Question:medium
A 45-year-old man who is a chronic smoker presents with a complaint of cough. The physician takes a biopsy of the airway, shown below. Which of the following cellular changes has happened in this patient?
A 45-year-old man who is a chronic smoker presents with a complaint of cough. The physician takes a biopsy of the airway, shown below. Which of the following cellular changes has happened in this patient?
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One adult epithelium is swapped for a hardier adult epithelium, and it can reverse if the smoker quits.
Updated On: Jun 23, 2026
- Hyperplasia
- Dysplasia
- Metaplasia
- CIN3
Show Solution
The Correct Option is C
Solution and Explanation
Clinical pearl: chronic smoker plus airway biopsy equals squamous metaplasia until proven otherwise.
Eliminate first: CIN3 belongs to cervical pathology, so it is out for a bronchus. Hyperplasia means more cells of the same type, which does not fit a description of one tissue becoming another. Dysplasia means atypical, disordered cells with loss of maturation; that is a pre-cancer change, not the simple lining swap seen here.
What is left: metaplasia, the replacement of the delicate ciliated columnar respiratory epithelium by stratified squamous epithelium. Cigarette smoke drives this adaptive change first; only later can dysplasia and carcinoma follow.
Key point: metaplasia is reversible, which makes it the textbook earliest response of the bronchial mucosa to smoking. That is why the medically correct option here is Metaplasia, even though the recalled key listed Dysplasia.
Reference: Robbins Basic Pathology, 9e, cellular adaptation.
Eliminate first: CIN3 belongs to cervical pathology, so it is out for a bronchus. Hyperplasia means more cells of the same type, which does not fit a description of one tissue becoming another. Dysplasia means atypical, disordered cells with loss of maturation; that is a pre-cancer change, not the simple lining swap seen here.
What is left: metaplasia, the replacement of the delicate ciliated columnar respiratory epithelium by stratified squamous epithelium. Cigarette smoke drives this adaptive change first; only later can dysplasia and carcinoma follow.
Key point: metaplasia is reversible, which makes it the textbook earliest response of the bronchial mucosa to smoking. That is why the medically correct option here is Metaplasia, even though the recalled key listed Dysplasia.
Reference: Robbins Basic Pathology, 9e, cellular adaptation.
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