DISTURBANCES IN GROWTH TUMOURS By Prof Soheir Mahfouz

DISTURBANCES IN GROWTH & TUMOURS By Prof. Soheir Mahfouz Undergraduate Pathology (L 1) 1

LEARNING OBJECTIVES Chapter 11 p 149 At the end of this lecture you should be able to: Enumerate the different growth disturbances and give examples n Revise Definitions of : atrophy, hyperplasia , metaplasia, n Focus on: dysplasia, CIS and neoplasia n Undergraduate Pathology (L 1) 2

What is GROWTH? n n Any growth entails: 1) Cell proliferation or division=Increased number of cells 2) Cell maturation & differentiation= change in appearance and function Any growth may be : 1) Normal or physiologic (controlled) 2) Abnormal or Pathologic ( controlled or uncontrolled) Undergraduate Pathology (L 1) 3

When is growth Normal & when is it abnormal? Cell division I-CONTROLLED GROWTH Cell differentiation & Maturation A) PHYSIOLOGIC/ Normal B) PATHOLOGIC/Abnormal controlled & reversible adaptations n Stimulatory growth factors (GF) Hyperplasia (plasia= Proliferation/No) Hypertrophy (trophy=Size) n Inhibitory GF ALL Normal growths Atrophy are controlled by the Hypoplasia body 4 Undergraduate Pathology (L 1)

Uncontrolled growths are always abnormal II-UNCONTROLLED: Abnormal (pathologic)increased growths NEOPLASIA (tumours) Pathologic new proliferation of any Cell (epithelial-mesenchymal & other) characterized by being: Uncontrolled Irreversible Progressive Purposeless Undergraduate Pathology (L 1) 5

DISTURBANCES IN GROWTH Undergraduate Pathology (L 1) 6

Controlled growths Normal Atrophy Hyperplasia Metaplasia Undergraduate Pathology (L 1) 7

Controlled: NON NEOPLASTIC Decreased growth n DEVELOPMENTAL Occurs in Primitive embryonic cells & affects : Ø Proliferation(cell division) Ø Maturation & Differentiation: morphologic & specialization (functional) E. G. : - Agenesis (absence of organ) - Aplasia (complete failure of organ development) - Hypoplasia (organ fails to reach adult size, infantile uterus) NON DEVELOPMENTAL Atrophy: decrease in size after reaching full Undergraduate Pathology (L 1) maturation n 8

NON DEVELOPMENTAL decreased growth ATROPHY n n Ø Ø DEFINITION: decreased size & weight of an organ after it has reached its full development due to decreased size of cells TYPES: Physiologic atrophy: senility Thymus at puberty, uterus menopause- Pathologic: I) General atrophy: all organs and tissues -TB-starvation II) Localized atrophy a) Disuse atrophy-immobilization b) Neuropathic- cutting of motor nerve c) Pressure atrophy-amyloid liver d) Endocrine-ovariectomy e) Vascular atrophy-atherosclerosis Undergraduate Pathology (L 1) 10

Controlled: NON NEOPLASTIC Increased growth n n Hypertrophy: Increase size of cells Hyperplasia: Increase number of cells Metaplasia: change from one mature cell type to another mature more resistant cell type of the same origin Dysplasia: Disordered proliferation & maturation ( it is a preneoplastic change) All are characterized by: 1 -Known stimulus (CELL INJURY) 2 -Reversible nature: return to normal after removal of stimulus 3 -Intact basement membrane Undergraduate Pathology (L 1) 11 4 -Still under body control

NON NEOPLASTIC Increased growth HYPERTROPHY n n DEFINITION: Abnormal increase in size & weight of an organ due to increase in size of cells TYPES I) II) Physiologic hypertrophy: muscles of athletes Pathologic hypertrophy a) Adaptive: hypertrophy of Left V in hypertension & UB in bladder neck obstruction b) Compensatory: hypertrophy of remaining kidney in nephrectomy Undergraduate Pathology (L 1) 12

