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CELL ADAPTATIONS
CELL INJURY
Dr. Salman Ahmad Ansari(MBBS)
Tutor, Dept of Pathology
Kanachur Institute of Medical
Sciences
06/05/23
Index
● Cellular adaptations
● Cellular injury:
● Reversible cell injury
- Hydropic change
- Fatty change
● Irreversible cell injury
- Necrosis
- Apoptosis
CELLULAR ADAPTATIONS
Cellular adaptations
Definition: Reversible changes that take place in a cell in
order for it to survive and function in an abnormal
environment
E.g: changes in size, number or differentiation of cell
Types of adaptation
1. Hypertrophy
2. Hyperplasia
3. Atrophy
4. Metaplasia
1. Hypertrophy
Definition: Increase in size of tissue or organ due to
increase in size of cells
Causes of hypertrophy
2 types
Physiological
Pathological
Pathological
● Hypertrophy of cardiac muscle:
left ventricular hypertrophy in
hypertension or valve defects
● Hypertrophy of smooth muscle:
urinary bladder muscle in benign
prostatic hyperplasia(BPH)
Physiological
● Hypertrophy of skeletal muscles
in bodybuilders, labourers,
athletes
● Hypertrophy of smooth muscle:
uterus in pregnancy due to
estrogen
Morphology
Gross:
involved organ is enlarged
Microscopy:
increase in size of cells and nuclei
2. Hyperplasia
Definition: Increase in number of cells in an organ or
tissue resulting in increased size of organ
Causes
Can be physiological or pathological
Physiological
Due to hormonal stimulation or compensation
● Breast hyperplasia at puberty, pregnancy and lactation
● Hyperplasia of uterus in pregnancy
● Compensatory hyperplasia: liver grows back after partial
removal(hepatectomy)
Pathological
Due to excessive endocrine stimulation or chronic irritation
Can progress to cancer
● Endometrial hyperplasia due to estrogen
● Bladder muscle - BPH
● Chronic injury: skin/oral mucosa
Morphology
Gross:
involved organ is enlarged
Microscopy:
increase in number of cells
3. Atrophy
Definition: reduced size of organ or tissue resulting
from decrease in cell size and number
Causes
Physiological
● Atrophy of embryonic structures
● Atrophy of brain, heart due to ageing(senile atrophy)
Pathological
Local or generalised atrophy
Local:
● Disuse atrophy: atrophy of muscles immobilised in plaster cast or
prolonged bed rest
● Denervation atrophy: muscle atrophy due to nerve damage in
poliomyelitis
● Ischemic atrophy(decreased bloody supply): brain atrophy due to
atherosclerosis of carotid artery
● Pressure atrophy: renal atrophy in hydronephrosis
Generalised:
● Starvation atrophy: malnutrition
Morphology
Gross:
involved organ is small and shrunken
Microscopy:
decrease in size of cells
4. Metaplasia
Definition: change from one cell type to another type
Types of metaplasia
a) Epithelial
b) Mesenchymal
Epithelial:
- Squamous metaplasia: chronic irritation of respiratory
columnar epithelial cells leads to squamous epithelial
change
- Cervix: chronic infection leads to squamous metaplasia
- Columnar metaplasia: squamous epithelium of
esophagus changes to columnar epithelium in
Barrett’s esophagus
- Intestinal metaplasia: gastric glands replaced by
intestinal type glands
CELLULAR INJURY
Cell injury
Definition: a variety of changes of stress that a cell suffers
due to external as well as internal environmental changes.
Causes
Cell injury can be due to:
- Reduced oxygen supply(hypoxia)
- Physical agents: trauma, radiation, electric shock
- Chemical agents: heavy metals, chemicals, pollutants, alcohol,
cigarette smoking
- Infectious agents: virus, bacteria, fungi, parasites
- Abnormal immune reactions: autoimmunity, hypersensitivity
reaction
- Nutritional imbalance
- Genetic factors: abnormal genes or chromosomal abnormalities
- Idiopathic: causes is not known
Types of cell injury
2 types
Reversible Irreversible
Reversible cell injury
If the stimulus is acute and brief or mild, the changes
produced in cell are reversible.
