Reactive changes

Reactive changes is a commonly used term that implies:

1. Inflammation.
2. Nuclear changes compatible with inflammation.

General

Nuclear changes are seen in:

• Inflammatory processes.
• Repair.
• Neoplastic processes.

Significance of nuclear changes in inflammation:

• The line between a reactive process and a neoplastic process may be fuzzy.

Consequence:

• In the context of inflammation, nuclear changes are typically present and the threshold for calling suspicious or malignancy is typically higher.

Microscopic

Features - generic:

• Nuclear changes - typically:
  • Nuclear enlargement.
  • Nuclear hyperchromasia.
  • Prominent nucleoli.
• Inflammation - any type (e.g. neutrophilic, plasmacytic, lymphoplasmacytic).
  • Typically intraepithelial inflammatory cells.

DDx:

• Waffle diagnosis (e.g. indefinite for dysplasia) - nuclear changes of unknown significance.
  • Terminology dependent on the anatomical site.
• Nuclear atypia.
  • This is often qualified as it may represent neoplastic process or a benign process dependent on the context.
  • Common qualifiers:
    • Worrisome lesions: "cannot exclude dysplasia", "suspicious for malignancy".
    • Suspected to be benign: "favour benign".
• Malignancy.

See also

• Reactive atypia.
• Nuclear atypia.
• NC ratio.
• Reactive squamous epithelium of the uterine cervix.