endocrine glands pathology
Post on 17-Feb-2016
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DESCRIPTIONEndocrine Glands Pathology
Eosinophilic pituitary adenoma (457)
Pituitary gland Anterior lobe:
Eosinophilic cell adenomas secreting prolactin most common, then GH Excess GH in child Gigantism. Adult acromegaly. Slide: cells don't stick together (scattered cells), looks like cytology instead of
tumor sample. Bright pink (eosinophilic) Basophilic cells (ACTH, MSH, TSH, FSH&LH) (tumors secreting those are rare) Chromophobic cells
Posterior lobe: Modified glial cells (pituicytes) Axonal processes of hypothalamic nerve cells
Scattered cells look like cytology
Monomorphism Normal anterior pituitary
contains different cell types for different hormones
Parathyroid adenoma (464)
Usually unilateral Produce PTH hypercalcemia symptoms
Osteoporosis, depression, seizure, gallstone, nephrolithiasis Benign tumor
Capsule between adenoma and normal tissue.
Some tendency to form follicles.Similar to normal parathyroid gland but more crowded.
Diffuse toxic hyperplasia of the thyroid (Graves disease) (452) Autoimmune, more common in
female. Most common cause of hyperthyroidism.
TSI (thyroid stimulating immunoglobulin) is main antibody. Acts as TSH. Often autoantibodies cross react
with connective tissue around eye exophthalmus
Hyperthyroidism Increase metabolic rate Increased sympathetic activity Sweating Heat intolerance Weight loss Flushed skin (to increase heat loss) Increased cardiac output Tremor, hyperactivity, anxiety,
insomnia Pretibial myxedema
Hypothyroidism Decreased metabolism Decreased sympathetic activity
Decreased sweating and constipation Cold intolerance Weight gain Cold skin (decreased blood flow) Decreased cardiac output
Shortness of breath Reduced exercise capacity
Fatigue, slowed mental activity Cretinism (in children) Myxedema (in older children or adult)
Plummer syndrome: multinodular goiter
Diffuse, homogenous goiter: Grave's: hyperthyroidic goiter Lack of iodine: hypothyroidic
Scallop (or moth eaten) appearance. Adjacent parenchymal cells use colloid to produce thyroid hormone, producing empty space
Scattered follicles with a lot of parenchyma.Lymphocytes (dark purple cells in nodules)Parenchyma
Metastatic papillary carcinoma of the thyroid in the lymph node (461)
Malignant tumors of the thyroid: Papillary most common.
75% - 85% Follicular 10% - 20% Medullary 5%. Bad
prognosis, produces amyloid. Marker is calcitonin. Scintigraphy with
radioactive iodine shows adenomas as cold areas.
Adrenal cortical adenoma (455)
Adrenal cortical adenoma: incidentaloma, usually clinically silent
Slide: Border is smooth (a thin layer) Typical benign tumor. Small islets (like normal
adrenal gland), but more crowded. Uniform nests. Dark pink cytoplasm. Small nuclei.
Adrenal cortical carcinoma (456)
Rare neoplasm. Large, invasive. Hypercortisolemia Cushing's Might also cause Conn syndrome (too much aldosterone). Usually asymptomatic until quite advanced (metastasis)
Slide no uniform nests. Sheets of solid cells not
forming structure Atypia, Pleiomorphism
some nuclei are much bigger, some with nucleoli. Dark nuclei.
Stays within adrenal gland (medulla tumor). Produce norepinephrine and epinephrine (like normal medulla cells) mostly benign, rarely malignant (atypical pheochromocytoma)
(metastasis)(10% malignant) Symptoms related to sudden (or chronic) release of
catecholamines Most common reason for secondary hypertension. Catecholamine cardiomyopathy
Slide: Pale cells forming round nests
near border of tumor (zellballen, German for cell balls)
Cells look paler than the ones from cortex.
Nuclei with salt and pepper chromatin typical for neuroendocrine tumors.
Well-differentiated neuroendocrine tumor (islet cell tumor, APUD-oma)(the pancreas) (458)
Well-differentiated neuroendocrine tumor A lot of them comes from
Langerhans. Gastrin, somatostatin, VIP
(vasoactive intestinal peptide), insulin, glucagon (rare). Neuroendocrine cells.
Most islet cell tumors are small except gastrinoma, which grows aggressively.
Insulinoma -cell tumors Clinical triad of attack:
Hypoglycemia when glucose level