Cell Adaptations

Presented
By
Ahmed El-Rashedy
Professor & Previous Head
of Pathology Department
Al-Azhar University

Prof. Dr. Ahmed Elrashedy

Hyperplasia
Def: Increase in the size of the organ due to an increase in
the number of its constituent cells.
Types:
I) Physiologic hyperplasia:
A) Hormonal-induced:
1. Hyperplasia of the pregnant uterus (estrogen-induced).
2. Hyperplasia of the female mammary ducts (estrogeninduced) in puberty and during pregnancy & lactation.
B) Compensatory:
1. Hyperplasia of the remaining liver tissue after partial
hepatectomy.
2. Hyperplasia of the remaining kidney after nephrectomy.

Prof. Dr. Ahmed Elrashedy

II) Pathologic (Hormonal-induced) hyperplasia:

1. Thyroid hyperplasia in Graves' disease (primary thyrotoxicosis ; thyroxin-induced).
2. Endometrial hyperplasia (estrogen-induced).
3. Fibrocystic disease of female breast (estrogen-induced).
4. Prostatic hyperplasia(estrogen-induced)in elderly males.
Hypertrophy
Def: Increase in the size of the organ due to an increase in
the size of its constituent cells.
Types:
I) Physiologic hypertrophy:
1. Hypertrophy of the myometrium in a pregnant uterus.
2. Hypertrophy of the skeletal muscles in athletes.

Prof. Dr. Ahmed Elrashedy

II) Pathologic (Obstructive) hypertrophy:

1. Left ventricular hypertrophy in case of aortic stenosis.
2. Gastric hypertrophy in case of pyloric stenosis.
3. Urinary bladder hypertrophy in case of bladder neck
obstruction by the hyperplastic prostate.

Atrophy
Def: Acquired decrease in the size of an organ after its full
development.
Types:
I) Physiologic atrophy:
1. Involution of the pregnant uterus after labour.
2. Involution of the female breast after weaning.
3. Atrophy of thymus gland at 5th year of life.
4. Atrophy of the ductus arteriosus between aorta & pulmonary
artery after labor.

Prof. Dr. Ahmed Elrashedy

II) Pathologic atrophy:

A) Localized:
1. Atrophy of myocardium in case of narrow coronary (ischemia).
2. Atrophy of the vertebrae in case of compression by aortic
aneurysm.
3. Atrophy of lower limb muscles in case of prolonged
immobilization or in case of paralysis.
B) Generalized (affecting the whole body):
1. Starvation (malnutrition).
2. Ageing (Senility).
Agenesis
Def: Complete absence of an organ since embryogenesis.
Aplasia
Def: Failure of development of an organ after its formation.
Hypoplasia
Def: Failure of development of an organ to its full size.

Prof. Dr. Ahmed Elrashedy

Metaplasia
Def: A change of one type of adult mature differentiated tissue
into another mature differentiated one in the same category.
Types:
I) Epithelial metaplasia:
A) Squamous metaplasia: Change into mature differentiated
stratified squamous epithelium (SSE).

a) From columnar epithelium:

1. From columnar bronchial mucosa into SSE in case of heavy
smoking & in chronic bronchitis.
2. From columnar gall bladder mucosa into SSE in case of gall
stones.
b) From transitional epithelium: of urinary bladder mucosa in
case of urinary bilharziasis.

Prof. Dr. Ahmed Elrashedy

B) Columnar Metaplasia:
Change from stratified squamous or specific organ epithelium

into mature simple columnar epithelium (SCE) or another

organ epithelium (in chronic infection).
1. Simple columnar endocervical (mucus-secreting) instead of
stratified squamous epithelium of the uterine ectocervix.
2. Simple columnar colonic (goblet cell-rich) epithelium instead
of gastric columnar (pepsin & acid-secreting) epithelium (in
chronic gastritis).
C) Serosal (Mesothelial) Metaplasia:
Change from simple squamous (flat) epithelium into mature

differentiated simple cubical or columnar epithelium.

1. Metaplasia in pleura covering the pulmonary infarct area.
2. Presence of endometrial tissue (lining the uterus) on the
peritoneum (endometriosis).

Prof. Dr. Ahmed Elrashedy

II) Mesenchymal (C.T.) metaplasia:

1. Change of hyaline cartilage into bony tissue in ageing (Bony
Ankylosis) .
2. Change of the skeletal muscle into bony & cartilaginous
tissue due to trauma (Traumatic myositis ossificans).
III)Tumor metaplasia:
Change of malignant columnar epithelium (adenocarcinoma)
partially into malignant stratified squamous epithelium
(Adenosquamous carcinoma).

Traumtic myositis ossificans

Adenosquamous carcinoma

Prof. Dr. Ahmed Elrashedy

Dysplasia
Def: Deranged or disordered development (dysplasia= bad molding).
Sites:
Commonly in the epithelial tissues.
It may be closely related to hyperplasia & thus, called Atypical

hyperplasia.

1.
2.
3.
4.
5.
6.
7.
8.