2 patterns seen under microscopy:
● cellular swelling(hydropic)
● Fatty change
Cloudy swelling(Hydropic change)
“Due to changes in ion concentration, there is increased water flow
into injured cells, leading to increased water content”
Causes: bacterial toxins, chemical poisons, malnutrition
Organs involved: Kidney, liver, heart and muscle
Gross features:
● organ affected is slightly enlarged due to swelling of cells
● Cut surface: cloudy appearance
Microscopic features:
● Cloudy swelling seen
Fatty change(steatosis)
“Abnormal accumulation of triglycerides(lipids) within cells”
Organs affected: liver mainly, heart, muscle, kidney
Causes:
● disorders with liver damage: alcohol abuse, malnutrition,
starvation
● Disorders with hyperlipidemia: obesity, diabetes mellitus,
congenital hyperlipidemia
Gross features(fatty liver):
● enlarged liver, yellow, soft, greasy
Microscopy:
● accumulation of fat in small vacuoles in cytoplasm
● Nucleus gets pushed to periphery of cells
IRREVERSIBLE CELL INJURY
Irreversible cell injury
Definition: When cell is exposed to continuous injurious
stimulus or if injury is severe, the cell undergoes cell death
2 types of cell death:
● Necrosis(always pathological)
● apoptosis(may be physiological or pathological)
NECROSIS
Necrosis
Definition: Necrosis refers to the morphological changes
which indicated cell death in a living tissue after an extremely
harmful injury
Causes of necrosis
All the causes of cell injury if severe and persistent can cause
necrosis
- Reduced oxygen supply(hypoxia)
- Physical agents: trauma, radiation, electric shock
- Chemical agents: heavy metals, chemicals, pollutants, alcohol,
cigarette smoking
- Infectious agents: virus, bacteria, fungi, parasites
- Abnormal immune reactions: autoimmunity, hypersensitivity
reaction
- Nutritional imbalance
- Genetic factors: abnormal genes or chromosomal abnormalities
- Idiopathic: causes is not known
Morphology
General changes seen:
● Increased eosinophilia
● Nuclear changes:
- Pyknosis: shrinking of nucleus - stains deeply
basophilic
- Karyolysis: fading of basophilic staining of nucleus -
“ghost nucleus”
- Karyorrhexis: nucleus breaks into smaller pieces
“Shrinks, fades and breaks up”
“P.K.K”
“Shrinks,
Fades
And
Breaks up”
Types of necrosis
Different morphological patterns of necrosis
1. Coagulative necrosis
2. Liquefactive necrosis
3. Caseous necrosis
4. Fat necrosis
5. Fibrinoid necrosis
6. Gangrene or Gangrenous necrosis
1. Coagulative necrosis
Outline of dead cells is preserved. Area affected is called “infarct”.
Causes: ischemia(poor blood supply)
Organs affected: heart, kidney, spleen(any organ except brain)
Gross features:
Necrotic tissue appears dry, pale, yellow, soft
Microscopy:
Outline of dead tissue is preserved
2. Liquefactive necrosis/Colliquative necrosis
When dead tissue rapidly undergoes softening and becomes a
thick liquid mass
Causes: - ischemic injury to CNS
- suppurative infections by bacteria
Organs affected: brain, abscess of any organ
Gross: abscess shows cavity containing pus and surrounding wall
with granulation tissue
Microscopy:
Pus: liquefied necrotic cell debris, dead WBCs, macrophages
3. Caseous necrosis
Features of both coagulative and liquefactive necrosis
Caseous means cheese-like
Causes: seen in tuberculosis - hypersensitivity reaction
Organs affected: lung, lymph nodes commonly
Gross:
● necrotic area is yellowish, soft, friable with well-defined borders
Microscopy:
● Lesion called granuloma
● Caseous necrosis in centre, surrounded by epithelioid cells,
4. Fat necrosis
Death of fat tissue due to injury
Causes:
1. Enzymatic: due to acute pancreatitis
2. Traumatic: due to physical injury
Gross:
● Chalky-white areas
Microscopy:
● Fat cells with pale outline, surrounded by inflammatory reaction
5. Fibrinoid necrosis
Special type of necrosis with deposition of pink-staining fibrin-like
material
Causes: immune-mediated vascular injury
Organs affected: arteries, arterioles, glomeruli of kidney
6. Gangrene/Gangrenous necrosis
Definition: massive necrosis with superadded
putrefaction(decomposition)
Putrefaction is decomposition by micro-organisms
Types:
● Dry gangrene
● Wet gangrene
6a. Dry gangrene
Site: affects distal part of limbs(like foot, toe, fingers)
Cause: due to arterial occlusion
Gross features:
● Dry, shrunken, shriveled(mummified) and dark brown/black
● Line of demarcation between the gangrenous area and adjacent
