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Hyperplasia in Colon Tissue : Dr. Andy Connolly from Stanford Medical School shows Sal what hyperplasia in colon tissue looks like
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- S: This is Sal here at Stanford Medical School with Dr. Andy Connely, a pathologist,
- this is the 2nd video in our series looking at these slides.
- Dr: We left off last time looking at this piece here, normal colon,
- we had said this is an example of something you'd see at the edge of a specimen for colon cancer.
- Now I'm going to the next one which is a slightly more worrisome area if
- you're a pathologist looking through the colon. I'm going to zoom in just a little bit
- S: That's very worrisome, compared to the last one.
- Dr: What we don't like about it, we saw before this is what a normal gland looks like,
- It's a test-tube shape, going down, and it has these cells which are normal.
- Now, all of a sudden it is a little thicker here, and what catches our eye is these are
- not straight test-tubes anymore, they divide, go in and out like that.
- S: They still are test-tubes, they just look like circles because of the cross-section?
- Dr: That's right, but when you come from the surface here and go down--
- they normally should never branch.
- So these ones are branching, and that's always bad, and in a cross-section
- there's normally a little hole in the middle, where the mucin...
- you can see it spilling out, coming right out.
- This one here looks different, it's piled up, it's bigger around, cells are piled up,
- and they branch.
- So we look a little more closely at this, and we say,
- "Hmm, I wonder if that's cancer? Could it be pre-cancer? Or just an area of irritation?"
- A common response of the body to irritation is to change.
- And like we said before, the epithelium is the top layer, facing the outside world.
- If it's irritated, it will change, and in this case it's changing by undergoing more growth.
- S: Even if it's not cancer, is there a higher chance of it becoming cancer in the future?
- Dr: A lot of cancers that appear in the body come from parts of the body that are
- either irritated or have some sort of environmental challenges that are constantly at them,
- and part of that is because there is a lot of cell division, if you keep dividing a cell,
- you might have errors in DNA.
- S: I see, so that's why skin cells, bowel cells...
- Dr: That's right, and even things like liver, if you keep damaging your liver,
- you might have higher chance for liver cancer.
- So when a pathologist looks at this area and says,
- "Well, it's a dividing gland...
- It's kind of thrown up in these areas..."
- But largely they're still making mucin, or they're this type here, which looks like it's tall
- and probably absorbing water.
- S: So even in these test-tube-like vessels, there are these absorptive cells as well?
- Dr: Right. So here, we would sign this off as 'hyperplasia'.
- S: Hyperplasia. Hyper-, too much of something. And -plasia?
- Dr: Growth. Plasia just means growth. So hyperplasia means too much growth.
- But the important thing, if you took away the irritant, it wouldn't do this.
- So if you took away whatever the irritant is, for the hyperplasia,
- it would go back to being normal.
- S: So there was some stimulus that was causing these cells to do this--some chemical, etc.
- Dr: Right. We're rarely sure because so many things just float on through.
- It's really hard to know. But this is probably too much growth due to some irritant.
- S: Is it possible that it was just when this section of the colon was taken out,
- if this was done a day later, [hyperplasia] might not have been there?
- Dr: Probably take longer that, a couple of weeks.
- Because what happens is the cells come from the bottom, and they work their way to the top,
- and eventually the top...
- S: So it works sort of like the skin, these cells are being constantly used up
- because things keep scraping by them.
- Dr: They do. There is a lot known now about stem cells, the stem cells for the intestines are these guys.
- S: How do you differentiate those from the others?
- Dr: At the very bottom, the bottom hemisphere, there are going to be cells that do not have
- the open chromatin, and kinda elongated. There maybe ones that are endocrine cells,
- meaning they release hormones. And so they may have hormone releasing cells,
- but in this bottom hemisphere, turns out to be where the intestine keeps [stem cells].
- S: Stem cells are cells that haven't picked their jobs yet?
- Dr: They haven't. There are all kinds of stem cells: the stem cells that can make a whole body/being,
- there is also the kind that can make the rest of the colon.
- So, this probably one that can make the rest of the epithelium,
- with these two different cell types. So they're down here at the bottom, where you'd want them.
- So this is a hyperplasia. I'd like to show you next, the next step which is a pre-cancer region.
- S: NEXT VIDEO!! =D