposited it is dark blue. At higher magnification, cell polymorphism and hyperchromia are noted.

Essential Elements: 1. polymorphic cells

2. nuclear hyperchromia

3. lime deposits

No. 138. Retinoblastoma

Histological specimen shows the posterior chamber of the eyeball. The choroid and retina are flattened and atrophic. Close to the retina is a tumor formed by elongated basophilic cells. Tumor growths have a rosette-shaped structure: a blood vessel lies in the center of the complex, and tumor cells are arranged radially around in the form of a muff. At the periphery of the complexes, necrosis is visible - a pale colored eosinophilic mass with small dark blue inclusions of nuclear dust. The tumor also contains calcifications—clumpy, large dark blue conglomerates.

Essential Elements: 1. tumor “rosettes”

2. foci of tumor necrosis

3. calcifications in the tumor

No. 139. Pigmented nevus (birthmark)

In the papillary layer of the skin and deeper, as well as at the border with the epidermis, there are clusters of cells that are intensely colored brown. At higher magnification, a dense content of melanin is noted in the cytoplasm of large cells (nevus cells) and in elongated connective tissue cells (melanophores).

Essential Elements: 1. melanin in nevus cells

2. melanin in melanophores

No. 140. Blue nevus

In the dermis, in its papillary and reticular layers, chaotically located clusters of cells with a high content of the brown pigment melanin are visible. This is a tumor. The cells contain clumps and grains of melanin pigment, which are clearly visible at higher magnification. Clumps of pigment lie freely among the cells.

Essential Elements: 1. melanin in tumor cells

2. free-lying pigment

No. 141. Melanoma

In a section of the eye, there is a choroid with a large amount of brown-brown pigment (melanin) and a tumor layer consisting of closely adjacent cells. There are also large deposits of melanin in the tumor, mainly in the periphery. At higher magnification, a chaotic arrangement of polymorphic cells with nuclear division patterns is noted. Small grains and clumps of melanin are visible in the cytoplasm and outside the cells.

Essential Elements: 1. choroid

2. tumor

3. polymorphic cells

4. melanin

No. 142. Sympathogonioma

The tumor has a lobular structure and consists of small round cells arranged randomly and compactly. At higher magnification, cells are identified that have a hyperchromic round-oval nucleus and a very narrow rim of cytoplasm. They resemble sympathogonia. Tumor cells in some places form so-called pseudorosettes. Pseudosockets are built from cells arranged in a ring shape; in the center there is a soft fibrous content, colored pink.

Essential Elements: 1. tumor lobules

2. tumor sympathogonia

3. pseudo-sockets

No. 143. Galioneuroma

A tumor of a cellular fibrous structure with fields of necrosis and foci of deposition of lime salts of a dark blue color. Clumps of stroma form cords running in different directions. Felt-like fibrous structures. Ganglion type cells are distributed unevenly. At higher magnification, these cells are polymorphic, the nuclei and cytoplasm have a color of varying intensity. There are cells with two nuclei. Around the ganglion type cells there are satellite cells.

Essential Elements: 1. ganglion type cells

2. satellite cells

3. cell cords

4. poly necrosis

5. pockets of lime deposits

No. 144. Meningioma

In a tumor, cells are arranged in concentric structures and whorls, the center of which contains a blood vessel. In some concentric structures lie psammomas - formations of a dark blue color, sometimes layered, round in shape. These are deposits of calcareous salts in necrobiotic, fibrous and hyalinized areas of the tumor. At higher magnification, oval, elongated or polygonal cells are noted; the cell nuclei are round oval and pale.

Essential Elements: 1. cellular concentric structures
2. psammomas

No. 145. Neurogenic sarcoma (malignant neurilemmoma )

The tumor consists of polymorphic cells, the bulk of which have a spindle-like shape. The nuclei are polymorphic, their division figures are visible. Multinuclear formations (symplasts) are found. Cells form bundles going in different directions. “Palisade” structures (Verocai bodies) are determined - alternating sections of parallel nuclei with sections consisting of fibers. Nerve trunks of a normal structure can be found in the tumor.

