Proliferation of epithelial cells (glandular, cylindrical)
Under the proliferation understand the process of cell division, leading to an increase in the volume of tissue. The most active proliferation occurs in the embryonic stage when the cells of the emerging Bud continuously and intensively divided. This process is regulated by hormones and biologically active substances, which are able to amplify it (growth factors) and to relax.
To see the term «proliferation» in the conclusions of the experts, many as one hour trying to find the meaning of the word, at the same time concerned about possible trouble, but do not panic: proliferation is not a disease.
Cells of many tissues in need of constant renewal, is a natural physiological process that is implemented by dividing the. Especially pronounced cell renewal in the skin, the mucous membranes of the digestive tract, respiratory system, uterus. That is, the proliferation in these tissues – is normal and necessary.
On the other hand, excessive proliferation of cells cannot be considered the norm and becomes pathological features.
The most frequently proliferation is a manifestation of the inflammatory process (gastritis, cervicitis), damage (surgery, trauma), tumors. Increased cell proliferation is the basis of overgrowth of tissue in the tumors in hyperplastic processes. Premalignant changes, including dysplasia, also accompanied by increased cell proliferation.
If inflammatory changes or traumatic injuries proliferation is usually transient in nature and aims to restore tissue to normal, in the case of tumor, it gets a different meaning. When tumors proliferation is not only redundant, but non-stop, cells divide continuously, leading to the emergence and growth of the tumor. Limit such proliferation does not exist, as there is no limit and cell division in the tumor.
Proliferation is often accompanied by atypia, i.e., proliferating cells acquire non-core features, change the looks and functionally. Atypia suggestive of the possibility of precancerous transformation. The appearance of the cells unusual hell if enhanced proliferation is not surprising: a quick reproduction creates the conditions for genetic mutations, and the cells do not have time to ripen as it should. In this case, quantity does not equal quality, and in a rapidly proliferating clone of cells sooner or later appear abnormal, mutated elements.
The fact of the high probability of atypia in cell proliferation makes it a potentially dangerous, so doctors treat it with suspicion. If the cells have changed their view or property, you can talk about the precancer and an urgent need to take measures to eliminate the pathological focus.
In the conclusions of morphologists can be found the indication of the severity of proliferation processes. This figure is quite subjective, because no clear criteria that distinguish these degrees do not exist. Moreover, in some organs moderate proliferation may be considered the norm, while in others even a slight enhancement of cell division causes anxiety. In this regard, patients should not focus on the degree, but if we are talking about pathological proliferation, it is clear that the stronger it is, the worse.
Video: about cell division and cancer development
Proliferation in gynecology (endometrial and cervical)
Perhaps the most often with the phenomenon of proliferation facing obstetrician-gynecologists. Cell division in the female genital organs is very actively going on in health and even more intense pathology. The presence of proliferation according to the conclusion of histological examination of the mucosa of the uterine body or cervical canal, the cervical fragment, freed by conization.
On the advice of the gynecologist makes conclusions about norm or pathology, and the woman receiving result in hand, seeks to learn more about the essence of proliferation. It is no secret that many experts are not too talkative and not embark on a detailed explanation of the meaning of individual terms, so try to understand, that could mean the proliferation in the uterus and what to do with it.
Uterus in different departments have different structure and different pavement. So, the neck is in the outer part is covered with stratified squamous epithelium, the cervical canal is lined by cylindrical and slimy body body (endometrium) – difficult arranged glandular tissue. During the menstrual cycle the uterus is experiencing fluctuations in hormones and prepares for potential pregnancy, so the proliferation is not only normal, but vital mechanism that changes the endometrium for implantation comfortable.
Proliferation of stratified squamous epithelium of the outer division of the cervix only makes sense to update the top layer, so the norm should not be too pronounced. In pregnant women due to hormonal changes found moderate proliferation of the glandular epithelium of the cervix, which is not considered a pathology.
Increase in the proliferation of the epithelium can talk about:
- Inflammation (cervicitis);
- Traumatic injuries (diagnostic curettage, abortion, removal of pathologically changed cervical fragments, breaks in childbirth);
- Tumor growth (polyps, papillomas, dysplasia, cancer).
Thus, based on the causal factor, conventionally in the cervix secrete a proliferation of inflammatory (cervicitis), hyperplastic (polyps, pseudo, tumors) and trauma (ruptures, scarring).
Different kinds of cervicitis (bacterial, viral, fungal) will inevitably lead to damage of the surface epithelium, which, seeking to restore its integrity, and begins to actively proliferate. Against this background expressed and other signs of inflammation, infiltration of inflammatory cell number (leukocytes, lymphocytes, macrophages), vasodilation of the microvasculature, swelling, so the reason for the increased reproduction of cells usually clear.
