endocrine pathology, umi
TRANSCRIPT
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DEPT PATOLOGI ANATOMI
FK UMI
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THYROID GLAND
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KELAINAN PADA
THYROID GLAND
Congenital
Infection
Neoplasma
Others (Graves Disease
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Thyroid gland The thyroid gland (N):
on the anterior tracheaof the neck.
Has a right lobe & a leftlobe connected by anarrow isthmus.
Weight: 10-30 gr.
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Normal thyroid (microscopic)
Consists of follicles lined by a an epithelium and filled withcolloid.
The interstitium, which may contain "C" cells
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THYROIDITISHashimoto Thyroiditis
(Chonic Lymphocytic Thyroiditis)
Subacute Granulomatous Thyroiditis(De Quervain Thyrooiditis)
Subacute Lymphocytic Thyroiditis
Riedel Thyroiditis
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Hashimoto's Thyroiditis
Thyroid failure because of autoimmune destruction
Microscopis :
extensive infiltration of the parenchym by a
mononuclear inflammtory infiltrat (germinalcenters)
Atrophic follicles thyroid
Hurtle cell (+) metaplastic respon of thenormally low cuboidal follicular epithelium to
ongoing injury
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Thyroid gland (atrophy)
This patient was hypothyroid.
The end result ofHashimoto's thyroiditis.
Hashimoto's thyroiditis
results from abnormal T cell
activation & subsequent Bcell stimulation to secrete a
variety of autoantibodies.
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Hashimoto's thyroiditis
(low power microscopic)
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Hashimoto's thyroiditis
(High power microscopic)
Demonstrates the pink Hrthle cells at the center and right.
Initially leads to painless enlargement of the thyroid, followed
by atrophy years later
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Sub-acute granulomatous thyroiditis
(DeQuervain's disease)
Caused by viral infection or postviralinflammatory process
Granulomatous
Multinucleated giant cell
Early stage : microabscess follicles
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Sub-acute granulomatous thyroiditis
(DeQuervain's disease)
Note:the foreign body giant cells with destruction of
thyroid follicles.
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RIEDEL THYROIDITIS
Unknown etiology
Characterized by extensive fibrosis involving thethyroid and contiguous neck structur
May be associated with idiopathic fibrosis inother sites in the body
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This thyroid gland is about normal in size, but there is a larger
colloid cyst at the left lower pole and a smaller colloid cyst at
the right lower pole.
larger colloid cystsmaller colloid cyst
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Diffuse and Multinodular Goiters
Enlargement of the thyroid or goiter
Reflect impaired synthesis of the thyroid hormon,most often caused by dietary iodine deficiency
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This diffusely enlarged thyroid gland is
somewhat nodular.
This represents the most common cause for an enlarged thyroid gland and
the most common disease of the thyroid--a nodular goiter.
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Multinodular goiter
(Low power microscopic)
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Grave's Disease
An autoimmune disorder Diffusely hyperplastic thyroid
The follicles are lined by tall columnar
epithelium The crowded, enlarged epithelial cells project
into the lumens of the follicles
The active cells resorb the colloid in the centers
of the follicles scallopedappearance of the edges of the colloid
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Grave's disease
(low power-autoimmune disease the action of TSI's)
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Grave's disease
(high power, the tall columnar thyroid epithelium)
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Follicular adenoma
The mass is well
circumscribed.
Gross : felt firm.
By scintigraphic scan
"cold."
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Follicular Adenoma
This adenoma is a well- differentiated neoplasm because
it closely resemble normal tissue.
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Classification & Incidence of Thyroid Cancer
Follicular cell origin Differentiated
Papillary 80% Follicular 10% Hurthle cell 3-5%
Undifferentiated Anaplastic 1-2%
Parafollicular cell origin Medullary 5%
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Papillary Carcinoma
Accounts for 90% radiation induced cancer
Classified as microcarcinoma, intrathyroidal, and
extrathyroidal Histologic variants: tall-cell, clear-cell, columnar, diffuse
sclerosing
Multicentric in 30-50% of tumors
Spreads via lymphatics with propensity for mid-and lower-anterior cervical chain (Level VI)
20-50% patients have involvement of cervical LN
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Follicular Carcinoma
Only 10% of thyroid cancers in developedcountries, although more prevalent in regions withiodine deficiency
Diagnosis depends on demonstration of vascularor capsular invasion
Classified as minimally or widely invasive Vascular invasion tends to have a more aggressive course
than capsular invasion
Uncommon to have multicentric disease
Hematogenous spread
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Contd
Where does follicular carcinoma tend to metastasize?
Bone
lung
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FOLLICULAR CA THYROID
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Anaplastic Carcinoma
Increasingly rare
Arise within differentiated cancers Pts > 60 years old with rapidly expanding neck
mass
Local invasion very common at time of dx(FNA)
Surgery plays limited role given advanced stageat dx
Radiation and chemotherapy have notdemonstrated any significant improvement insurvival
Median survival ~ 4 - 6 months
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Medullary Thyroid Carcinoma Originates from the parafollicular C cells
Elevation in calcitonin and CEA (50%) 80% have sporadic MTC (unifocal), remainder have
genetic component
75% patients have LN metastasis at time of dx, 20%
distant mets
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Sectioning through a lobe of excised thyroid
gland reveals papillary carcinoma
Multifocal
Because of the propensity
to invade lymphaticswithin thyroid, andlymph node metastasesare common.