Essential Elements: 1. tumor cells

2. nuclear fission figures

3. simplasts

4. Verocai corpuscles

5. nerve trunks

No. 146. Teratoma

The tumor consists of connective tissue in which areas of well-differentiated mature stratified squamous epithelium, intestinal and respiratory epithelium randomly alternate, forming organoid structures. There are elements of peripheral nerves, fatty tissue, smooth muscles, and cartilage.

Essential Elements: 1. connective tissue

2. epithelium

3. nerve trunks

4. adipose tissue

No. 147. Teratoblastoma

The tumor reveals foci of proliferation of immature intestinal, respiratory, stratified squamous epithelium, immature striated muscles, cartilage, located among immature, loose, sometimes myxomatous mesenchymal tissue. Areas consistent with neuroblastoma are visible. Among the immature elements of the embryonic type there are areas of mature teratoma tissue.

Essential Elements: 1. foci of mucus formation in mesenchymal tissue

2. immature epithelium

3. immature striated muscles

4. areas of neuroblastoma

5. areas of mature teratoma

No. 148. Fibrous epulis

The surface of the epulis is covered with squamous epithelium with acanthotic growths. Epulis consists of bundles of mature connective tissue, arranged in no particular order, chaotically, with a small number of blood and lymphatic vessels. Inflammatory infiltrates are located perivascularly and among connective tissue structures. At higher magnification, inflammatory infiltrates consist predominantly of plasma and lymphoid cells, among which are neutrophils.

Essential Elements: 1. connective tissue bundles

2. inflammatory cell infiltrate

3. epithelium with acanthotic growths

No. 149. Giant cell epulis

Epulis cellular structure. Its main structural component is giant cells of irregular shape with a large number of nuclei. At higher magnification, among the giant cells there are mononuclear cells with an oval nucleus and red blood cells, free-lying and in the form of clusters (blood islands).

Essential Elements: 1. giant cells

3. red blood cells

4. blood islands

No. 150. Angiomatous epulis

The epulis is covered with stratified squamous epithelium with massive acanthotic growths. Epulis contains a large number of vessels, predominantly of the venous type. At higher magnification, between the vessels there are cellular elements and thin layers of connective tissue, leukocytes.

Essential Elements: 1. vessels

2. connective tissue bundles

3. neutrophils

4. epithelium with acanthotic growths

No. 151. Fibrous bone dysplasia

In the bone, a tumor-like proliferation of cellular-fibrous tissue is detected without the formation of a capsule. At the border, clusters of osteoclasts are visible, due to which the pre-existing bone is reabsorbed. Cellular-fibrous tissue is represented by collagen, reticulin fibers and fibroblast-like cells, among which primitive bone beams and areas of incomplete osteogenesis (areas of osteoid tissue) are randomly located.

Essential Elements: 1. collagen and reticulin fibers

2. fibroblast-like cells

3. primitive bone beams

4. osteoclasts

No. 152. Eosinophilic granuloma

A focus of destruction is identified in the bone, in which large histiocytes are visible with clearly defined round or oval nuclei, finely dispersed chromatin and clearly visible one or two nucleoli, with a wide zone of cytoplasm stained oxyphilic. In addition to histiocytes, eosinophilic granuloma contains eosinophils, a small number of lymphocytes, plasma cells, non-core leukocytes, multinucleated giant cells, fibroblasts, and xanthoma cells. Areas of cell decay, hemorrhages, and areas of connective tissue proliferation are visible.

Essential elements: 1. histiocytes

2. eosinophils

3. areas of cell decay

4. foci of fibrosis

No. 153. Radicular cyst

The inner layer of the cyst wall consists of stratified squamous epithelium of varying thickness. In some places the epithelium is desquamated and the surface is represented by a granulation shaft. The epithelium is located on the connective tissue membrane of the bundle structure. Perivascular round cell infiltrates, cholesterol crystals and xanthoma cells are locally found in the capsule.

Essential Elements: 1. cyst wall

3. connective tissue membrane

4. cellular infiltrates

No. 154. Follicular cyst

The cyst wall consists of granulation tissue of varying degrees of maturity and bundles of collagen fibers. The inner surface of the cyst is lined with stratified squamous epithelium, which is located on granulation tissue.