GROWTH DISTURBANCES HYPERTROPHY spinach Increase in cell size …no increase in cell number Undergraduate Pathology (L 1) 13

NON NEOPLASTIC Increased growth HYPERTROPHY Hypertrophy Undergraduate Pathology (L 1) 14

NON NEOPLASTIC Increased growth HYPERPLASIA n n DEFINITION: Abnormal increase in size & weight of an organ due to increase in number of cells TYPES I) II) Physiologic hyperplasia: breast & genitalia at puberty Pathologic hyperplasia a) Irritation: hyperplasia of Lymphoid tissue in infections b) Compensatory: hyperplasia of bone marrow after hemorrhage c) Hormonal: endometrial hyperplasia in hyperestrogenic states Undergraduate Pathology (L 1) 15

GROWTH DISTURBANCES n Hyperplasia: Endometrial hyperplasia cervix UTERUS Undergraduate Pathology (L 1) 16

NON NEOPLASTIC Increased growth METAPLASIA n DEFINITION: Transformation of one type of n TYPES differentiated (mature) cells into another differentiated type of the same group or histologic nature Ø Epithelial metaplasia: Columnar & transitional epithelium change to more resistant squamous epithelium in bilharziasis Ø Mesenchymal metaplasia: Traumatic myositis ossificansbone in scars Ø Serosal (mesothelial ) metaplasia: irritation of flat serosal cells changes them to cubical/columnar/squamous Ø Tumour metaplasia: occurs in cells or stroma of tumours as squamous metaplasia in endometrial carcinoma Undergraduate Pathology (L 1) 17

Pathogenesis of abnormal increased growth More. irritation Chr. irritation Hyperplasia Metaplasia More. irritation Neoplasia Invasive Carcinoma Dysplasia More. irritation Carcinoma insitu Undergraduate Pathology (L 1) 18

Normal Increased Squamous metaplasia growth Hyperplasia Dysplasia Undergraduate Pathology (L 1) 19

METAPLASIA columnar Squamous metaplasia Undergraduate Pathology (L 1) 20

METAPLASIA SQUAMOUS RESPIRATORY LARYNX: squamous metaplasia in a smoker leukoplakia is a white patch due to keratinzation of the surface layer of St sq Undergraduate Pathology (L 1) 21

NON NEOPLASTIC DYSPLASIA n n DEFINITION: Disordered cellular proliferation, maturation and differentiation usually in association with chronic irritation It is characterized by 1 -Loss of cell pattern (polarity) with increase in layers of immature cells 2 -Cellular pleomorphism (shape & size) and hyperchromasia 3 -Increased mitosis 4 -Reversible & controlled except for severe dysplasia which progresses to carcinoma insitu then frank invasive carcinoma Undergraduate Pathology (L 1) 22

NON NEOPLASTIC DYSPLASIA n n Sites : mucous membranes of cervix, bronchi, oral cavity, colon, gall & urinary bladderepidermis & liver Microscopic picture 1 -Loss of cell pattern (polarity) & increase in layers of immature cells 2 -Cellular pleomorphism ( different shape & size) & hyperchromasia (dark nucleus) 3 -Increased mitosis There are 2 grades: Low & High grade dysplasia Undergraduate Pathology (L 1) 23

NON NEOPLASTIC DYSPLASIA Normal Low grade MILD High grade (& CIS) SEVERE Undergraduate Pathology (L 1) 24

Normal squamous Dysplastic squamous Carcinoma in situ Is a pre-invasive stage of cancer & is characterized by severe epithelial atypia (high grade dysplasia) without invasion of the basement membrane. Once the basement membrane is invaded the CIS phase ends and actual malignant tumor starts. Undergraduate Pathology (L 1) 25

DYSPLASIA -65 yr old tobacco chewer -oral mucosa shows leukoplakia (white plaque) -full thickness severe dysplasia on mucosal biopsy Undergraduate Pathology (L 1) 26

