Disorders of growth

1. Disorders of Growth
Mohammed Fathy Bayomy, MSc, MD
Lecturer
Clinical Oncology & Nuclear Medicine
Faculty of Medicine
Zagazig University

2. Hypertrophy
 Definition: increase in number of organelles & size of cells  increase size
of organ
 Causes & Types
1- Physiological Hypertrophy
* Uterus in pregnancy due to hormonal stimulation
2- Pathological Hypertrophy
* Adaptive hypertrophy
- Left ventricular hypertrophy in hypertension
- Hypertrophy of urinary bladder in bilharzial bladder neck obstruction &
prostatic hyperplasia
* Compensatory Hypertrophy
- Increase size of one kidney after removal of other

3. Hyperplasia
 Definition: increase in number of cells in organ, usually accompanied with
some degree of hypertrophy, can occur only in cells capable of synthesizing
DNA so nerve, skeletal muscle, cardiac muscle cells have little or no
capacity for hyperplastic growth
 Causes & Types
1- Physiological Hyperplasia
* Hormonal hyperplasia: endometrial hyperplasia due to estrogenic
stimulation after menstruation
* Compensatory Hyperplasia: liver cell hyperplasia following partial
hepatectomy (TGF-α)
* Bone marrow Hyperplasia: following hemorrhage

4. 2- Pathological Hyperplasia
* Hormonal Hyperplasia: endometrial hyperplasia due to excessive
estrogen production by ovarian tumor
* Compensatory Hyperplasia: regeneration nodules formation in liver
cirrhosis
* Irritative Hyperplasia: lymphoid hyperplasia in response to antigenic
stimulation

5. Metaplasia
 Definition: reversible change in which adult cell type is replaced by another
of same category (epithelial or mesenchymal)
 Causes & Types
1- Epithelial Metaplasia
* Squamous Metaplasia: - Urinary bladder mucosa in bilharzial cystitis
- Mucosa of bronchi in smokers,
- Endocervical mucosa in chronic cervicitis
- Gall bladder mucosa in chronic cholecystitis
* Columnar Metaplasia: - Gastric mucosa at edges of chronic peptic ulcer
(intestinalization of stomach)

6. 2- Mesenchymal Metaplasia
* Traumatic myositis ossificans
* Bone formation in scars, atheromatous lesions, tuberculous lesion
3- Serosal Metaplasia: squamous metaplasia occur in pleura & peritoneum
4- Tumor Metaplasia: adenoacanthoma of endometrium
5- Mucoid Metaplasia: in adenocarcinoma of breast

7. Dysplasia
 Definition: disorder of growth characterized by pleomorphism,
hyperchromatism, loss of normal orientation (alteration in maturation of cells
& their relationship to other cells)
 Pathological Features
* Encountered principally in epithelia
* According to extent of involvement; graded into mild, moderate, severe
(Grade I, Grade II, Grade III)
* Mild & moderate dysplasia: not involve entire thickness of epithelium
(mild: lower 1/3, moderate: lower 2/3), reversible when initiating factor
removed
* Severe dysplasia: involve entire thickness, irreversible progress to invasive

8.  Examples
* Cervical dysplasia in chronic cervicitis
* Urothelial dysplasia in bilharzial & chronic cystitis
* Hepatocellular dysplasia in chronic hepatitis & liver cirrhosis

9. Carcinoma In Situ (CIS)
 Synonym: intraepithelial carcinoma, preinvasive carcinoma, stage 0 carcinoma
 Definition: sever from of epithelial dysplasia & represent preinvasive stage that
detected only by microscopic examination
 Pathological Features: changes involve whole thickness of epithelium
* Cells are large sized
* Cells are variable in size
* Nuclei: large & hyperchromatic
* Numerous mitotic figures
* No invasion of basement membrane
 Sites
* Cervical uteri
* Urinary bladder
* Bronchial mucosa
* Skin (Bowen’s disease)

10. Precancerous lesions
 Definition: non-malignant lesions that may undergo malignant transformation
Criteria Examples
Chronic
Inflammatory
lesions
* Chronic gastritis * Chronic cholecystitis
* Bilharzial cystitis * Ulcerative colitis
* Tertiary syphilis of tongue
* Sinuses of chronic osteomyelitis
Chronic ulcers * Varicose ulcer * Chronic skin ulcer * Chronic gastric ulcer
Growth dis. * Metaplasia * Dysplasia * Leukoplakia
Congenital * Undescended testicles * Xeroderma pigmentosa
Metabolic
Deficiency
* Goiter * Iron def. * Paget’s disease
* Chronic lymphatic edema of skin
Hyperplastic * Endometrial hyperplasia * Liver cirrhosis
* Mammary cystic hyperplasia
Hamartoma * Multiple neurofibromatosis * Multiple exostosis
Benign tumors * Adenomas * Papillomas * Colonic polyposis

11. Neoplasia (tumor)