Essential Elements: 1. granulation tissue

2. bundles of collagen fibers

3. stratified squamous epithelium

No. 155. Primordial cyst (keratocyst)

The cyst wall is thin, represented by connective tissue fibers, the inner surface is lined with stratified squamous epithelium with pronounced parakeratosis. Islands of odontogenic epithelium are visible in the cyst wall. The contents of the cyst are horny masses.

Essential Elements: 1. fibrous capsule

2. stratified squamous epithelium

3. islands of odontogenic epithelium

No. 156 Mixed tumor of the salivary gland

The structure of the tumor is varied. The cells form cords and nests of irregular shape. In places, glandular tubes are visible, in the lumen of which a homogeneous pink secretion has accumulated. Among the tumor cells there are “lakes” of basophilic substance (mucoid component), in which stellate cells (myxoid component) lie. There are areas with cartilage-like cells (chondroid component). At higher magnification, the tumor cliques are round-oval, forming primitive glands in some places.

Essential Elements: 1. strands of tumor cells

2. mucoida lakes

3. myxoid lesions

4. chondroid areas

No. 157. Mucoepidermoid tumor

The tumor consists of epithelial strands and glands, which are mainly cystic and contain eosinophilic secretions. The stroma is developed and represented by bundles of collagen fibers with a small number of fibrocytes and fibroblasts. At higher magnification, the epithelial cells are in some places of the epidermoid type, in others they are clearly glandular.

Essential Elements: 1. Epidermoid cell sheets

No. 158. Papillary cystadenolymphoma

The tumor consists of glandular structures in which cysts and papillary growths are detected, as well as lymphoid tissue with the presence of light centers of reproduction. At higher magnification, the glandular structures and cystic cavities of the papillae are lined by double-layered epithelium. The cysts contain eosinophilic masses.

Essential Elements: 1. glandular structure

2. papillae

4. lymphoid tissue

5. light breeding centers

No. 159. Acinic cell tumor

Tumor of the glandular structure. Tumor cells are grouped into small and rather large alveolar structures. Sometimes there are small cystic formations filled with basophilic contents.

Essential Elements: 1. alveolar tumor structures

2. cystic formations

No. 160. Adenocarcinoma of the salivary gland

In the connective tissue, proliferations of tumor polymorphic glands are detected. The cells that form the glands are cubic, cylindrical, irregular in shape with hyperchromic nuclei. The lumen of the glands contains basophilic or oxyphilic content. There are lymphohistiocytic infiltrates in the tumor stroma.

Essential Elements: 1. polymorphic glands

2. polymorphic cells

3. lymphohistiocytic infiltrates

No. 161. Ameloblastoma

Tumor of a nested structure. At the periphery of the nests, tall cylindrical cells are arranged in a palisade, and as they approach the center they become increasingly loosened, become stellate and form an epithelial reticulum in which cavities are visible. Homogeneous masses lie at the center of some nest formations.

Essential Elements: 1. nested structures

2. columnar epithelium

3. epithelial reticulum

No. 162. Malignant ameloblastoma

The tumor is represented by islands or follicles of epithelial cells located in the connective tissue. The central sections of the follicles consist of polygonal cells resembling the pulp of a dental organ. At higher magnification, it is clear that the epithelial cells forming the follicles are hyperchromatic, polymorphic, and in some of them mitoses are detected, including atypical ones.

Essential Elements: 1. epithelial tumor follicles

2. cellular polymorphism

3. mitoses in epithelial cells

No. 163. Cementoma

The tumor consists of cellular-fibrous connective tissue, in which intensely calcified round or lobulated cement-like masses - cementicles - are located in violet color. Mostly the cementicles lie isolated, but some are fused with each other.

Essential Elements: 1. connective tissue

2. cementicles

No. 164. Abrikosov’s tumor

The tumor consists of large cells, their nuclei are round and located centrally. The cytoplasm is colored pale pink. At higher magnification, granularity of the cytoplasm is noted. The grains in the cell are scattered evenly. The stroma in the tumor is poorly represented. Delicate fibrous structures surround small complexes of tumor cells, forming cells.

