Professional Documents
Culture Documents
College of Medicine
Case 1
Submitted by:
II-A Group 1
Abdulatiffh, Sittie Alia
Abecia, Evalaine
Aboy, Jose Lorenz
Acabo, Gideon Rey
Alarcon, Maelisa Grace
Alawi, Juhara
Arellano, Jemer Grace
Arendain, Gerald Ian
Ardosa, Rondy
Atuel, Kristhy
6/25/2014
Case 1
A 50-year old security guard presents with a long-standing history of retrosternal burning and belching
which he commonly gets after meals. He has been smoking since the age of 13 and he consumes five
bottles of beer every night. A month ago he was treated for gastroesophageal reflux dyspepsia. Upper
gastrointestinal endoscopy reveals streaks of red to velvety mucosa at the gastroesophageal junction.
Biopsy from this site shows the presence of gastric and intestinal-type columnar cells.
1. Review the anatomy and histology of the organ involved.
Esophagus:
-
Anatomy
o
Passes through the esophageal hiatus in the muscular right crus of the diaphragm just to the
left of the median plane at the level of T10 vertebra.
Terminates by enetering the stomach at the cardial orifice of the stomach to the left of the
midline at the level of the 7th left costal cartilage and T11 vertebra.
Esophagogastric junction: lies to the left of T11 vertebra; where the mucosa abruptly changes
from esophageal to gastric mucosa
Histology
o
Mucosa
Lamina propria houses the esophageal cardiac glands and occasionally lymphoid
nodules
Submucosa
Denses, fibroelastic connective tissue that houses the mucous glands known as
esophageal glands proper
Muscularis externa
2. Given the endoscopy and biopsy findings, what is the type of cell adaptation involved in this
case? And discuss its mechanism of cellular adaptation.
The concept of Barret's esophagus is simple. The normal squamous mucosa of the esophagus is
replaced by glandular mucosa as an adaptive process usually because there is a reflux of the gastric
(highly acidic) materials from the stomach into the esophagus and therefore, the esophagus responds
by becoming more gastric-like and less squamous-like since gastric mucosa (simple columnar) has
tall columnar epithelial cells which secretes a layer of thick mucus that protects from gastric materials
which the former squamous cells do not have.
Columnar metaplasia of the distal esophagus represents a squamous to columnar metaplastic
reaction that develops from an esophageal stem cell and may pass through an intermediate phase
characterized by the presence of a type of epithelium that possesses a mixture of squamous and
columnar features, termed multilayered epithelium.
Alcohol and tobacco paves the way for acid reflux into the esophagus through its effect on the LES.
Presence of acid in the esophagus initiates compensatory mechanisms in the cells to adapt to this
new environment hence the metaplasia observed in the esophageal lining.
4. Is this physiologic or pathologic? Reversible or irreversible?
This is a pathologic form of metaplasia, since the change is caused by chronic irritation of the lower
esophagus by the reflux of hydrochloric acid from the stomach and carries with it undesirable effects
such as the ones experience by the patient. However, the change in the epithelium is reversible if the
patient undergoes a combination of anti-reflux therapy and endoscopic thermal injury.
5. What other types of cellular adaptation? Discuss and differentiate each type as to its causes, mechanism, microscopic findings, and
give examples.
Cellular Adaptation
Causes
Mechanism
Mechanical stretch/agonists/growth factors
|
Signal transduction pathways
|
Transcription factors
- Stimulation by hormones and growth factors
|
Increased synthesis of contractile proteins
Increased induction of embryonic/fetal genes
Increased production of growth factors
Physiologic
- Hormonal
Hyperplasia
- Compensatory
Pathologic
-
Atrophy
Physiologic
Normal development
Pathologic
-
- Increased autophagy
Inadequate nutrition
Pressure
Cellular Adaptation
Hypertrophy
-
Microscopic Findings
Increase in the size of the
cells, resulting to increase
size of the organ
No new cells, just larger cells
Examples
The
for
In the heart, the stimulus for hypertrophy is usually chronic hemodynamic overload, results
from either hypertension or faulty vales
shaped uterine smooth muscle cells from a normal uterus, compared with C, large plump cells
from the gravid uterus, at the same magnification.
Hyperplasia
-
Hormonal hyperplasia is well illustrated by the proliferation of the glandular epithelium of the
female breast at puberty and during pregnancy. Usually accompanied by enlargement
(hypertrophy) of the glandular epithelial cells.
(a) Macroscopic aspect of a normally regenerating liver. (b) Pale liver with hemorrhage
resulting from stenosis of the suprahepetic vena cava. (c) H&E staining of a normally
regenerating liver section ( 400 original magnification). Note the number of mitotic figures
present in the section (black arrows). (d) H&E staining of the liver shown in panel (b) ( 200
original magnification). Note the presence of necrotic areas (asterisk).
Atrophy
Carpal Tunnel Induced Atrophy: Chronic, severe compression of the median nerve within the
carpal tunnel has led to atrophy of the Thenar muscles (hand on right). A normal appearing
Thenar Eminence is demonstrated on left.
Normal brain of a young adult. B. atrophy of the brain in an 82 years old male with
atherosclerotic cerebrovascular disease, resulting in reduce blood supply. Note that
loss of brain substance narrows the gyri and widens the sulci. The meninges have
been stripped from the right half of each specimen to reveal the suface of the brain
Modifiable
Non-modifiable
Smoking
Chronic GERD
Alcohol
direct damage to LES
direct
cellular
adaptation