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Hyperplasia in Colon Tissue

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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

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Hyperplasia in Colon Tissue

Hyperplasia in Colon Tissue : Dr. Andy Connolly from Stanford Medical School shows Sal what hyperplasia in colon tissue looks like