Essential Elements: 1. tumor cell complexes

2. grains in the cytoplasm of tumor cells

No. 165. Osteoblastoclastoma

The tumor consists of elongated cells with a round or oval nucleus, among which are multinucleated giant cells - osteoclasts. In the tumor, newly formed bone beams are visible, which are surrounded by mononuclear cells - osteoblasts.

Essential Elements: 1. giant cells - osteoclasts

2. bone beams

3. osteoblasts

No. 166. Osteoma of the jaw bones

At low magnification, the tumor is represented by a solid bone mass of a fibrous and lamellar structure with very narrow vascular canals. At higher magnification, moderate cellular polymorphism is observed.

Essential Elements: 1. bone mass of fibrous structure

2. bone mass of lamellar structure

3. narrow vascular channels

4. tumor cells

No. 167. Brain in leukemia

In the brain, foci of leukemic infiltration are clearly visible, surrounded by a zone of diapedetic hemorrhages. At higher magnification, myeloid-like, poorly differentiated, round-shaped cells are identified, the nuclei of which are poor in chromatin.

In the brain there is a picture of pericellular and perivascular edema.

Essential Elements: 1. leukemic infiltrate

2. hemorrhage

No. 168. Myocardium in leukemia

The structure of the myocardium and endocardium is preserved. In the myocardial stroma and in the thickness of the endocardium there are leukemic infiltrates of poorly differentiated cells. At higher magnification, the infiltrates consist of myeloid-like, poorly differentiated cells. Their nuclei are large, irregular in shape, and the rim of cytoplasm is narrow.

Essential Elements: 1. leukemic infiltrates in the myocardial stroma

2. leukemic infiltrates in the endocardium

3. tumor polymorphic cells

No. 169. Lymph node in leukemia

The follicular structure of the lymph node is changed due to the proliferation of round small cells. At higher magnification, small cells with a hyperchromic nucleus are determined; almost completely occupying the cytoplasm. They resemble lymphocytes. Similar cells are also visible in the lymph node capsule and surrounding fatty tissue.

Essential Elements: 1. lymphocyte-like elements

No. 170. Bone marrow of the tubular bone of an adult in normal conditions and in chronic myeloid leukemia

There are two sections in the preparation. In one of them, the bone marrow of the tubular bone of an adult is normal: the bone marrow cavities are filled with adipose tissue, there are no foci of hematopoiesis. In another section, the bone marrow cavities are expanded, the bone beams are thinned. In the bone marrow spaces there is a diffuse proliferation of tumor immature and mature cells of the granulocytic series, megakaryocytes and a small number of fat cells are detected.

Essential Elements: 1. diffuse infiltrates of mature and immature granulocytes

2. megakaryocytes

3. atrophic bone beams

No. 171. Liver in myeloid leukemia

At low magnification, it is clear that the liver structure is erased due to diffuse infiltration of tumor cells. At higher magnification, their pronounced polymorphism is visible: some of the cells are large, with a bean-shaped nucleus and granular chromatin. In other cells, the nuclei are weakly segmented; they resemble band-nuclear leukocytes in appearance. There are single marks with a segmented nucleus and eosinophilic cytoplasm. The surviving hepatocytes are atrophic, with granular cytoplasm, and contain a yellow-brown pigment - lipofuscin.

Essential Elements: 1. polymorphic diffuse tumor proliferation

2. atrophic hepatocytes

No. 172. Leukemic infiltrates in the kidney with lymphocytic leukemia

The preparation contains a section of a kidney. Diffuse and focal leukemic infiltrates of poorly differentiated cells are visible in the stroma. At higher magnification, the infiltrates consist of blasts of lymphocellular origin, which are characterized by a high nuclear-cytoplasmic ratio.

Essential Elements: 1. leukemic infiltrates in the stroma

2. blast cells

No. 173. Plasmacytoma

The histological section reveals diffusely proliferated plasma cells of various types. They generally contain darkly colored, eccentrically located nuclei and fairly abundant basophilic cytoplasm. Nuclei with a fine chromatin structure and pale cytoplasm are visible.