It may be related to metaplasia & this is called Leukoplakia.

It is usually associated with chronic irritation or inflammation.
Common Sites are:
Uterine cervix.
Uterine cervical severe dysplasia (GIII
Vulva.
Dysplasia): Intraepithelial neoplasia (CIN) :
carcinoma in-situ (CIS)
Vagina.
Skin.
Oral cavity.
Urinary bladder mucosa.
Gall bladder mucosa.
Respiratory mucosa.

Prof. Dr. Ahmed Elrashedy

Dysplasia:
Cytological Changes :

1. Loss of normal orientation of one epithelial cell to its

2.
3.

4.

5.

adjacent one.
Change in the cellular size & shape (Cellular
pleomorphism).
Change in the nuclear size & shape (Nuclear
pleomorphism).
Change in the staining character; deeply stained blue
nucleus (Hyperchromasia) due to increased DNA
content.
Occasional appearance of mitotic figures in the nuclei.

Prof. Dr. Ahmed Elrashedy

Dysplasia:
Fate:
1. Dysplasia is not necessarily precancerous.
2. It is potentially reversible i.e. the epithelium may return
into normal state after removal of the factors that cause it.
Grades: Depending upon the proportion of the epithelial
thickness involvement, three grades are found:
1. Grade I (Mild dysplasia): involves the lower 1/3 rd of
thickness.
2. Grade II(Moderate dysplasia): involves the lower 2/3rds
of thickness.

3. Grade III (Severe dysplasia = Intra-epithelial neoplasia

= Carcinoma in-situ): Full thickness involvement of the
epithelium by atypical cells showing cytologic features.

Prof. Dr. Ahmed Elrashedy

Non-Neoplastic Lesions
I) Heterotopia (Ectopia):
Def: Presence of an organ or a tissue in an abnormal site.
Examples:
1. Ectopic gastric tissue in upper part oh the oesophagus.
2. Ectopic gastric tissue Michel's intestinal diverticulum.
3. Ectopic adrenal cortical tissue in kidney.
4. Ectopic splenic tissue (accessory spleen) in extra-splenic
sites.
II) Choristoma:
Def: Microscopic normal cells or tissues in an abnormal site.
Examples:
1. Pancreatic tissue in the wall of stomach or small intestine.
2. Adrenal cells in the kidney, ovary or lungs.

Prof. Dr. Ahmed Elrashedy

Non-Neoplastic Lesions
III) Hamartoma:
Def: Tumor-like mass of developmental origin. The

hamartomatous tissue is composed of the normally present

tissue but in haphazard arrangement.
Examples:
1. Rhabdomyoma of the heart.
2. Adenomas of the liver, kidneys & pancreas.
3. Developmental cysts of the lungs, kidneys & pancreas.
4. Hamartoma of the lung: formed of haphazardly arranged

bronchial mucosa, cartilagenous, vascular ,fibrous &

smooth muscular tissues.
5. Vascular hamartomas: Hemangiomas & Lymphangioma.
6. Pigmented hamartomas (Nevi).
7. Osteochondromas (Exostosis).

Prof. Dr. Ahmed Elrashedy

III) Hamartomas
A. Vascular Hamartomas (Hemangiomas & Lymphangiomas)
Sites:
1. Skin: Face, scalp & neck.
2. Mouth & oral cavity: a) Lips.
b) Tongue.
3. Internal organs:
a)Muscles. b)Liver.
c)Brain. d)Bones.
Pathology:
a) Gross: Flat or elevated , Red-blue masses.
b) L/M: Ectatic vascular channels either small-callipered (Capillary
hemangiomas) or wide & communicating (Cavernous
hemangiomas & lymphangiomas) filled with blood & lymph
(appearing as homogenous pink) respectively and separated by F.T.

Prof. Dr. Ahmed Elrashedy

Hamartomas
B. Pigmented Hamartomas (Nevi)
Sites:
1. Skin.
2. Mucocutaneous (conjunctiva, nose & anal canal).
3. Choroid of the eye.
4. Meninges.
Origin:
Melanocytes & Melanoblasts.
Age:
1) At birth (Birth mark).
2) During childhood.
3) Early adulthood.

Pathology:
A) Gross:
1) Flat or Elevated papules.
2) Hairy or Not.
3) Light brown-to-black.

Prof. Dr. Ahmed Elrashedy

Pathology:
B) L/M:
1) Infantile (Junctional) Nevus: Groups of
polygonal melanocytes with intracytoplasmic
dark brown melanin pigment, found at the
dermoepidermal junction.
2) Intradermal Nevus:
Groups of the
previously described nevocytes inside the
dermis.
3) Compound Nevus: The nevocytic groups
are found both inside the dermis & also
attached to the epidermis.

Relation to cutaneous neoplasms:

1) Juvenile nevus: due to the extensive mitotic
activity may be mistaken for malignancy.
2) Junctional adult nevus: is a precancerous
lesion.

Junctional Nevus

Intradermal Nevus

Compound Nevus

Prof. Dr. Ahmed Elrashedy