GENERAL PATHOLOGY LAB

Laboratory Exercise #2
Cellular Adaptations to Stress
Name

Year and Section

Date Submitted

1. Cite specific cases that exhibit each cellular adaptation to stress (hypertrophy,
hyperplasia, metaplasia, and atrophy).
a. Be able to present clinical summary of each case.
b. Show pictures of autopsy findings: normal and abnormal gross and histopathologic
changes that would support cellular adaptation manifested and identify the morphologic
changes based on the pictures shown.
c. Determine the specific type of cellular adaptation and the cause why such cellular
adaptation happens. Link the gross and microscopic findings to its pathologic causes and
clinical presentation. An example is provided to you below.

PUT YOUR ANSWER IN A SHORT BOND PAPER-TYPE WRITTEN. DO NOT COPY PASTE.
FOLLOW THE FORMAT I HAVE INDICATED IN THE EXAMPLE BELOW.

1. Hypertrophy
A. Clinical Summary:
A 68-year-old man initially sought medical advice five years prior to his
death. His symptoms at that time were exercise intolerance and occasional
peripheral edema. He gave a history of a "heart murmur" that was diagnosed
25 years ago during an employment physical. No follow up care had been
given for this murmur.
The patient's terminal admission was for signs of severe heart failure -- the
patient had marked peripheral edema and shortness of breath and chest x-
ray revealed significant cardiac enlargement and pulmonary edema with
bilateral pleural effusions. He sustained a cardiac arrest shortly after
admission and could not be resuscitated.

B. Autopsy Findings: pictures (normal and abnormal) of gross and histopathologic changes
Autopsy disclosed a markedly enlarged heart weighing 650 grams and having dilated chambers.
The aortic valve was calcified and showed evidence of stenosis and insufficiency. The
coronary arteries were narrowed 60 to 70% by atherosclerosis. No acute coronary occlusions
were found and there was no evidence of myocardial infarction

GROSS IMAGE
 This is a gross photograph of a
cross section of a normal human
heart taken at autopsy (right) and
the heart from this case

Morphologic changes:
 Concentric hypertrophy of the left ventricular wall
 marked thickening of the left ventricular wall
 moderate thickening of the right ventricular wall

HISTOLOGICAL IMAGE
 Normal myocardium (left) is compared here to hypertrophied myocardium (right).
Morphological changes:
 The muscle fibers are thicker and the nuclei are larger and darker in the
hypertrophied myocardium.
 The clear spaces between the muscle fibers are due to processing artifacts and
are not present during life

C. Cellular adaptation: Pathologic hypertrophy

 Autopsy findings showed aortic valve was calcified and showed evidence of stenosis and
insufficiency. This increases mechanical load on the heart which results in increased
myocardial demand contributing to the myocardial cells to compensate by undergoing
hypertrophy as evidenced by the following gross morphologic changes (e.g. concentric
hypertrophy of the left ventricular wall, marked thickening of the left ventricular wall,
moderate thickening of the right ventricular wall) and histologic changes (muscle fibers
are thicker and the nuclei are larger and darker in the hypertrophied myocardium).
 Aortic valve stenosis and insufficiency subsequently results to the characteristic signs of
severe heart failure manifested by the patient.

2. Hyperplasia
A. Clinical Summary:
A woman on her late 20’s due to her pregnancy she has experienced an
increase of size of her breast, also increase in the thickness of
endometrium in her menstruation, and also liver growth after her
labour.
B. Autopsy Findings:
Pictures of normal and abnormal growth of the woman during her pregnancy
Morphologic Changes:
 Suddenly various apoptotic cells were seen during pregnancy.
 Separation was started in the second trimester with an expansion in how much
harsh endoplasmic reticulum and the presence of a hypertrophic Golgi body and lipid
drops inside various epithelial cells.
C. Cellular adaptation: Physiological Hyperplasia
 There is a huge expansion in oxygen demand during pregnancy. This is because of a
15% increase in the metabolic rate and a 20% increase utilization of oxygen. There
is a 40-50% increase in minute ventilation, generally because of an increase in tidal
volume, as opposed to in the respiratory rate.
 As the pregnancy continued there was an expansion in the number of cells showing
these elements. There was also an increase in the size of the lipid droplets and the
quantity of apical vacuoles.

3. Metaplasia
A. Clinical Summary:
A female entering her teen age undergo her first menstruation proving she will soon
become a lady. In most cases of menstruation what happens is squamous metaplasia
would occur in the uterine cervix of a female during their menstruation cycle and it will
eventually transform
B. Autopsy Findings:
 Picture of mature and immature squamous metaplasia (development of squamous
metaplastic epithelium)

Morphologic Changes:
 At first, little cuboidal reserve cells develop underneath the columnar epithelium.
This is followed by multiplication and separation of these cells into immature
squamous epithelium. At last, loss of the overlying columnar cells happens to leave
stratified squamous mucosa.
C. Cellular adaptation: Physiological Metaplasia
  Squamous metaplasia, by a wide margin the most well-known (to the point that
some see it as a typical finding) is focused on the change zone; momentary
metaplasia includes the exocervical squamous epithelium; and tubal,
tuboendometrial, and gastrointestinal metaplasia influence the glandular epithelium
of the endocervix.
 The term squamous metaplasia is utilized to assign the central or broad replacement
of the bmucus-secreting glandular epithelium by stratified squamous epithelium,
which, in its late stage, is morphologically vague from the epithelium regularly
coating the exocervical segment

4. Atrophy
A. Clinical Summary:
A 16 year old boy started to show symptoms of an illness called “Charcot-Marie-Tooth”,
which is an inherited nerve problem that causes further abnormalities in the nerves that
supply our commonly used body parts in our body like feet, legs, hands, and arms. It
could also affect your sensory and motor neurons.
B. Autopsy Findings:
Below is an illustration of normal foot and a person with “Charcot-Marie-Tooth” disease.

Morphologic Changes
 As seen in the illustration from above it is clearly seen that the patient diagnosed
with the “Charcot-Marie-Tooth” disease have trouble in making his/her foot straight
like the illustration from the left, making it appear shrink and small.
 Morphological and ultrastructural changes in the axons, myelin, nodes of Ranvier,
and mitochondria help in grasping the functions of the mutated genes, and
somewhat, the pathways prompting illness.
C. Cellular adaptation: Physiological
Atrophy
 This kind of shrinking is cause by
the disease called “Charcot-Marie-
Tooth” in which in this disease it
affects the peripheral nerves and
prompts moderate weakness of
extremities where it would cause
in the muscles not being used
enough.
 CMT is caused by defects in the
gene that are responsible for
making and maintaining the
myelin (protecting sheath around many nerves, expanding conductivity) and axonal
designs.