Essential Elements: 1. fields of plasma cells

No. 174. Lymphogranulomatosis

The structure of the lymph node is lost, lymphatic follicles are absent, and fields of sclerosis are visible. At higher magnification, large basophilic cells with a large hyperchromic nucleus are determined - Hodgkin cells; giant cells with a central location of two or more nuclei - Berezovsky-Sternberg cells; eosinophils; reticular and lymphoid cells, neutrophils. There are foci of necrosis.

Essential Elements: 1. Hodgkin cells

2. Berezovsky-Sternberg cells

3. eosinophils

4. foci of necrosis

5. fields of sclerosis

No. 175. Lipoidosis and liposclerosis of the aorta.

Hematoxylin + Sudan III staining

The preparation shows a section of the aorta. In the place of intimal thickening, deposits of lipoids are visible in the form of grains and lumps of yellowish-orange color - lipoidosis. The intima at the site of lipoid deposition is thickened due to overgrown connective tissue - liposclerosis. At higher magnification, it is noted that Lipoids are located in the interstitial substance and in the cytoplasm of cells (xanthoma cells).

Essential Elements: 1. lipoids in the interstitial substance of the intima

2. intimal sclerosis

3. xanthoma cells

No. 176. Atheromatous plaque in the aorta
Van Gieson staining.

The preparation shows a cross section of the aorta. The inner layer of the aorta (intima) has a plaque-like thickening that bulges into the lumen. On the surface, the plaque is covered with connective tissue (fibrous cap), and in the underlying sections a structureless mass of atheromatosis and transparent, needle-shaped cholesterol crystals are visible. At higher magnification, in some places on the periphery of the detritus there are xanthoma cells - large cells with a light, foamy-looking cytoplasm.

Essential elements: 1. plaque cover

2. atheromatous mass

3. cholesterol crystals

4. xanthoma cells

No. 177.Cerebral vessels in arterial hypertension

The preparation contains a section of the brain. Arterioles have a narrow lumen and thickened walls. Layers are not defined. When stained with hematoxylin and eosin, the wall of the arterioles is homogeneous and pink. When stained according to Van Gieson, the wall is yellow-pink: overgrown fibrous tissue of pink color and structureless yellow masses (hyalinosis) are visible. The endothelium in the vessels is preserved.

Essential Elements: 1. hyalinized arteriolar walls

2. overgrown connective tissue in the wall of arterioles

No. 178. Brain during hypertensive crisis

The preparation contains a section of the brain. There is corrugation and destruction of the basement membrane of the endothelium of the arterioles and a peculiar arrangement of its nuclei in the form of a palisade, which is an expression of spasm. The wall of the arterioles is thickened, homogeneous, pale, the structure is erased. Sometimes proliferation of adventitia cells and glial elements of brain tissue is visible. In the walls of other arterioles, areas of intense pink color, structureless, slightly granular are detected - fibrinoid necrosis. There is a light rim around the vessels, glial and ganglion cells - edema. In the brain tissue there are focal accumulations of red blood cells.

Essential Elements: 1. plasmatic impregnation of the walls of arterioles

2. fibrinoid necrosis of arteriole walls
3. swelling

4. hyalinized arteriolar walls

5. diapedetic hemorrhages

No. 179. Arternolosclerosis of the kidney

Coloring according to Wine Gizon + according to Gornovsky.

The surface of the bud is uneven and wavy. Under the capsule, in places of retraction, the glomeruli are sclerotic, small and pink in color, the tubules are collapsed and close to each other (atrophy). In places of bulging under the capsule, large glomeruli and tubules are visible (hypertrophy). The walls of muscular arteries are significantly thickened, their lumen is narrowed. The tissue of such vessels contains a lot of black elastic fibers (hyperelastosis), smooth muscle cells and connective tissue (myofibrosis).

Essential Elements: 1. sclerotic glomeruli

2. hypertrophied glomeruli

3. arterial hyperelastosis

4. arterial myofibrosis

No. 180. Recurrent myocardial infarction

In the myocardium, areas of necrosis of irregular shape and pink color are determined. The contours of cardiomyocytes and nuclear dust are visible in them. Around the infarcts there are full-blooded vessels and round cell infiltrates (demarcation shaft). In other areas of the myocardium, granulation tissue has formed in place of dead muscle cells.

