1

Cellular adaptation
.Physiological response of cells to normal stimulation

Hypertrophy
Def.:A reversible increase in the size of an organ or tissue due to increase in size of it's
specialized cells through an accumulation of more structural components.
So the purely hypertrophied organ has no new cells just bigger ones.
The increase size of cells is due to the synthesis of more structural components.
The concentration of DNA per unit of tissue weight is less in hypertrophic tissue, and
there is sharp rise in the RNA\DNA ratio during the enlargement phase.
Hypertrophy is usually a response of an individual cell to an increased functional demand
or by specific hormonal stimulation.
Hypertrophy is mediated by
i. Growth factors, cytokines, and other trophic stimuli
ii. Increased expression of genes and increased protein synthesis
Hypertrophy and hyperplasia often occur together
Pure hypertrophy without accompanying hyperplasia occurs only in striated muscle cells.
Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013

1. Skeletal muscles: As a response to increase muscle activity ,during exercise.

2. Cardiac muscle: Any demand for increased work leads to hypertrophy of the fibers of the
chambers affected.

3.Smooth muscles:
i. Uterus.
ii. Arteries.
iii. Alimentary tract.
iv. Urinary bladder.
The muscle fibers return to a normal size when the increased work stimulus is
removed.
Compensatory hypertrophy: May occur in the survivor of a pair of organs when one is
removed. E.g: Following nephrectomy.
Hypertrophy due to hormonal changes : E.g: Excessive secretion of growth hormone
(usually due to a tumour of the anterior pituitary) results in acromegally .
Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013

HYPERPLASIA
Def.: Hyperplasia is the increase in size of an organ or tissue due to an increase in
THE NUMBER of it's specialized cells, due to specific stimulus.
HORMONAL INFLUENCES ARE IMPORTANT IN THIS GROWTH
RESPONSE .
1. Hyperplasia in the endocrine glands: e.g. Parathyroid hyperplasia occurring in
chronic renal failure.
Hyperplasia of the thyroid gland in pregnancy.
2. Hyperplasia in the target organs of the endocrine glands: e.g.
i- Breasts: (physiological):Hyperplasia of the epithelial tissue and surrounding
specialized connective tissue is a normal feature of the female breast at puberty,
during pregnancy and lactation.
Pathological hyperplasia in cystic hyperplasia (cystic disease of the breast ).
ii- Endometrial hyperplasia.

iii- Prostate (benign nodular hyperplasia).

vi- Bone marrow: Hyperplasia is most commonly seen where demand for red
blood cells is increased.
Compensatory hyperplasia:
It occurs when a portion of the tissue is removed or diseased .
Irritative: surface epith., lymph node.
Clinical effects:1- mass (breast, prostate, thyroid).
2- uterine bleeding
3- Mechanical obstruction
Prognostic significance:
- usually reversible,
- May progress to malignancy, as in surface epithelium.
Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013

Adaptive responses resulting in reduced tissue mass

i.
ii.

Developmental
Acquired
Developmental:
* Agenesis: is a complete failure of development.
*Hypoplasia: is a partial failure of the tissue to reach normal size.
Acquired:
*Aplasia : It used in medicin as for example in aplastic anaemia .

ATROPHY
Atrophy is a reversible decrease in the mass of functioning cells in a tissue
by decrease in size and / or number of its cells .
There are two mechanisms of reduction :1) decrease in the size and volume of individual cells:
a) reduction in cellular metabolism .
b) Reduction in synthesis of structural proteins.
c) Increase in the catabolism.
2)Death of established cells:
Loss of cells by single cell necrosis (apoptosis) causing a reduction in
the number of functioning cells.
Involution : is a form of physiological organ atrophy involving apoptosis of
cells.
In Atrophy there is an increase in the concentration of DNA per unit tissue
weight .
Atrophy can occur under physiological or pathological conditions .
1) Physiological atrophy:
Examples: a) Atrophy of ductus arteriosus in infants
b) Atrophy of thymus in adults .

c) Atrophy of gonads and other reproductive organ in

old age.
2) Pathological atrophy : May be either general or local.
1) Generalized atrophy results from :
i) Simple starvation severe malnutrition ,mal absorption and malignant
cachexia .
Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013

ii)Osteoporosis :
iii)Atrophy due to increased catabolism .
2)Localized Atrophy :i)Disuse atrophy .

ii)Pressure Atrophy .
iii)Neuropathic Atrophy.
iv)Endocrine Atrophy . v)Post irradiation atrophy .
vi)Reduced blood supply (when the reduction is not sufficiently severe
to cause necrosis).
ABNORMALITIES OF CELLULAR DIFFERENTIATION :
METAPLASIA
Metaplasia is a reversible transformation of one type of differentiated tissue in to another
type of similar differentiation .
It' usually appears to be the result persistent trauma (chronic irritation ) .
It is thought to arise by genetic reprogramming of epithelial stem cells or of un differentiated
mesenchymal cells in C.T.
The cells sensitive to stress are replaced by other cell type better capable to stand adverse
environment .
FORMS OF METAPLASIA :
Epithelial
Connective tissue
Mesothelial

A)Epithelial :
Causes:
Chronic irritation
Avitaminosis A
Gene activation
Unknown causes.
Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013

1) Squamous metaplasia :
i) From pseudostartified columnar epithelium :a)In bronchi in chronic bronchitis or due to
cigarette smoking .

b)In nasal sinuses ,in chronic sinusitis .

ii)From simple columnar epithelium :
a) endometrium in senility .
b)Gall bladder in chronic cholecystitis .
c)Prostatic ducts in ageing and oestrogen therapy .
d)Endocervical mucosa and glands associated with cervical erosion .
iii)From transitional cell epithelium:

a)Renal pelvis with calculi .

b)Urinary bladder with chronic cystitis or schistosomiasis .
iv)From mesothelium of the pleura (Asbestosis) .
2)Columnar metaplasia:
i)Pink cell or apocrine metaplasia seen in cystic disease of the breast.
Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013

ii)Intestinal metaplasia of the gastric mucosa in chronic atrophic gastritis .

iii)The oesophageal squamous epithelium is replaced by gastric epithelium in response to
exposure to gastric acid in cases of gastric reflux (glandular or gastric metaplasia Barrett's
aesophagus).

B)Connective tissue:
1)osseous metaplasia:
i)In sites of dystrophic calcification:
a)Scars
b)Old tuberculous lesions.
c)Medial calcification of arteries .
ii)In muscle. E.g: myositis ossificans trauma to a muscle may lead to a haematoma ,the
haematoma undergoes organization.The fibroblasts invading the haematoma may change to
osteoblasts which lay down osteoid tissue.
C)Serosal(Mesothelial):Irritation of serosal cells lining the serous sacs my change them to
cubical, columnar , glandular or stratified squamous .E.g :Asbestosis.

Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013

DYSPLASIA
Def.A disturbance of cell proliferation and maturation with in an epithelium.
The changes consist of increased mitosis .the production of abnormal cell in varying
numbers and a tendency to disorder in their arrangement.
*It is usually accompanied by chronic inflammatory change or on exposure to carcinogenic
substance.

Dysplasia is a non-neoplastic proliferation.

Dysplasia may or may not progress to cancer.

Prof. Salha A. Sallam, Pathology Department , Tripoli Univ. 2012-2013