Atrophy

Metaplasia
Cloudy swelling
Fatty change
Atrophy
Definition:-
 Diminution in size of cells, organs or tissues after attainment of
full development is called atrophy.

 Atrophy is seen whenever some tissue is not engaged to its

optimal capacity.

 If the stimulus responsible for atrophy becomes overwhelming,

it causes death of the cell.

 During atrophy there is

 Active reduction in size/number of cells, as well as

 Cessation of growth of the tissue.

 Imbalance between protein synthesis and degradation causes

atrophy.
Physiologic Atrophy
 During embryonic and fetal life

 Branchial clefts, notochord, thyroglossal duct, Mullerian

duct, Wolffian duct.

 During neonatal life:

 umblical vessels, ductus arteriosus.

 During early adulthood:

 Thymus

 Late adulthood and old age:

 Uterus, testes, bone, gums, cerebrum, lymphoid tissue,

mandible in edentulous patients.
 PATHOLOGICAL ATROPHY
1. Disuse : Atrophy of muscles after immobilization in a plaster
cast

2. Denervation: Loss of nerve supply.

3. Diminished blood supply: causes rapid atrophy of the

concerned organ

4. Nutritional: Protein calorie malnutrition.

5. Loss of trophic endocrine stimulation: Lack of ACTH leads to

atrophy of adrenals.

6. Pressure: Tumors produce atrophy of neighboring tissue

7. Hormonal: Chronic use of corticosteroid ointment causes

atrophy of skin

8. Senile
Protein Calorie malnutrition
Atrophy of Kidney
Atrophy of Muscle Fibers
Atrophy of Testis
 Metaplasia
• Definition: It is a reversible condition in which one
type of differentiated tissue transforms to another
type of differentiated tissue - usually of a similar
type.

• Advantage of metaplastic response: -

– Metaplasia occurs so that cells better adapted to withstand
stressful trauma replace more sensitive cells.

• Disadvantage of the metaplastic response:-

– Metaplastic tissue is incapable of carrying out the functions
of the cells that have been replaced

– Metaplastic cells are also more prone to malignant

transformation.
 Common examples of metaplasia
1. Epithelial

– Columnar to squamous: it is the commonest type

• Usually seen in respiratory tract of smokers

• In salivary, pancreatic or bile ducts due to stones.

– Squamous to columnar:

• In Barret’s esophagus due to GE reflux.

2. Mesenchymal:

– Myositis ossificans after fractures,

– Bone formation in atheromatous plaques or in bronchial

cartilage.
Esophagus showing Intestinal Metaplasia
Squamous Metaplasia in endocervical gland
 Cloudy Swelling
• Two patterns of cell injury are seen:

– Reversible cell injury and

– Irreversible cell injury.

• Reversible cell injury can manifest in two forms

 Cloudy swelling, also known as hydropic degeneration.

 Fatty change.

• Cloudy swelling

• It is due to compromised function of the cell membrane

• The cell membrane is unable to maintain normal fluid and ion

homeostasis.

• It is the first change to appear after cell injury.

• In cloudy swelling, cell cytoplasm becomes pale and swollen due to

accumulation of fluid.
 Fatty Change (Steatosis)
• Abnormal accumulation of TGs is called fatty change.

• Fatty change is seen more commonly in organs like liver, heart,

kidney and skeletal muscle.

• In initial stages fatty change is reversible; when prolonged, it may

cause cell death.

• Fatty change is commonly encountered in: -

– Chronic alcoholism,

– PCM,

– Starvation,

– Prolonged anoxia and

– DM.

• Initially, fatty change is detectable only at microscopic level. Later, the

infiltrated organ becomes enlarged, pale and yellow.
 Fat Metabolism
Free fatty acids Diet
Increased mobilization from
adipose tissue

Fatty acids Oxidized to Ketone bodies

Phospholipids
Cholesterol esters

Triglycerides

Lipoproteins Exit from liver

 Pathogenesis of Fatty change
1. Alcoholism:
• Increased mobilization of FFA from peripheral tissues
• Decreased oxidation of fatty acids.
• Acetaldehyde (a product of alcohol metabolism) depresses tubulin
function thereby diminishing lipoprotein exit.

2. Starvation:
• Increased mobilization of FFA from peripheral tissues.

3. Protein Calorie Malnutrition:

• Decreased synthesis of apoprotein, thereby diminished lipoprotein
formation

4. Anoxia:
• Decreased oxidation of fatty acids

5. Diabetes Mellitus:
• Various abnormalities of lipid metabolism are seen.
Fatty Change Liver
Fatty Change Liver
 Hyperplasia
• Definition: An increase in number of cells of an organ or a
tissue resulting in increased volume of the organ or tissue is
called hyperplasia.

• An organ can undergo hyperplasia only when it is composed of

labile or stable cells.

• Organs/tissues that readily show hyperplasia: liver, kidney,

fibrous tissue, endothelium, surface epithelial cells and
hemopoietic tissue.

• Organs/tissues with moderate capacity for hyperplasia: bone,

cartilage, smooth muscle of bvs and uterus, solid glandular
epithelium

• Organs/tissues that cannot undergo hyperplasia: neurons and

cardiac muscle fibres
 Causes of hyperplasia
• Physiological • Pathological
– Hormonal: breast – Hormonal: endometrial
enlargement during hyperplasia, fibrocystic
pregnancy, lactation disease, Graves disease etc.

and puberty; – Non-hormonal: lymphoid

enlargement of hyperplasia in infections,
uterus during vascular and connective
pregnancy tissue hyperplasia during
wound healing, hyperplasia
– Compensatory: liver of erythroid tissue in chronic
anemia, hyperplasia of skin,
and kidney
GI and respiratory epithelium
enlargement after when chronically irritated
partial resection.
 Physiological Hypertrophy
Hypertrophy
• Increased muscle mass in
weight lifters
• Definition:
• Hypertrophy of uterus during
Increase in size pregnancy
of the cell • Breast hypertrophy during
lactation
without increase
in number is
called Pathological Hypertrophy
hypertrophy. • Cardiac hypertrophy seen in
HT and valvular heart ds.
• Hypertrophy of urinary
bladder as seen in BPH and
urinary strictures