Essential Elements: 1. area of ​​necrosis

2. demarcation zone

3. granulation tissue

No. 181. Progressive cardiosclerosis

In the Myocardium, there are foci of necrobiosis and necrosis of cardiomyocytes, areas of granulation and mature connective tissue, round cell infiltrates, and full-blooded vessels.

Essential Elements: 1. foci of necrobiosis of cardiomyocytes

2. foci of cardiomyocyte necrosis

3. areas of granulation tissue

4. areas of connective tissue

No. 182. Abramov-Fiedler myocarditis

In the myocardium there is uneven blood supply, foci of “devastation” (necrosis). There is weak cross-striation in the cytoplasm of cardiomyocytes. At the ends of individual muscle cells there are flask-shaped swellings containing 2-3 nuclei - “muscle buds”. The stroma is loose (edematous), infiltrated with plasma cells, lymphocytes, eosinophils, and macrophages.

Essential Elements: 1. foci of myocardial devastation

2. “muscle kidneys”

3. loose (edematous) stroma

4. plasma cells

5. lymphocytes

6. eosinophils

No. 183. Diffuse endocarditis (Talalaev’s valvulitis)

The mitral valve leaflet in the cross section is unevenly thickened and, mainly, fibered due to edema. Focal basophilia is noted - places of disorganization and accumulation of acidic mucopolysaccharides. At higher magnification, the preservation of the endothelium covering the valve leaflet is noted.

Essential Elements: 1. areas of defibration

2. foci of basophilia

3. preserved endothelium

No. 184. Acute warty endocarditis

On a cross-section of the mitral valve leaflet, its uneven thickening is noticeable. Warty fibrin deposits of intense pink color are visible on the surface. At higher magnification, there is a violation of the integrity of the endothelium at the site of fibrin deposition. In the thickness of the valve leaflet there are accumulations of histiocytes and fibrinoid necrosis (a structureless pink mass).

Essential Elements: 1. fibrin deposits (wart)

2. accumulations of histiocytes

3. endothelial lining defect

No. 185. Recurrent warty endocarditis

In the preparation, the mitral valve leaflet is cut through with part of the atrium and ventricle. In the distal section, the valve leaflet is club-shaped thickened, with a warty overlay of fibrin of an intense pink color. The club-shaped thickening is an organized fibrinous mass, where bundles of collagen fibers and newly formed vessels are visible. Fresh foci of disorganization are basophilic. Areas of fibrinoid necrosis are structureless and pink in color visible in the thickness of the organized wart. On the surface of the wart there are fresh deposits of fibrin, and in its thickness there are accumulations of histiocytes.

Essential Elements: 1. organized wart

2. fibrinous deposits

3. newly formed vessels

4. accumulation of histiocytes

No. 186 Sclerotic valve in rheumatic heart disease

The abdominal cavity is the area of ​​the body located between the diaphragm and a conventional line passing through the pelvis.

It contains organs and anatomical formations, which are divided into two groups: intraperitoneally located (under or under the visceral layer of the peritoneum) and extraperitoneally located (in the retroperitoneal part).

The first group includes: stomach, spleen, part of the intestine, gall bladder, abdominal aorta. The second group is the adrenal glands, pancreas, ureters, and the main part of the duodenum. The organs partially covered by a serous membrane include the liver.

Lymphoma is a collection of atypical (with altered DNA) cells of the lymphatic system, forming a malignant tumor. This type of neoplasia tends to spread in the lymphoid tissue (glands, nodes, bone marrow and spleen), affecting it and nearby organs.

The lymphatic system is part of the vascular system and is a network of complexly intertwined vessels through which a colorless liquid (lymph) flows, carrying lymphocytes. This is the body’s protection from viruses, infections, foreign implants, and tumor formations.

In the peritoneum and retroperitoneal space there are visceral (on the insides) and parietal (along the walls) lymph nodes (LN). Through the lymphatic vessels, the fluid located between the cells of the tissues and organs of the abdominal cavity enters the blood.

Lymphocytes are produced here, and protein and fats are also absorbed. A tumor consisting of uncontrollably dividing cells of this part of the lymphatic system is abdominal lymphoma.

