Reactive changes

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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.

The line between a reactive process and a neoplastic process may be fuzzy. 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:
    • Nuclear enlargement.
    • Nuclear hyperchromasia.
    • Prominent nucleoli.
  • Inflammation - acute and/or chronic.

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