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Pathoma- Chapter 1: Growth Adaptations
Terms in this set (76)
Hyperplasia and Hypertrophy
An increase in stress on an organ leads to what?
-An increase in organ size
-Basically, if an organ has to do more work, it will become bigger to do so
What are the two ways by which an organ can become bigger due to increased stress?
-1.) Increase the size of the cells of the organ
-2.) Increase the number of cells of the organ
What is an increase in cell size called?
What is an increase in the number of cells of an organ called?
What is the structure that gives the cell its size and shape?
If we want the cell to enlarge (as in the case of hypertrophy), what must happen to the cytoskeleton?
-The cell must increase the production of the cytoskeleton
What is the cytoskeleton predominantly made of?
-Therefore, in order for hypertrophy to occur, protein synthesis must be taking place within the cell
In order to produce proteins, what must happen first?
What is one mechanism of hypertrophy?
-Gene activation and protein synthesis
What else must occur for hypertrophy to occur?
-The production of organelles
-For example, you will need to increase the number of mitochondria within a cell if you are going to increase its size
The new cells are produced from what?
Do hyperplasia and hypertrophy occur together?
Example of Hyperplasia and Hypertrophy occurring together:
Uterus During Pregnancy
-The uterus will increase in size to provide room for the developing fetus in two ways:
-The smooth muscle of the uterus will undergo hyperplasia
-The smooth muscle of the uterus will undergo hypertrophy
What is one important exception to the trend of seeing hyperplasia and hypertrophy in unison?
Why will you not see hyperplasia in permanent tissues?
-They do not have stem cells, so they cannot perform hyperplasia (cannot make new cells)
Permanent tissues undergo which process: hyperplasia or hypertrophy?
What are the three permanent tissues within the human body?
Pathologic hyperplasia can progress to what?
-Dysplasia and cancer
What is pathologic hyperplasia?
-Hyperplasia that occurs due to some underlying pathologic process
What is an example of physiologic hyperplasia?
-Pregnancy- where due to some physiology of the organism, hyperplasia occurs
-Remember that there is no increased risk for cancer with physiologic hyperplasia
What is a classic example of pathologic hyperplasia?
The endometrium grows with exposure to what hormone?
The endometrium develops and sheds with exposure to what hormone?
If the endometrium is overexposed to estrogen for long periods of time, what can happen?
-Endometrial hyperplasia will occur
Endometrial hyperplasia can eventually progress to what?
-The formation of endometrial carcinoma
What is the one exception in which a pathologic hyperplasia does not give rise to a dysplasia and cancer?
-Benign prostatic hyperplasia
If there is a decrease in stress on an organ, what happens?
-Leads to a decrease in organ size
What is the decrease in organ size called?
What are the two ways by which atrophy can occur?
-1.) The size of the cells that make up the organ to decrease
-2.) The number of cells within the organ to decrease
How does a decrease in the number of cells within an organ occur?
A decrease in cell size occurs via what two primary mechanisms?
-The ubiquitin-proteosome degradation of the cytoskeleton
-Autophagy of cellular components
What is the mechanism by which the cytoskeleton is broken down to decrease cell size?
The ubiquitin-proteosome degradation pathway
What is ubiquitin?
-Is a protein that is posted/tagged onto the intermediate filaments of the cytoskeleton
What is the proteosome?
-Is an organelle within the cell that recognizes ubiquitin-tagged proteins and destroys them
In order to decrease the size of a cell, the organelles must be done away with. How is this done?
-The mechanism by which cellular components (including organelles are consumed) is called autophagy
What is happening in autophagy?
-The cell consumes its own components in vacuoles
-These vacuoles then fuse with lysosomes- destroying the cellular components
If the stress on an organ changes, then the organ will respond by doing what?
-It will change its cell type (metaplasia)
Metaplasia is most often seen in what tissue type?
What are the three types of epithelium?
-Squamous (can be keratinizing or non-keratinizing)
-Columnar (lines a lot of the gut)
-Transitional (urothelium) (Predominantly lines the urinary tract)
What is the idea behind why metaplasia occurs?
-The metaplastic cells are better able to handle the new stress
What is a classic example of metaplasia?