Causes

The reasons that provoke the formation and development of lymphoma have not been determined. But risk factors were identified that were present in patients with such a neoplasm in the abdominal cavity:

1. Viral infections. These include the Epstein-Barr virus, which causes, in addition to lymphoma, diseases of the liver and abdominal organs that produce mucus. And also HIV, viral hepatitis C, herpes;
2. Bacterial infections. For abdominal lymph node neoplasia, the most dangerous is helicobacter pylori, which affects the mucous membrane of the stomach, duodenum, and causes dysfunction of the digestive system;
3. Chemicals. These substances, by penetrating into the internal organs of the peritoneum (gastrointestinal tract, liver) in excess quantities, can provoke mutation of cells of the lymphatic system. This includes chemicals used in hazardous industries, as well as some medications;
4. Immunosuppressive drugs. This therapy is used for diseases when one’s own immune cells attack healthy tissue, or after organ transplantation, in order to prevent organ rejection;
5. Genetic memory body about similar diseases in blood relatives.

Kinds

There are more than thirty types of lymphomas. They differ in composition, place of primary localization, size and other features. But it is customary to distinguish two large groups of neoplasia:

Hodgkin's lymphoma, or otherwise – lymphogranulomatosis. It is distinguished by the presence of peculiar granulomas consisting of Sternberg cells (large multinucleated cells 20 microns in size) and has 6 varieties.

Such tumors tend to develop from B-lymphocytes and mainly affect the male population aged 20-25 years and 50-55 years. It is characterized by painless enlargement of lymph nodes with the formation of several groups.

Hodgkin's lymphoma begins to spread from the spleen with a gradual transition to other lymph nodes, and manifests itself in the form of significant intoxication of the body: severe sweating at night, weight loss and prolonged elevated temperature (38 0). In the future, this leads to complete exhaustion and death. But lymphogranulomatosis can be successfully treated;

Non-Hodgkin lymphoma or lymphosarcoma. It has 61 types and is detected mainly in patients 60 years of age and older. Tumors of this type do not have Stenberg cells, but are represented by T cells and B cells.

Based on the speed of development, they distinguish between aggressive lymphosarcoma, characterized by rapid growth and metastasis and/or germination into other tissues, as well as indolent lymphosarcoma, which grows slowly, but is prone to relapse and has an unpredictable nature.

However, it is aggressive Non-Hodgkin's lymphomas that respond better to treatment.

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Stages and complications

The stage of lymphoma growth is the most important information for determining treatment. The indicator includes not only the size of the tumor, but also the course of the disease and infection of other organs and tissues. Oncology of the lymphatic system of the abdominal cavity is divided into 4 stages:

1. First stage includes neoplasms affecting one group of lymph nodes. If the tumor is localized in one lymph node or spleen, then the tumor is designated only I. And if it is located in other organs of the abdominal cavity, then it is additionally designated E;
2. Second stage differs in its spread to more than one group of lymph nodes, but subdiaphragmatic localization. The defeat of one lymph node and a single adjacent organ (tissue) is marked II. In addition to the digital designation, this type is marked with the letter E;
3. Third stage involves the spread of lymphoma to an organ or tissue of the chest and one lymph node. In this case, an additional E is placed. The location of the neoplasia in the spleen and several LNs on both sides of the diaphragm are marked S;
4. Fourth stage speaks of diffuse spread of the tumor to many organs distant from the primary location.

To detail the stage of development of a cancerous tumor, letter designations are also used to characterize the presence (B) or absence (A) of such a symptom complex: night sweats, fever with a temperature above 38 degrees and weight loss of more than 10%.

Symptoms

Depending on the location, all types of lymphomas have specific symptoms. Signs of the development of neoplasia in the abdominal cavity may include:

• intestinal obstruction, at the stage of squeezing it with enlarged lymph nodes;
• feeling of fullness in the stomach, with minimal food intake due to tumor pressure;
• increase size of the spleen and/or liver;
• loss of appetite, nausea, pain in the area where the tumor is located, vomiting;
• flatulence, difficulties with defecation (constipation or vice versa) and ascites (filling of the abdominal cavity with fluid).

Common signs of lymphoma may also be present:

• an imperceptible increase in the size of LU groups;
• sudden unmotivated weight loss;
• fever and increased night sweats;
• weakness and immediate fatigue.