Similar changes occur when the true erosion, lesions of the cervix in childbirth, while abortion, intrauterine manipulation. The proliferation reflects the regeneration (recovery) of stratified squamous epithelium and is more likely physiological.
Accelerated cell division when the above changes are usually not dangerous, although it requires treatment with subsequent monitoring of its effectiveness. If the mucosa has recovered, then there is no need for concern.
It is quite another importance is the proliferation of epithelium with atypia. In stratified squamous surface epithelium atypia often accompanies defeat oncogenic types of human papillomavirus, when the risk of malignant transformation is very high, and pseudo cervix, popularly referred to as simply erosion.
Pseudo – is the emergence in the outer part of the cervix glandular epithelium, similar to that which normally lines the cervical canal. The process is hormonal in nature, often occurs on the background of viral infection and cervicitis. The proliferation of the pseudo concerns as squamous epithelium, which grows into these centers, seeking to «neutralize» and cylindrical, constituting the actual erosion cancer.
Excessive proliferation of glandular epithelium in the structures of the pseudo leads to the formation of papillae, branching and new glands in the cervix thicker. The cell proliferation of squamous epithelium, tending to replace abnormal glandular complexes, often accompanied by dysplasia, and therefore, the process has become the way of the formation of cancer.
Proliferation with dysplasia in stratified squamous epithelium is the most dangerous combination. Increased proliferation of the cells, a violation of their correct orientation in the thickness of the epithelial layer, the appearance of abnormal external features – all signs of dysplasia, a precancerous main process of the cervix.
The cervical canal leading into the uterus, lined by columnar epithelium, which is also quite capable of reproduction. In normal proliferation of the cylindrical epithelium is necessary for cell renewal, but also found in the pathology – inflammation, polyps of the cervical canal, adenoma and carcinoma.
The endometrium is the inner layer of the uterine body, which has a complex organization and continually changing its structure throughout the menstrual cycle. In the phase of desquamation (bleeding) it is rejected if the pregnancy does not occur, and then must again be formed and to increase in volume. This happens all the time. It is clear that without proliferation, there is not enough, cells must actively share, restoring slomannye during menstruation the endometrium.
The endometrial cell proliferation actively occurs in the first half of the cycle, which is called the proliferation phase. During this period the endometrium is under the influence of estrogen, actively produced in the ovary, while there is brewing another egg.
Proliferation mainly concerns the endometrial glands, which before ovulation should be as «uglenitsa». In early proliferation (5-7 day cycle) glands presents narrow tubes with dark-colored kernels, but to the 8-10 day (mid stage phase of proliferation), they begin to take on a convoluted appearance, numerous mitoses, indicating efficient cell division. To the 14th day of the menstrual cycle glands become much convoluted they are, the cell nuclei are at different levels. At this point, the proliferation must give way to the next phase of secretion. This happens in normal.
In the pathology expressed proliferation of components reflects endometrial hyperplastic processes and tumor. Endometrial hyperplasia – not that other as proliferation, which stayed like that, moving in the secretory phase of the maturation of the mucosa. Increased proliferation of endometrial cells leads to excess iron component, cystic transformation and fraught with atypia.
Allocates diffuse hyperplasia of the endometrium, when the whole endometrium is thickened and does not match the phase of the cycle, and focal endometrial polyps. Polyps are proliferative when the main feature becomes the division of the glandular epithelium, and secretory, are more typical for the second phase of the cycle.
The key point in the clinical evaluation of endometrial hyperplasia is the presence or absence of atypia (atypical or non-atypical hyperplasia). Intensively dividing under the influence of hormones, the cells acquire a greater chance of mutations, so the SMS – quite likely a consequence of the proliferation and hyperplasia.
In non-atypical glandular hyperplasia of the affected tissue is removed, and the gynecologist decides on additional conservative therapy. Atypical hyperplasia may require more radical measures until removal of the uterus, although such decisions are made based on the age, causes hyperplasia, the reproductive plans of the women.
Thus, independent of the values as pathology proliferation in the uterus has not, is not a disease as such, it only reflects the processes that take place there and may be a consequence of the norm and pathology. Attitude to proliferation in the uterus is determined by its causes and localization:
- In the cervix without atypia in a background of inflammation, trauma, erosion – conservative treatment;
- In the neck with atypia – removal of the affected area, conservative treatment according to the cause (hormones, antimicrobials, etc.);
- Endometrial proliferation in the first half of the cycle is the norm, there is no cause for concern in a patient of reproductive age, menopause any proliferation tells about the resumption of growth of the endometrium and requires thorough examination (possible hyperplasia, polyps, cancer);
- Proliferation with hyperplasia – a dangerous phenomenon requiring curettage of the uterus and hormones;
- Proliferation with atypia is a precancerous condition involving the removal of the entire endometrium or uterus.