normal skin
Microscopy:
● smudging of soft tissue
● Line of demarcation made of granulation tissue and inflammatory cells
6b. Wet gangrene
Site: affects moist tissues or organs(bowels, lung, mouth), diabetic
foot
Cause: due to venous blockage
Gross features:
● Soft, swollen, putrid, rotten, dark
● No clear line of demarcation
Microscopy:
● Liquefactive necrosis
More dangerous than
dry gangrene ☠
DRY GANGRENE WET
Site Limbs Bowels
Example Gangrene due to
atherosclerotic occlusion
Intussusception,
volvulus
Cause Arterial block Venous block
Onset slow sudden
Pathogens Absent Present
Gross features Dry(mummified) Swollen, moist
Line of demarcation Present Not clear
Putrefaction minimal Marked, foul smelling
Spread slow rapid
Prognosis fair poor
6c. Gas gangrene
Special type of gas gangrene caused by infection with gas-
forming anaerobic clostridium bacteria
APOPTOSIS
Apoptosis
Definition: it refers to programmed cell death, in which cell
activates enzymes which degrade the cell’s own nucleus and
cytoplasmic proteins
Causes of apoptosis:
1. Physiological
2. Pathological
Physiological apoptosis:
E.g:
- Removal of excess cells during development of embryo
- Breakdown of endometrium during the menstrual cycle
- Elimination of neutrophils after immune response
Pathological apoptosis:
E.g:
- Elimination of cells with damaged DNA
- Killing of cells infected by virus
- Elimination of neoplastic cells
Morphology
● Cells shrink
● Cytoplasm becomes dense
● Nucleus condenses and fragments
● Formation of cytoplasmic blebs and apoptotic bodies
● Phagocytosis of apoptotic cells/bodies by macrophages
and degradation by lysosomal enzymes
Feature Apoptosis Necrosis
Cause Physiological or
pathological
Always pathological
Extent Single cell or small
group of cells
Large group of cells
Nucleus Fragmentation Pyknosis, karyorrhexis,
karyolysis
Cell contents Intact(apoptotic
bodies)
Leak out of cell
Inflammatory
response
Absent Present in surrounding
tissue
Fate of dead cells Ingested by
neighbouring cells
Ingested by
neutrophils and
macrophages
References:
● Ramadas Nayak - Textbook of Pathology for
Undergraduates
Questions:
salman.s.ansari92@gmail.com
For notes,
scan:
For PPT, scan:

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Cell adaptations, Cell injury, Necrosis, Apoptosis - Pathology - Nursing

  • 1. CELL ADAPTATIONS CELL INJURY Dr. Salman Ahmad Ansari(MBBS) Tutor, Dept of Pathology Kanachur Institute of Medical Sciences 06/05/23
  • 2. Index ● Cellular adaptations ● Cellular injury: ● Reversible cell injury - Hydropic change - Fatty change ● Irreversible cell injury - Necrosis - Apoptosis
  • 4. Cellular adaptations Definition: Reversible changes that take place in a cell in order for it to survive and function in an abnormal environment E.g: changes in size, number or differentiation of cell
  • 5. Types of adaptation 1. Hypertrophy 2. Hyperplasia 3. Atrophy 4. Metaplasia
  • 6. 1. Hypertrophy Definition: Increase in size of tissue or organ due to increase in size of cells
  • 7.
  • 8. Causes of hypertrophy 2 types Physiological Pathological
  • 9. Pathological ● Hypertrophy of cardiac muscle: left ventricular hypertrophy in hypertension or valve defects ● Hypertrophy of smooth muscle: urinary bladder muscle in benign prostatic hyperplasia(BPH) Physiological ● Hypertrophy of skeletal muscles in bodybuilders, labourers, athletes ● Hypertrophy of smooth muscle: uterus in pregnancy due to estrogen
  • 10. Morphology Gross: involved organ is enlarged Microscopy: increase in size of cells and nuclei
  • 11. 2. Hyperplasia Definition: Increase in number of cells in an organ or tissue resulting in increased size of organ
  • 12.
  • 13. Causes Can be physiological or pathological Physiological Due to hormonal stimulation or compensation ● Breast hyperplasia at puberty, pregnancy and lactation ● Hyperplasia of uterus in pregnancy ● Compensatory hyperplasia: liver grows back after partial removal(hepatectomy)
  • 14. Pathological Due to excessive endocrine stimulation or chronic irritation Can progress to cancer ● Endometrial hyperplasia due to estrogen ● Bladder muscle - BPH ● Chronic injury: skin/oral mucosa
  • 15. Morphology Gross: involved organ is enlarged Microscopy: increase in number of cells
  • 16. 3. Atrophy Definition: reduced size of organ or tissue resulting from decrease in cell size and number
  • 17.
