2. Understand how these cells respond to injury.

The normal cell is confined to a fairly narrow range of function and structure by its state of metabolism,
differentiation, and specialization; by constraints of neighboring cells; and by the availability of metabolic
substrates. Adaptations are reversible functional and structural responses to changes in physiologic states (e.g.,
pregnancy) and some pathologic stimuli, during which new but altered steady states are achieved, allowing the
cell to survive and continue to function.

Hypertrophy
Hyperplasia
Atrophy

Metaplasia

A. Cellular adaptations
Hypertrophy refers to an increase in the size of cells, resulting in an increase in the size of the organ.
The most common stimulus for hypertrophy of muscle is increased workload.
Hyperplasia is an increase in the number of cells in an organ or tissue, usually resulting in increased
mass of the organ or tissue. It is the result of growth factor-driven proliferation of mature cells, and in
some cases, by increased output of new cells from tissue stem cells. It has two types, (1) physiologic
hyperplasia which can be divided into (a) hormonal hyperplasia, which increases the functional capacity
of a tissue when needed, and (b) compensatory hyperplasia, which increases tissue mass after damage
or partial resection; (2) pathologic hyperplasia which is usually caused by excesses of hormones or
growth factors acting on target cells. Pathologic hyperplasia constitutes a fertile soil in which cancerous
proliferation may eventually arise.
Atrophy is reduced size of an organ or tissue resulting from a decrease in cell size and number. It can
be physiologic atrophy which is common during normal development; and pathologic atrophy which
depends on the underlying cause and can be local or generalized.
Metaplasia is a reversible change in which one differentiated cell type (epithelial or mesenchymal) is
replaced by another cell type.
B. Cell injury
Reversible cell injury. By removal of damaging stimulus.
Irreversible cell injury. Cell cannot recover. It reaches a lethal hit or the point-of-no-return.
C. Cell death
Necrosis is the result of denaturation of intracellular proteins and enzymatic digestion of the lethally
injured cell.
Apoptosis is a pathway of cell death that is induced by a tightly regulated suicide program in which cells
destined to die activate enzymes that degrade the cells own nuclear DNA and nuclear and cytoplasmic
proteins.

3. Given the gross findings of the organ, identify type of necrosis involved in this case.
Liquefactive necrosis is characterized by digestion of the dead cells, resulting in transformation of the tissue into
a liquid viscous mass. Microbes stimulate the accumulation of leukocytes and liberation of enzymes from these
cells. The necrotic material is frequently creamy yellow because of the presence of dead leukocytes and is called
pus.