Cellular pathology

Introduction to pathology

What is pathology?
Pathology is the
scientific study of
diseases

The ultmate goal of pathology

Is the identification of cause of disease which

leads to the successful therapy and

prevention of disease

Cellular
responses to
injury

When cells have ability to adjust

acording to their environment
Stuctural and
functional changes
Acording to demand
and stress
Process is called
cellular adaptation

What is cellular
adaptation
Reversible changes in
number ,size ,function
or morphology of cells
in response to changes
in their environment

Normal
cell
Stress
/injury

adaptation

Normal
cell
Stress/injury
Cellular
injury

Example for adaptation

Eg:what happens when myocardium subjects

to increased load
Eg :in mitral valve stenosis

Mitral valve thickened and orifice

narrowed

Need additional effert to pump bld

Cells undergo hypertrophy(enlarge) and

maintain the pump

Example for cell injury

When coronary artery is occluded by
atheroma blood flaw to myocardium
reduces and muscle cells undergo injury

If mild occlusion: reversible injury

If complete occlution:irreversible injury

adaptation

Inability to adjust

Leads
surviv
al of
cell

Celllar injury

Leads cell death

Adaptation is divided as
1.Physiological adaptation-

responses of cells to normal

stimulations made by hormones
and chemical mediators in
special circumstances
Eg:enlargement of breast and
uterus during pregnancy

2.Pathological adaptation
It is a response to stress or increases load
Enables cells to escape the injury by

modulating their structure and function

There are 4 forms

4 responses to
adaptation
1.hypertrophy
2.hyperplasia
3.atrophy
4.metaplasia

hypertroph
y

hyperplasi
a

Cellular
adaptati
on

atrophy

metaplasia

hypertrophy
Definition
Is an increase in size of cells resulting

increase in the organ

Occurs mainly in permenent cells
Eg:heart,skeletal muscleCells
enlarge by increasing amount of organells
and structural proteins

2 types
1.physiological
Eg:hypertrophy of smooth muscle with weight

lifting
2.pathological
eg:myocardial hypertrophy with valve
stenosis

hyperplasia

Increase in number of cells as a response to

stress
Occurs when cells can replicate
Can occur with hypertrophy of the same
organ(hypertrophy and hyperplasia)

Physiological hyperplasia

1.hormonal hyperplasia
Proliferation of glandular epithelium of female

breast with pregnancy

2.compensatory hyperplasia
When part of a tissue is removed or diseased
Eg:liver partial resecction-can restore liver of
normal weight by mitotic proliferation

Pathological hyperplasia
By excessive hormonal or growth factor

stimulus
1.endometrial hyperplasia- due to
disturbances of balance bw estrogen and
progesterone
2.in wound healing- proliferation of
fibroblasts and blood vessels leads repair of
tissue

Atrophy
Is the process of shrinkage of size of cell by

loss of cell substances

Even entire tissue or organ can diminishes
Although atrophic cells are diminished
function they are not dead

Survival still possible

Causes of atrophy
1.decreased work load

eg:muscle atrophy in imobilized patients

due to fractures
2.loss of innervation
3.diminished blood supply
4.inadeuate nutrition
5.loss of endocrine stimulation

eg:menaupause-atrophy of uterus
6.aging(senile atrophy)

In atrophy
Cells still alive in a new equilibrium

established bw cell size and diminished blood

supply ,nutrition etc
In artophy reduced protein synthesis

increased protein degredation

In microscopic examination increased
autophagic vacuoles seen
Leading increased autophagy (self eating)

autophagy
Is the process in which starved cells eat its

own components as an attempt to find

nutrients and survive

Reduced brain substance, wide sulci,

narrow gyri

metaplasia
Is a reversible change in which adult cell type

is replaced by another adult cell type

Here cells are replaced by another cell type
which can easily withstand against stress
Formed by genetic programming of stem cells
Not by trans differentiation of already
differentiated cells

:in cigarette smokers: normal ciliated epithelium in

trachia and bronchi replaced by stratified squamous

epithelium
:in vit a defeciancy also squamous metaplasia of

respiratory epithelium
In chronic gasric reflux - stratified sq.epithelium in

lower oesophagous
Metaplatic transformation to gastric columnar

epithelium

What are the types of epithelium?

If influences that lead metaplasia are

prolonged

Can induce metaplastic transformation

If persistant leads malignant transformation

Cell injury
Normal cells are in a state of

homeostasis(equilibrium) with environment

Injury is a set of biochemical or morphologic
changes occur when this state of homeostasis
is disturbed by adverse influenses
Cell injury may be reversible or
irreversible

Causes of cell injury

1.Oxygen deprivation-hypoxia

ischemia-most common cause

inadequate oxygenation of

blood
eg;pneumonia
reduced oxygen carring
capasity of bld

eg;CO poisioning

2.chemical agents

glucose,salt,CO,pestisides,murcury
3.infectious agents
virus,bacteria,fungi,protozoa
4.immunological reactions

eg:autoimmune reactions

allergic reactions
5.genetic defects

accuilation of damaged DNA-trigger cell

death

6.nutritional imbalances

protein calorie insufficiency ,vit def

7.physiological agents trauma ,extreme

temp, electric shock, radiation

8.aging-reduced ability to respond injurious

agents

Reversible cell injury

In a state of reversible changes

2 morphological formes
1.cellular swelling
first menifestation of all forms of cell injury
plasma membrane alterations
blebbing
swelling of cell
swelling of mitochondria,ER
ORGAN looks pallor with increased turgor
and weight

2.Fatty change
Appearance of lipid vacuoles in cytoplasm
Sp.cells involving fat metabolism

eg;hepatocytes,myocytes

Cell death
With continuing damage the inury become

irreversible
Then cell cannot recover

2 forms of cell death

necrosis
appoptosis

Cell necrosis
When damage to membrane is severe enz

leak out of lysosomes

Enter cytoplasm

Digest the cell

NECROSIS

IN NECROSIS
INCREASED eosinophilia
Break down of plasma memb and orgenellar

memb
This is the major pathway of cell death in
many common injuries
Nessasarily pathologic

Apoptosis
Regulated suicidal program of cells when cell

is deprived of growth factor or if DNA or

PROTEINS are damaged

Cell it self get killed

appoptosis
Is an active enzymetic process
Energy dependent
Neucleo proteins are condenced and broken

down
Cell is fragmented by formation of apoptotic
bodies(fragments of nuclei and
cytoplasm)
Tightly regulated process
Not always pathological
No complete loss of membrane

Causes of appoptosis
Programmed cell destruction in

embryogenesis
Involution of hormone dependent tissue

regression of lactating breast after

weaning
Death of tissue after finishing the role

nutrophils after inflammatory response

lymphocytes after immune response

Viral infection
In DNA damage radiation, anticancer drugs

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