BASIC CLINICALL SKILL:

CELL ADAPTATION,
CELL INJURY,
AND CELL DEATH

Dr Ni Putu Sriwidyani, Sp.PA

 CELL ADAPTATION
1. Atrophy
2. Hypertrophy
3. Hyperplasia
4. Metaplasia
 Atrophy
• Definition : shrinkage in the size of the cell
• Organ : Endometrial atrophy in
menopausal women
• Morphology :
Thinning of endometrial layer
Small gland with low cuboids epithelium
Endometrial atrophy
 Hypertrophy
• Definition : an increase in the size of cell
• Organ : Myocardium hypertrophy in
congestive heart failure
• Morphology :
– Enlarge of myocardium around fibrosis (compare
with the normal myocardium)
Myocardium hypertrophy
 Hyperplasia
• Definition : an increase in number of cells in
an organ
• Organ : Benign prostate hyperplasia in
elderly, Endometrial hyperplasia
• Morphology :
– Increase number of cells, stratified epithelium &/
papillary gland
– Increase number of gland
Endometrial hyperplasia Prostate hyperplasia
 Metaplasia
• Definition : a reversible change in which one adult cell
type (epithelial cell or mesenchymal) is replaced by
another adult cell type
• Organ : Squamous metaplasia in cervical uterine with
uterine prolapsed
• Morphology :
– Endocervix contains surface epithelium, gland and stromal
component
– The surface epithelium and gland epithelium lined by stratified
squamous cells (normal: a single layer cylindrical cells)
Squamous metaplasia of uterine cervix
 CELL INJURY
Reversible injury
1. Cellular swelling
2. Fatty change

Irreversible injury
1. Necrosis
a. Coagulative necrosis
b. Liquefactive necrosis
c. Caseous necrosis
d. Enzymatic necrosis
2. Apoptosis
 Cellular swelling
• Cellular swelling appears whenever cells are in
capable of maintaining ionic and fluid
homeostasis.
• Organ : Hepatocyte swelling in high dose
paracetamol uptake
• Morphology :
– Enlarge of hepatocyte
– Granular cytoplasm
Cellular
swelling
of
hepatocyte
Fatty change
• Organ : Hepatocyte in alcoholisms
• Morphology :
– Clear (lipid containing) vacuoles in cytoplasm
– Eccentric located nuclei
Fatty change
 Coagulative necrosis
• Cause : ischemia
• Organ : Hepatocyte in septic shock,
tumor cells
• Morphology :
Para central necrosis of hepatocyte
Necrotic cells show eosinophilic cells
Cell outline (+)
Coagulative necrosis of tumor cells

Coagulative necrosis of hepatocyte

Liquefactive necrosis
• Cause : bacterial infection
• Organ : Appendix vermiformis &
mesoappendix in acute appendicitis
• Morphology :
Necrotic tissue in mucosal, submucosal, serosal layer
and mesoappendiks
Cell outline (-)
Replaced by inflammatory cells and cell debris
Liquefactive necrosis in acute appendicitis
Caseous necrosis
• Cause : Mycobacterium tuberculosa
• Organ : lymph node, lung
• Morphology
– Tubercle (granuloma) formation
– Central necrosis (eosinophilic amorphous material),
cell outline (-)
– Surrounded by epitheloid cells, lymphocyte,
Langhans giant cell
 X

Caseous necrosis of the lung tuberculosis

 Enzymatic necrosis
• Cause : pancreatic enzyme in acute
pancreatitis
• Organ : Pancreas, omentum
• Morphology :
• Acinar cell outline (+)
• Necrotic cells show basophilic anucleate cells
Enzymatic necrosis of
pancreas
 Apoptosis
• Organ : apoptosis in actively growing tumor
• Morphology :
– Single cell
– Small, dense nuclei
– Intensely eosinophilic cytoplasm
Apoptosis in penile cancer
Intra & extra cellular accumulation
1. Lipids
a. Steatosis (Fatty change)
b. Cholesterol
2. Protein
a. Hyaline change
3. Pigment
a. Melanin
b. Carbon
c. Hemosiderin
Steatosis
• Organ : Fatty change of hepatocyte
• Morphology :
Clear (lipid containing) vacuoles in the cytoplasm
Eccentric located nuclei
Steatosis (fatty change) of the liver
 Cholesterol deposition
• Organ : Atherosclerosis in coronary artery
• Morphology :
Subintimal cholesterol deposition
Intimal thickening
Dystrophic calcification
 ATHEROSCLEROSIS

-Intimal layer thickening

-Cholesterol deposition
-Dystrophic calcification
 Hyaline change
• Organ : kidney in chronic pyelo-nephritis
• Morphology :
– Hyaline (amorphous eosinophilic) material in tubular
lumina
Hyaline change in chronic pyelonephritis
Melanin pigment
• Organ : skin with pigmented nevus
• Morphology :
Golden brown pigment in melanocyte cytoplasm
Melanin pigment in intradermal nevus
Hemosiderin pigment
• Organ : lung
• Morphology :
– Brown pigment within alveolar macrophages (Heart
Failure Cells)
Hemosiderin pigment in Heart Failure Cell
 Pathologic calcification
1. Dystrophic calcification
2. Metastatic calcification
Dystrophic calcification
• Calcification encountered in areas of
necrosis
• Organ : Atherosclerosis in coronary artery
• Morphology :
– Sub intimal cholesterol deposition
– Intimal thickening
– Calcification (basophilic, amorphous granular
material)
 x

Dystrophic calcification in atherosclerosis

 Metastatic calcification
• Calcification encountered in normal tissue
whenever there is hypercalcemia