As the tumor grows, the level of platelets, leukocytes and red blood cells in the blood decreases, which leads to anemia, hemorrhages and frequent bleeding.

Diagnostics

To make a diagnosis, the specialist collects information from the patient about the manifestations and course of the disease, cases of cancer in relatives and the characteristics of his body (allergies, previous illnesses, etc.).

This is followed by palpation of the abdominal lymph nodes, as well as the liver and spleen, to identify characteristic compactions. The main way to confirm the diagnosis of lymphoma is histological evidence of the presence of Stenberg cells in the lymph node. For this use:

• General and biochemical blood test. Protein levels, liver and kidney tests, and Coombs' test are checked. Quantitative indicators of lymphocytes, leukocytes and erythrocytes are studied. Hemoglobin, ESR and platelets are determined. The blood is also tested for HIV and hepatitis, since these diseases often accompany lymphoma;
• Needle biopsy. This procedure is carried out using a long hollow needle, which is brought to the affected lymph node and takes a piece of tissue. Next, the biomaterial is examined for cytology. If ascites occurs, the effusion is sent for analysis. If the tumor is located in the abdominal cavity in a difficult-to-reach manner, the operation is performed under ultrasound or CT control;
• Excisional biopsy. It involves excision of the entire LN from the abdominal cavity for further histological, morphological and immunophenotypic analysis, since puncture is often not enough for an accurate diagnosis. The degree of development of the process is determined by bone marrow biopsy (trephine biopsy of the ilium).

In order to clarify the type of lymphoma, as well as the degree of development and prevalence, the following additional instrumental examinations are carried out:

• CT scan;
• Ultrasound of all lymph nodes and organs (peripheral, retroperitoneal and intra-abdominal);
• radionuclide examination of the skeletal system.

Instrumental methods make it possible to monitor the response of lymphoma to the therapy used and determine the effectiveness of treatment.

Treatment

Chemotherapy and radiation therapy are considered to be the main and most effective methods in the treatment of abdominal neoplasia. Combining them is also allowed.

Chemotherapy

This method is carried out at the initial stages of development of an abdominal tumor. It involves the use of antitumor chemicals (cytostatics), which are aimed at destroying cancer cells that have a high rate of division. Procedures (from 4 to 6) are carried out to block the development of the tumor (maximum remission).

Each type of lymphoma requires a selective approach in such treatment: polychemotherapy (several drugs) is used for lymphogranulomatosis of the abdominal lymph nodes, and lymphosarcoma requires an individual approach, depending on the morphology and malignancy.

Cytostatics are administered intramuscularly, into the area of ​​neoplasia or directly into it, intravenously, into the supply artery, or orally. They differ in the method of action, chemical composition and nature. Main types:

• antibiotics;
• hormones;
• alkylating drugs;
• antimetabolites.

Radiation therapy

This treatment is used at the first stage of development of an abdominal tumor in the absence of significant symptoms (intoxication). It is based on irradiating the formation with directed point radiation.

Under the influence of X-ray radiation, mutated cells stop developing and die. To prevent relapses, the beam is directed not only to the affected lymph node, but also to nearby groups.

Combination therapy

This type of therapy involves the simultaneous use of radiation and chemotherapy. This is practiced from the second stage of development of lymphoma, which has already affected several lymph nodes, and in the presence of severe intoxication.

Forecast

The favorable outcome of treatment of abdominal lymphoma after the applied therapy varies depending on the stage of detection, organ of localization and type of tumor.

The first and second stages of neoplasia development (localized, localized or focal) are characterized by an average of 90 percent and 70 percent survival at five years, respectively.

For tumors of the stomach and spleen, this figure is even higher – 95-100%. And liver neoplasia is characterized by persistent remission (subsidence) in 70 and 60 percent of cases at the 1st and 2nd stages of growth.

The third stage on average guarantees a five-year survival rate for 65 percent of patients. The one that stands out from this indicator is liver lymphoma, which is characterized by a high growth rate and aggressive metastasis. Her forecast is 30%.

For the last stage, the probability of survival to 5 years is 30% (excluding liver neoplasm).