Cells must constantly adapt, even under

normal conditions, to changes in their

environment.
These physiological adaptations usually
represent responses of cells to normal
stimulation by hormones or endogenous
chemical substances. For example, as in
the enlargement of the breast and
induction of lactation by pregnancy.
Pathologic adaptations may share the
same underlying mechanisms, but they
provide the cells with the ability to
survive in their environment and
perhaps escape injury.
Then cellular adaptation is a state that
lies intermediate between the normal,
unstressed cell and the injured,
overstressed cell.
There are numerous types of cellular
adaptations:
some involve up or down regulation of specific
cellular receptors involved in metabolism of
certain components.
Others are associated with the induction of new
protein synthesis by the target cell.
Other adaptations involve a switch by cells
from producing one type of a family of
proteins to another or markedly
overproducing one protein.
These adaptations then involve all steps
of cellular metabolism of proteins
receptor binding, signal transduction,
transcription, translation, or regulation of
protein packaging and release.
In this section we consider some common
adaptive changes in cell growth, size,
and differentiation that underlie many
pathologic processes.
1. Hyperplasia

(1) Definition: An increase in the number of
cells in an organ or tissue, which may then
have increased volume.

(2) Types:

Physiologic: Response to need, e. g.
hyperplasia of the female breast epithelium at
puberty or in pregnancy.

Left Normal breast Right Hyperplasia
From ROBBINS BASIC PATHOLOGY2003
Compensatory: Response to deficiency, e. g.
Hyperplasia following surgical removal of part
of liver or of one kidney; hyperplasia of the
bone marrow in anemia.
Excessive stimulation: Pathologic: as in
ovarian tumor producing estrogen and
stimulating endometrial hyperplasia;
pancreatic islet hyperplasia in infants of a
diabetic mother (stimulated by high glucose
level).
Failure of regulation: Pathologic, as in
hyperthyroidism or as in hyperparathyroidism
resulting from renal failure or vitamin D
deficiency.
Neoplastic: Total loss of normal control
mechanism. Should not be termed
hyperplasia.

Hyperplasia is also an important response of
connective tissue cells in wound healing, in
which proliferating fibroblasts and blood
vessels aid in repair.
(3) Mechanisms:

Most forms of pathologic hyperplasia
are instances of excessive hormonal
stimulation or are the effects of growth
factors on target cells.
2. Hypertrophy:

(1) Definition: An increase in the size of
cells, and with such change, an increase
in the size of the organ.
Left Normal heart
center Hypertrophied heart
Right Hypertrophied and dilated heart
Hypertrophied heart
From ROBBINS BASIC PATHOLOGY2003
Physiologic hypertrophy of the uterus during pregnancy.A,
gross appearance of a normal uterus (right) and a gravid
uterus (left) that was removed for postpartum bleeding,
Normal uterus
gravid uterus
From ROBBINS BASIC PATHOLOGY2003
(2) Types:

Physiologic: i. e. the physiologic
growth of the uterus during pregnancy
involves both hypertrophy and
hyperplasia. The cellular hypertrophy is
stimulated by estrogenic hormones
through smooth muscle estrogen
receptors.
Pathologic: causes:
increased workload, hormonal stimulation and
growth factors stimulation.
i.e. hypertrophy of heart the most common
stimulus is chronic hemodynamic overload,
due either to hypertension or to faulty valves.
It eventually reaches a limit beyond which
enlargement of muscle mass is no longer able
to compensate for the increased burden, and
cardiac failure ensues.
The relationship between
hyperplasia and hypertrophy:
Although hypertrophy and hyperplasia
are two distinct processes, frequently
both occur together, and they well be
triggered by the same mechanism.
3. Atrophy

(1) Definition: Acquired loss of size due
to reduction of cell size or number of
parenchyma cells in an organ.

(2) Types:

Physiologic: i. e. Aging; shrinking
mammary gland after lactation; the
uterus after delivery or in old age.
Diminished blood supply:
Loss of nerve stimulus:
Loss of endocrine stimulation:

Inadequate nutrition:
pressure:
The fundamental cellular change is
identical in all, representing a
retreat by the cell to a smaller size
at which survival is still possible.
Although atrophic cells may have
diminished function, they are not
dead.
Atrophy represents a reduction in
the structural components of the
cell. The cell contains fewer
mitochondria, myofilaments, a
lesser amount of endoplasmic
reticulum, and increasing in the
number of autophagy vacuoles.
Some of the cell debris within the
autophage vacuole may resist digestion
and persist as membrane bound
residual bodies that may remain as a
sarcophagus in the cytoplasm. When
present in sufficient amounts, they
impart a brown discoloration to the
tissue (brown atrophy).
Left Normal Right Atrophy
)
Atrophy of the brain
(offered by Prof. Orr )
4. Metaplasia

( 1 ) Definition: Metaplasia is a reversible
change in which one adult cell type is
replaced by another adult cell type.

(2) Causes:

Changes in environment: i. e. stones in
excretory ducts of salivary gland, pancreas,
or bile duct lead to change from columnar
epithelium to stratified squamous epithelium.
Squamous metaplasia in bronchitis
offered by Prof.Orr
Schematic diagram of columnar to squamous metaplasia
From ROBBINS BASIC PATHOLOGY2003
Irritation or inflammation: i. e. In
the habitual cigarettes smoker, the
normal columnar ciliated epithelial cells
of the trachea and bronchi are often
replaced focally or widely by stratified
squamous epithelial cells.

Nutritional: vitamin A deficiency
causing squamous metaplasia.
Epithelial metaplasia is a two-edged
sword and, in most circumstances,
represents an undesirable change.
Moreover, the influences that
predispose to such metaplasia, if
persistent, may induce cancer
transformation in metaplastic epithelium.
Thus, the common form of cancer in
the respiratory tract is composed of
squamous cells.
Metaplasia may also occur in
mesenchymal cells but less clearly as an
adaptive response. i. e. fibrous
connective tissue cells may be come
transformed to osteoblast chondroblasts
to produce bone or cartilage where it is
normally not encountered.