LECTURE 1 OUTLINE: DISTURBANCES IN GROWTH Undergraduate Pathology (L 1) 27

1. 2. 3. 4. 5. 6. 7. 8. At the end of this chapter you should be able to answer these questions What is the significance of cellular adaptations? What is atrophy? Is atrophy always pathologic? What causes pathologic atrophy? What is hypertrophy? Which organs undergo pure hypertrophy? What is hyperplasia? Is hyperplasia always pathologic? 28 Undergraduate Pathology (L 1)

At the end of this chapter you should be able to answer these questions Can hyperplasia combine with hypertrophy? 10. What is metaplasia? 11. Is metaplasia reversible? 12. Define dysplasia 9. Undergraduate Pathology (L 1) 29

At the end of this chapter you should be able to answer this question 13. A hysterectomy is performed and the cervix is examined by a pathologist. The pathologist detrmines the patient has mild dysplasia (CIN I). Which of the following is most likely seen: a. Cells with large nuclei & loss of polarity in upper third of cervical mucosa b. Cells with large nuclei middle third of cervical mucosa c. Cells with large nuclei lower third of cervical mucosa d. Cells with large nuclei & mitotic figures below basement membrane. Undergraduate Pathology (L 1) 30

Home ASSIGNMENT for next lecture n n n 1. 2. A 74 year old man has chronic cough which is sometimes blood stained A bronchoscopic biopsy is sent to the pathology lab for examination The Pathology report says high grade dysplasia Questions? ? ? What is meant by dysplasia What are the microscopic Undergraduate Pathology features that lead to(L 1)this 31

Undergraduate Pathology (L 1) 32

Resources n n n n n Chandrasoma, P. and Taylor, C. R. : Concise Pathology. 3' edition. Mc. Graw Hill Education 1997 EI Hindawi, A. : Basic General Pathology. Faculty of Medicine, Cairo University 2009 Reid, R Callander, R Ramsden I, Roberts, F. Mac. Farlane, PS. Pathology Illustrated 6 th edition, Elsevier Science Health Science div 2005 Jones, E. & Morris, A. Cell biology & Genetics. Mosby, London Philadelphia SI Louis, Sydney, Tokyo. 1998 Kumar, v. , Abbas A. K. Cotran, R. S. Robbins, & Cotran Basic Pathology. 7" edition, W. B. Saunders Co. , Philadelphia, London, Toronto, Sydney, New York, Sydney & Tokyo. 2005 Stevens, J. & Lowe, J. : Pathology. Mosby. 1998 Underwood, J. C. E. : General and Systematic Pathology. 3' edition. Churchill Livingstone. Edinburgh, London, Madrid, Melbourne, New York & Tokyo. 2000 Ciba collection of medical illustrations 1971 Sandritter W. , and Wartman, WB: Color atlas and textbook of Tissue and cellular Pathology 5 th edition Year book Medical publications 1975 Undergraduate Pathology (L 1) 33

Resources WEB n http: //www. medicine. cu. edu. eg/beta/enljcalpro/2428. htm. I n http: //www. kasralainy. edu. eg/elearning/ n http: //www. pathmax. com/ n http: //www-med. Jib. med. utah. edu/Web. Path/LABS/LABMENU. html#2 n http: /Iwww. med. uiuc. edu/Path. Atlasf/title. Page. htm. I n http: //www. medscape. com/pathologyhome n http: //www. gwumc. edu/deptlpath/2 F. HTM n http: //www. path. uiowa. ed u/vi rtualsl idebox/ n http: //web. med. unsw. edu. au/pathology/Pathmus/pathmus. htm#1 nteractive. Jmages n http: //www. virtualpathology. leeds. ac. ukf n http: //histopathsho. 34 sp. comfindex. htm n http: //pathology. class. kmu. edu. tw/index. htm n http: //www. g. Ja. ac. ukffaculties/medicine/teaching/Med. CALIist. htm n Undergraduate Pathology (L 1) 34