Tumor proliferation represents an increase in tissue neoplasms by dividing its cells, often with atypia. It has no independent value, but only characterizes the growth of the neoplasia, that is, if there is swelling, and proliferation, and its severity depends on how quickly grow neoplasia. Carcinoma of the cervix, cervical canal and endometrial always accompanied by enhanced proliferation, which is evident already at the stage of dysplasia.
Proliferation in gastroenterology
Proliferation of the epithelium of the stomach occurs in normal and constantly. Mucosa of this organ needs regular updating, so the cells are actively dividing. At the same time, any damage causes an acceleration of cell division.
The main reasons causing increased proliferation of the gastric epithelium, are gastritis, ulcers, polyps and tumors. In acute gastritis in the background of a pronounced inflammatory component in the form of edema of the mucosa, the exfoliation of the surface layer, hemorrhages are detected in proliferating areas of cover-pit epithelium, which reflects the regeneration process of the mucous membrane.
Chronic gastritis that are so common these days in all age groups, also occur with increased epithelial proliferation. Especially clearly this process is evident in hyperplastic forms of the disease, when the mucous is thickened, possible polovinnyi sprawl.
Stomach ulcer during exacerbation occurs with damage to the wall of the organ that the organism seeks to resolve. The result is a proliferation of the epithelium, pronounced at the edges of the ulcer. With such a proliferation associated hyperplastic polyps, often found in the edges of the ulcer.
A particular danger is a precancerous proliferation in the wall of the stomach, begin to multiply when the dark elongated cells from the area of the necks of the gastric glands. Initially this process is regenerative in nature, but as the differentiation of cells disrupted, the normal mucosal recovery does not occur. Instead, cancer cells are covered with dark elongated nuclei, located in their base.
Pre-cancerous proliferation may be of limited or diffuse in nature, but is always found in the upper parts of the glands, while deeper layers remain malaisienne. Dark cells of dysplastic epithelium does not secrete mucus and, consequently, do not fulfill their direct functions. Over time, they displace the normal glandular lining of completely replacing it.
The next stage of this proliferation is the development of gastric carcinoma, and it may be a small section of one gland. Malignant transformation occurs at any time, but the background of existing precancerous cell proliferation and normal structure of other glands.
Changes in the breast are fairly common, including among young girls and women. The body is constantly experiencing the effects of sex hormones, undergoes characteristic changes throughout the menstrual cycle, pregnancy and lactation, therefore, more susceptible of disease. According to statistics, 60% of women of reproductive age have signs of mastitis.
The breast is considered a benign process, but where it exists the risk of malignancy is increased in several times. Proliferative options are even more dangerous, they increase the likelihood of cancer in 25-30 times.
The presence or absence of proliferation – the most important characteristic in the evaluation of the variety of mastitis. Nonproliferative forms are pockets of fibrous tissue, cystic modified ducts, the epithelium of which does not will proliferate and even atrophic. The risk of malignant transformation is relatively small.
Proliferative mastopathy is much more dangerous because cells of ducts and lobules of the gland are divided, constituting a danger for cancerous degeneration. The more of these foci of proliferation in prostate tissue and the more active is the reproduction of the epithelial component, the more likely the breast cancer in the future, so all forms of proliferative mastopathy considered pre-cancerous conditions.
The expression of proliferation there are several degrees of mastitis. At the first degree proliferation is not detected, while in the latter it is, but the cells are a symptom of atypia, a third degree of mastitis manifests itself active proliferation of epithelial cells with atypia.
Thus, cell proliferation of the mammary gland is not only the criterion of form of mastitis, but increased probability of cancer, so excess division of epithelial always attracts the attention of specialists. The diagnosis of this change is carried out by cytological examination obtained by puncture of the fabric.
What to do in the presence of proliferation?
Upon detection of the proliferation wherever it was, the specialist first determines the cause, and then make a plan of patient management. There is no specific method of treatment for proliferation per se, because it is not an independent pathology, but a reflection of other diseases. If reinforced the division caused by inflammation, the doctor will prescribe anti-inflammatory therapy, if necessary, updating it with antibacterial or antiviral agents.
Precancerous proliferation with atypia in a background of dysplasia may require more radical measures, excising the affected area. In the case of proliferation against the background of cancer treatment is made according to all principles of cancer care until the removal of the organ.
Any proliferation, indicating pathology, is a Wake-up signal, so patients with such changes are always in the field of view of the doctor. After treatment of the underlying disease is usually made by controlling Cytology or biopsy, to assess the effectiveness of therapy and risk of malignant transformation in the future.