endocrine glands pathology

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Endocrine Glands Pathology

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  • 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

    eosinophilic

    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

    Pretibial edema

    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

    goiter

    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.

    Anaplastic

  • 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.

    Intracytoplasmic lipid

    Smooth border

  • 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.

    Mitosis.

    mitosis

  • Pheochromocytoma (265)

    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

    Fleshy appearance.

    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

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