  • 18. Causes Physiological ● Atrophy of embryonic structures ● Atrophy of brain, heart due to ageing(senile atrophy)
  • 19. Pathological Local or generalised atrophy Local: ● Disuse atrophy: atrophy of muscles immobilised in plaster cast or prolonged bed rest ● Denervation atrophy: muscle atrophy due to nerve damage in poliomyelitis ● Ischemic atrophy(decreased bloody supply): brain atrophy due to atherosclerosis of carotid artery ● Pressure atrophy: renal atrophy in hydronephrosis Generalised: ● Starvation atrophy: malnutrition
  • 20. Morphology Gross: involved organ is small and shrunken Microscopy: decrease in size of cells
  • 21. 4. Metaplasia Definition: change from one cell type to another type
  • 22.
  • 23. Types of metaplasia a) Epithelial b) Mesenchymal
  • 24. Epithelial: - Squamous metaplasia: chronic irritation of respiratory columnar epithelial cells leads to squamous epithelial change - Cervix: chronic infection leads to squamous metaplasia - Columnar metaplasia: squamous epithelium of esophagus changes to columnar epithelium in Barrett’s esophagus - Intestinal metaplasia: gastric glands replaced by intestinal type glands
  • 25.
  • 27. Cell injury Definition: a variety of changes of stress that a cell suffers due to external as well as internal environmental changes.
  • 28. Causes Cell injury can be due to: - Reduced oxygen supply(hypoxia) - Physical agents: trauma, radiation, electric shock - Chemical agents: heavy metals, chemicals, pollutants, alcohol, cigarette smoking - Infectious agents: virus, bacteria, fungi, parasites - Abnormal immune reactions: autoimmunity, hypersensitivity reaction - Nutritional imbalance - Genetic factors: abnormal genes or chromosomal abnormalities - Idiopathic: causes is not known
  • 29. Types of cell injury 2 types Reversible Irreversible
  • 30. Reversible cell injury If the stimulus is acute and brief or mild, the changes produced in cell are reversible. 2 patterns seen under microscopy: ● cellular swelling(hydropic) ● Fatty change
  • 31. Cloudy swelling(Hydropic change) “Due to changes in ion concentration, there is increased water flow into injured cells, leading to increased water content” Causes: bacterial toxins, chemical poisons, malnutrition Organs involved: Kidney, liver, heart and muscle Gross features: ● organ affected is slightly enlarged due to swelling of cells ● Cut surface: cloudy appearance Microscopic features: ● Cloudy swelling seen
  • 32.
  • 33. Fatty change(steatosis) “Abnormal accumulation of triglycerides(lipids) within cells” Organs affected: liver mainly, heart, muscle, kidney Causes: ● disorders with liver damage: alcohol abuse, malnutrition, starvation ● Disorders with hyperlipidemia: obesity, diabetes mellitus, congenital hyperlipidemia
  • 34. Gross features(fatty liver): ● enlarged liver, yellow, soft, greasy Microscopy: ● accumulation of fat in small vacuoles in cytoplasm ● Nucleus gets pushed to periphery of cells
  • 35.
  • 36.
  • 38. Irreversible cell injury Definition: When cell is exposed to continuous injurious stimulus or if injury is severe, the cell undergoes cell death 2 types of cell death: ● Necrosis(always pathological) ● apoptosis(may be physiological or pathological)
  • 40. Necrosis Definition: Necrosis refers to the morphological changes which indicated cell death in a living tissue after an extremely harmful injury
  • 41.
  • 42. Causes of necrosis All the causes of cell injury if severe and persistent can cause necrosis - Reduced oxygen supply(hypoxia) - Physical agents: trauma, radiation, electric shock - Chemical agents: heavy metals, chemicals, pollutants, alcohol, cigarette smoking - Infectious agents: virus, bacteria, fungi, parasites - Abnormal immune reactions: autoimmunity, hypersensitivity reaction - Nutritional imbalance - Genetic factors: abnormal genes or chromosomal abnormalities - Idiopathic: causes is not known
  • 43. Morphology General changes seen: ● Increased eosinophilia ● Nuclear changes: - Pyknosis: shrinking of nucleus - stains deeply basophilic - Karyolysis: fading of basophilic staining of nucleus - “ghost nucleus” - Karyorrhexis: nucleus breaks into smaller pieces “Shrinks, fades and breaks up”
  • 45. Types of necrosis Different morphological patterns of necrosis 1. Coagulative necrosis 2. Liquefactive necrosis 3. Caseous necrosis 4. Fat necrosis 5. Fibrinoid necrosis 6. Gangrene or Gangrenous necrosis
  • 46. 1. Coagulative necrosis Outline of dead cells is preserved. Area affected is called “infarct”. Causes: ischemia(poor blood supply) Organs affected: heart, kidney, spleen(any organ except brain) Gross features: Necrotic tissue appears dry, pale, yellow, soft Microscopy: Outline of dead tissue is preserved
  • 47.
