Cellular

Adaptations of
Growth and
Differentiation
• 1- Physiological adaptations
• They represent response of cells to normal
stimulation by hormones or endogenous
chemical substances e.g. enlargement of the
breast and induction of lactation by
pregnancy. Also, replacement of labile
tissues, e.g. skin, bone marrow or cyclic as
endometrium.
• Pathological adaptations
• In such cases adaptations occur as a result of
certain stimuli which are not lethal, i.e. a state
intermediate between normal unstressed cells and
injured overstressed ones.
• Adaptive changes in cell growth and
differentiation include: hyperplasia, hypertrophy,
atrophy, and metaplasia.
 Hyperplasia
• Definition:
• It is an increase in the size of an organ or
tissue due to increase in the number of
constituent parenchymal cells. It may be
physiological or pathological.
• 1- Physiological hyperplasia
• Might be hormonal as in the female breast
during puberty and pregnancy or
compensatory as in hyperplasia of liver
hepatocytes after partial hepatectomy due to
increase in its functional demands.
Hyperplasia of the breast
• Pathological hyperplasia
• In such cases, increased level of circulating
hormones produce hyperplasia in the target
organs, e.g. hyperplasia of the endometrium due to
hyperestrinism, and senile prostatic hyperplasia
due to increase in the level of androgen and
estrogen.
• However, hyperplasia due to certain stimuli stops
with removal of these stimuli and may serve a
useful function.
 Hypertrophy
• Definition
• It is an increase in the size of an organ or tissue
due to enlargement of individual cells without
increase in the number of cells.
• It usually occurs in organs in which
proliferation and mitosis are restricted, e.g.
skeletal muscle and heart muscles. These
tissues have restricted ability to adjust to
environmental demands by proliferation and
have to achieve homeostasis by increasing in
function of their individual cells. It may be
physiological or pathological.
• 1- Physiological hypertrophy e.g. pregnant
uterus, and muscles of athletes.
• 2- Pathological hypertrophy (adaptive
hypertrophy)
• e.g. hypertrophy of the stomach in pyloric stenosis
or cardiac muscle hypertrophy in chronically
hypertensive patients.
• Hypertrophy and hyperplasia are closely related
and both may contribute to an overall increase in
the organ size.
Cardiac muscle hypertrophy
 Atrophy
• Definition
• It is reduction of the size of an organ after
reaching its normal adult size. It is usually
the result of decrease in both the number
and size of the cells. It is often associated
with fibrosis. It may be physiological or
pathological
• Physiological atrophy
• Atrophy of the ovary and breast after menopause,
and senile atrophy of heart.
• Pathological atrophy
• It depends on the cause. It may be localized
or generalized
• Examples:
• Ischemic atrophy: due to decrease of blood
supply e.g. atherosclerosis,
• b- Pressure atrophy: due to long
continued pressure on a tissue leading to
decrease in its blood supply with atrophy of
its cells e.g. amyloidosis of the liver in
which the extracellular deposition of
amyloid substance leads to pressure atrophy
of hepatocytes.
• c-Neuropathic atrophy: e.g. when a motor nerve
supplying a muscle is affected as in poliomyelitis.
• d- Decreased work load: e.g. immobilized limb.
• e- Starvation: leading to generalized atrophy.
• The atrophic cells in all cases, are still surviving
cells, but with diminished function.
 Metaplasia
• It is a reversible change in which an adult cell type
(epithelial or mesenchymal) is replaced by another
adult cell type of the same tissue. It may represent
an adaptive substitution of cells more sensitive to
stress by other cell types better able to withstand
the adverse environment.
• Metaplasia is thought to arise by genetic
'deprogramming" of epithelial stem cell or of
undifferentiated mesenchymal cells in connective
tissue.
• Epithelial squamous metaplasia
• e.g. uterine endocervical glandular epithelium due
to chronic irritation,
• transitional epithelium of urinary bladder, ureter
or renal pelvis due to chronic irritation by
bilharziasis or stones,
• columnar epithelium of gall bladder due to chronic
irritation by stones or inflammation
• pseudostratified ciliated columnar respiratory
epithelium due to chronic irritation by habitual
cigarette smoking or in vitamin A deficiency.
• The adaptive metaplastic epithelium is better
able to survive, but important protective
mechanisms (such as mucus secretion and
ciliary clearance of particulate matter in the
respiratory epithelium) are lost.
• If the influences that induce metaplastic
transformation of the epithelium are persistent,
they may lead to cancer transformation in the
metaplastic epithelium, e.g. squamous
metaplasia of transitional epithelium of the
urinary bladder by bilharziasis will lead to
squamous cell carcinoma.
• Mesenchymal cell metaplasia:
• Transformation of fibroblasts to osteoblasts
or chondroblasts to produce bone or
cartilage in soft tissues in foci of injury.
• Involution:
• It is a form of physiologic atrophy. It is
return to normal size after hyperplasia and
hypertrophy, if the causative stimuli are
removed and equilibrium returns back e.g.
uterus after labour.
• Dysplasia
• A term used to describe disorderly but non-
neoplastic proliferation. It is a loss in the
uniformity of individual cells as well as in
their architectural orientation
• Dysplastic changes reveal pleomorphism,
hyperchromatism, abundant mitoses, and
loss of normal orientation. Dysplastic
changes are mostly seen in epithelial cells
especially in the cervix uteri.
• When dysplastic changes are mild they are
often reversible by removal of the inciting
cause (e.g. chronic irritation).
• On the other hand, when dysplastic changes
are marked and involve the entire thickness
of the epithelium, the lesion in this case is
considered as pre-invasive neoplasm and is
referred to as "carcinoma in situ".