Reactive changes is a commonly used term in pathology that implies:
- Nuclear changes compatible with inflammation.
- The absence of both neoplasia and the suspicion of neoplasia, i.e. it implies benignancy.
Reactive inflammatory changes and inflammatory changes can be considered synonyms.
Nuclear changes are seen in:
- Inflammatory processes.
- Neoplastic processes, i.e. pre-cancerous conditions (e.g. dysplasia) and cancer.
Significance of nuclear changes in inflammation:
- The line between a reactive process and a neoplastic process may be fuzzy, i.e. it may be very difficult to be certain whether something is benign or malignant.
- In the context of inflammation, nuclear changes are typically present and the threshold for calling suspicious for malignancy or malignancy is typically higher.
Features - generic:
- Nuclear changes - typically:
- Nuclear enlargement.
- Nuclear hyperchromasia.
- Prominent nucleoli.
- Inflammation - any type (e.g. neutrophilic, plasmacytic, lymphoplasmacytic).
- +/-Proliferation (e.g. mitotic figures) or changes suggestive of proliferation (e.g. hyperplasia).
- Cytoplasmic changes may be present.
- Waffle diagnosis - nuclear changes of unknown significance.
- Nuclear atypia.
- This is often qualified as it may represent a neoplastic process or a benign process.
- Common qualifiers:
- Worrisome lesions: "... cannot exclude dysplasia", "... cannot exclude malignancy", "... suspicious for malignancy".
- Suspected to be benign: "... favour benign".