  • 48.
  • 49.
  • 50. 2. Liquefactive necrosis/Colliquative necrosis When dead tissue rapidly undergoes softening and becomes a thick liquid mass Causes: - ischemic injury to CNS - suppurative infections by bacteria Organs affected: brain, abscess of any organ Gross: abscess shows cavity containing pus and surrounding wall with granulation tissue Microscopy: Pus: liquefied necrotic cell debris, dead WBCs, macrophages
  • 51.
  • 52. 3. Caseous necrosis Features of both coagulative and liquefactive necrosis Caseous means cheese-like Causes: seen in tuberculosis - hypersensitivity reaction Organs affected: lung, lymph nodes commonly Gross: ● necrotic area is yellowish, soft, friable with well-defined borders Microscopy: ● Lesion called granuloma ● Caseous necrosis in centre, surrounded by epithelioid cells,
  • 53.
  • 54.
  • 55. 4. Fat necrosis Death of fat tissue due to injury Causes: 1. Enzymatic: due to acute pancreatitis 2. Traumatic: due to physical injury Gross: ● Chalky-white areas Microscopy: ● Fat cells with pale outline, surrounded by inflammatory reaction
  • 56.
  • 57. 5. Fibrinoid necrosis Special type of necrosis with deposition of pink-staining fibrin-like material Causes: immune-mediated vascular injury Organs affected: arteries, arterioles, glomeruli of kidney
  • 58.
  • 59. 6. Gangrene/Gangrenous necrosis Definition: massive necrosis with superadded putrefaction(decomposition) Putrefaction is decomposition by micro-organisms Types: ● Dry gangrene ● Wet gangrene
  • 60. 6a. Dry gangrene Site: affects distal part of limbs(like foot, toe, fingers) Cause: due to arterial occlusion Gross features: ● Dry, shrunken, shriveled(mummified) and dark brown/black ● Line of demarcation between the gangrenous area and adjacent normal skin Microscopy: ● smudging of soft tissue ● Line of demarcation made of granulation tissue and inflammatory cells
  • 61.
  • 62. 6b. Wet gangrene Site: affects moist tissues or organs(bowels, lung, mouth), diabetic foot Cause: due to venous blockage Gross features: ● Soft, swollen, putrid, rotten, dark ● No clear line of demarcation Microscopy: ● Liquefactive necrosis More dangerous than dry gangrene ☠
  • 63.
  • 64. DRY GANGRENE WET Site Limbs Bowels Example Gangrene due to atherosclerotic occlusion Intussusception, volvulus Cause Arterial block Venous block Onset slow sudden Pathogens Absent Present Gross features Dry(mummified) Swollen, moist Line of demarcation Present Not clear Putrefaction minimal Marked, foul smelling Spread slow rapid Prognosis fair poor
  • 65. 6c. Gas gangrene Special type of gas gangrene caused by infection with gas- forming anaerobic clostridium bacteria
  • 67. Apoptosis Definition: it refers to programmed cell death, in which cell activates enzymes which degrade the cell’s own nucleus and cytoplasmic proteins Causes of apoptosis: 1. Physiological 2. Pathological
  • 68. Physiological apoptosis: E.g: - Removal of excess cells during development of embryo - Breakdown of endometrium during the menstrual cycle - Elimination of neutrophils after immune response Pathological apoptosis: E.g: - Elimination of cells with damaged DNA - Killing of cells infected by virus - Elimination of neoplastic cells
  • 69. Morphology ● Cells shrink ● Cytoplasm becomes dense ● Nucleus condenses and fragments ● Formation of cytoplasmic blebs and apoptotic bodies ● Phagocytosis of apoptotic cells/bodies by macrophages and degradation by lysosomal enzymes
  • 70.
  • 71. Feature Apoptosis Necrosis Cause Physiological or pathological Always pathological Extent Single cell or small group of cells Large group of cells Nucleus Fragmentation Pyknosis, karyorrhexis, karyolysis Cell contents Intact(apoptotic bodies) Leak out of cell Inflammatory response Absent Present in surrounding tissue Fate of dead cells Ingested by neighbouring cells Ingested by neutrophils and macrophages
  • 72. References: ● Ramadas Nayak - Textbook of Pathology for Undergraduates Questions: salman.s.ansari92@gmail.com For notes, scan: For PPT, scan: