Desmoplasia

In medicine, desmoplasia is the growth of fibrous or connective tissue. It is also called desmoplastic reaction to emphasize that it is secondary to an insult. Desmoplasia may occur around a neoplasm, causing dense fibrosis around the tumor, or scar tissue (adhesions) within the abdomen after abdominal surgery. In medicine, desmoplasia is the growth of fibrous or connective tissue. It is also called desmoplastic reaction to emphasize that it is secondary to an insult. Desmoplasia may occur around a neoplasm, causing dense fibrosis around the tumor, or scar tissue (adhesions) within the abdomen after abdominal surgery. Desmoplasia is usually only associated with malignant neoplasms, which can evoke a fibrosis response by invading healthy tissue. Invasive ductal carcinomas of the breast often have a scirrhous, stellate appearance caused by desmoplastic formations. Desmoplasia originates from the Ancient Greek δεσμός desmos, 'knot', 'bond' and πλάσις plasis, 'formation'. It is usually used in the description of desmoplastic small round cell tumors. Neoplasia is the medical term used for both benign and malignant tumors, or any abnormal, excessive, uncoordinated, and autonomous cellular or tissue growth. Desmoplasia refers to growth of dense connective tissue or stroma. This growth is characterized by low cellularity with hyalinized or sclerotic stroma and disorganized blood vessel infiltration. This growth is called a desmoplastic response and occurs as result of injury or neoplasia. This response is coupled with malignancy in non-cutaneous neoplasias, and with benign or malignant tumors if associated with cutaneous pathologies. The heterogeneity of tumor cancer cells and stroma cells combined with the complexities of surrounding connective tissue suggest that understanding cancer by tumor cell genomic analysis is not sufficient; analyzing the cells together with the surrounding stromal tissue may provide more comprehensive and meaningful data. Normal tissues consist of parenchymal cells and stromal cells. The parenchymal cells are the functional units of an organ, whereas the stromal cells provide the structure of the organ and secrete extracellular matrix as supportive, connective tissue. In normal epithelial tissues, epithelial cells, or parenchymal cells of epithelia, are highly organized, polar cells. These cells are separated from stromal cells by a basement membrane that prevents these cell populations from mixing. A mixture of these cell types is recognized, normally, as a wound, as in the example of a cut to the skin. Metastasis is an example of a disease state in which a breach of the basement membrane barrier occurs. Cancer begins as cells that grow uncontrollably, usually as a result of an internal change or oncogenic mutations within the cell. Cancer develops and progresses as the microenvironment undergoes dynamic changes. The stromal reaction in cancer is similar to the stromal reaction induced by injury or wound repair: increased ECM and growth factor production and secretion, which consequently cause growth of the tissue. In other words, the body reacts similarly to a cancer as it does to a wound, causing scar-like tissue to be built around the cancer. As such, the surrounding stroma plays a very important role in the progression of cancer. The interaction between cancer cells and surrounding tumor stroma is thus bidirectional, and the mutual cellular support allows for the progression of the malignancy. Stroma contains extracellular matrix components such as proteoglycans and glycosaminoglycans which are highly negatively charged, largely due to sulfated regions, and bind growth factors and cytokines, acting as a reservoir of these cytokines. In tumors, cancer cells secrete matrix degrading enzymes, such as matrix metalloproteinases (MMPs) that, once cleaved and activated, degrade the matrix, thereby releasing growth factors that signal for the growth of cancer cells. MMPs also degrade ECM to provide space for vasculature to grow to the tumor, for the tumor cells to migrate, and for the tumor to continue to proliferate.