What is the esophagus normally lined with?
-Non-keratinized Stratified Squamous Epithelium
-There is a very sharp demarcation between the esophagus and the underlying stomach
What is the stomach lined by?
What happens if acid refluxes from the stomach into the lower esophagus?
-This will result in a change in stress within the lower portion of the esophagus
What does the change in stress in the lower esophagus do?
-Conversion of the squamous epithelium to a columnar, non-ciliated mucinous epithelium
What is the type of epithelium seen in a Barrett Esophagus?
-columnar, non-ciliated mucinous epithelium (see goblets of mucous within them)
-The idea here is that columnar epithelium is much better suited to handle acid
What is the mechanism by which metaplasia occurs?
-Reprogramming of stem cells
Is metaplasia permanent?
-It is reversible (important)
-Removal of the stress that caused the metaplasia will result in the reversal of the metaplasia
-For example, treatment of GERD may reverse Barrett Esophagus
What can metaplasia progress to?
-Dysplasia and cancer (important)
Barrett Esophagus is a risk factor for what cancer?
-Adenocarcinoma of the esophagus
What is the one metaplasia that does not increase the risk for cancer?
What is apocrine metaplasia?
-Is one of the changes seen with fibrocystic changes of the breast
-The fibrocystic changes can increase the risk for breast cancer, but apocrine metaplasia does not (important)
What vitamin deficiency can result in metaplasia?
-Vitamin A deficiency
What are the most common symptoms seen with Vitamin A deficiency?
-Immune system becomes deficient (Vitamin A is necessary for the proper maturation of the cells of the immune system)
What cancer is caused by a 15:17 translocation?
-Acute Promyelocytic Leukemia
The 15:17 translocation involves what receptor?
-The vitamin A receptor (retinoic acid receptor)
Acute Promyelocytic Leukemia
What happens when the retinoic receptor is negatively impacted?
-It causes the cells to remain in the 'blast' stage, and the accumulate resulting in a promyelocytic leukemia
Acute Promyelocytic Leukemia
What is one of the treatments?
-ATRA (All-trans Retinoic Acid)- a derivative of vitamin A
-Has the ability to bind the mutated receptor and allows the cells to mature
Vitamin A is necessary for the maintenance of specialized epithelia within the body, such as?
-The conjunctiva of the eye- is a highly specialized squamous epithelium
What happens to the conjunctiva of the eye if there is a Vitamin A deficiency?
-Can result in metaplasia of those cells- resulting in a thickness of those cells (keratomalacia)
-In vitamin A deficiency, the thin squamous lining of the conjunctiva undergoes metaplasia into stratified, keratinizing squamous epithelium
What are mesenchymal tissues?
-Include things like bone, fat, blood vessels, and cartilage
-AKA connective tissues
What is the classic example of mesenchymal tissue metaplasia?
What happens in myositis ossificans?
-Inflammation of the skeletal muscle (usually due to trauma) results in a metaplastic production of bone within the skeletal muscle
How do you know that a myositis ossificans is not an osteosarcoma?
-The adjacent bone will appear grossly normal
-If you look carefully, you will see a distinct separation between the bony metaplasia and the bone next to it
What is dysplasia?
-There is disordered cellular growth
Dysplasia is used to refer to what?
-Proliferation of precancerous cells
What is the classic example of dysplasia?
-Cervical intraepithelial neoplasia (CIN)
CIN can be subdivided into how many types?
-CIN I, II, and III
What does dysplasia arise from?
-Longstanding pathologic hyperplasia (i.e. endometrial hyperplasia) or metaplasia (i.e. Barrett Esophagus)
Is dysplasia permanent?
-It is reversible (important)
-If you remove the inciting stress, the dysplasia can reverse
If the stress persists, the dysplasia could progress to what?
-Carcinoma (which is irreversible)
Is a carcinoma reversible?
-Carcinoma is irreversible (important)
What is aplasia?
-Failure of cell production during embryogenesis
What is the classic example of aplasia?
-Unilateral renal agenesis
What is hypoplasia?
-Decrease in cell production during embryogenesis
-Results in a relatively small organ
What is the classic example of hypoplasia?
-Streak ovary seen in Turner Syndrome
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