The larger mass is cystic
and contains papillaryexcresences.
Most often arise inmiddle-aged females
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Papillary Carcinoma
(Microscopic)
The fronds of tissue have thin fibrovascular cores. The fronds have an
overal papillary pattern.
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Papillary Carcinoma
(Microscopic)
Note the small psammoma body in the center. The cells of the
neoplasm have clear nuclei.
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Medullary Carcinoma
These neoplasms are derived from the thyroid "C" cells and, therefore,
have neuroendocrine features such as secretion of calcitonin
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PARATHYROID GLAND
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Parathyroid hyperplasia
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Parathyroid hyperplasia
There is little or no adipose tissue, but any or all cell types
normally found in parathyroid are present.
Note the pink oxyphil cells here.
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Parathyroid adenoma
A rim of normal parathyroid tissue (with a pink oxyphil cell nodule)
at the upper right, and a small benign parathyroid cyst (an incidental
finding) is at the upper left.
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Parathyroid adenoma
rim of normal
parathyroid
A rim of normal parathyroid tissue admixed with adipose tissue
cells is seen compressed to the right and lower edge of the
adenoma.
Gross appearance of a
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Gross appearance of a
parathyroid carcinoma
Note the large size and irregular cut surface.
These carcinomas have a tendency to invade surrounding tissues in
the neck, complicating their removal.
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Parathyroid carcinoma
The nests of neoplastic cells that are not very pleomorphic.
Note the bands of fibrous tissue between the nests.
Parathyroid carcinomas infiltrate surrounding structures in the neck.
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A normal parathyroid gland for comparison.
Adipose tissue cells are mixed with the parathyroid tissue.
The amount of fat varies somewhat.
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NORMALPARATHYROID
GLAND
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PITUITARY GLAND
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The normal gross appearance of the pituitary
gland removed from the sella turcica
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The normal microscopic appearance of the
pituitary gland
The adenohypophysis is at the right and the neurohypophysis is at the left.
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The normal microscopic appearance of the
adenohypophysis
The adenohypophysis contains three major cell types: acidophils,
basophils, and chromophobes.
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Neurohypophysis
The neurohypophysis shown here resembles neural tissue, with glial
cells, nerve fibers, nerve endings, and intra-axonal neurosecretory
granules
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Microadenoma of the anterior pituitary
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Adenohypophyseal adenomaEndocrine neoplasms are
composed of small round cells
with small round nuclei andpink to blue cytoplasm.
The cells may be arranged in
nests or cords and endocrine
tumors also have prominent
vascularity.
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The circumscribed mass lesion present here in
the sella turcica is a pituitary adenoma
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The microscopic appearance of the pituitary
adenoma
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Craniopharyngioma
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ADRENAL GLANDS
Sectioning across the adrenals reveals a golden
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Sectioning across the adrenals reveals a golden
yellow outer cortex and an inner red to grey
medulla (Normal adrenal glands )
Each adult adrenal gland weighs
from 4 to 6 grams.
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These adrenals are black-red from extensive
hemorrhage in a patient with meningococcemia.
This produces the Waterhouse-Friderichsen syndrome.
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This is the microscopic appearance of the
adrenals with meningococcemia.
There is marked hemorrhagic necrosis with acute adrenal
insufficiency.
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An enlarged adrenal
gland
Demonstrate tan-white
metastatic carcinomainfiltrating in and around the
residual golden yellow cortex
. The most common primary
site for adrenal metastases is
lung.
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This is a caseating granuloma of
tuberculosis in the adrenal gland.
Tuberculosis used to be the most
common cause of chronic adrenalinsufficiency.
Now, idiopathic (presumably
autoimmune) Addison's disease is
much more often the cause for
chronic adrenal insufficiency.
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This adrenal gland removed surgically in a patient with
Cushing's syndrome
Some remaining atrophic adrenal is seen at the right.
The adenoma is composed of yellow firm tissue just like
adrenal cortex.
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Adrenal adenoma
Here is a 1.3 cm left adrenal adenoma found in a patient with
hypertension.
Such adenomas are typically less than 2 cm in size and yellow
on cut surface.
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Microscopically, the adrenal cortical adenoma at the
right resembles normal adrenal fasciculata.
The capsule is at the left. There may be some cellular
pleomorphism.
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Adrenal cortical
carcinoma
Such neoplasms are
usually functional (secretingcorticosteroids or sex
steroids).
They have a poor
prognosis.
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Adrenal cortical carcinoma (microscopically
at high power)
The larger the neoplasm, the more likely it is malignant, but
the best indicators are invasion and metastasis.
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This high power microscopic appearance of an
adrenal cortical carcinoma
It is difficult to determine malignancy in endocrine
neoplasms based upon cytology alone.
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This large adrenal neoplasm has been
sectioned in half.
Note the grey-tan color of the tumor compared to the
yellow cortex stretched around it and a small remnant
of remaining adrenal at the lower right.
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This pheochromocytoma demonstrates the
chromaffin reaction.
This neoplasm of the adrenal medulla contains catecholamines
(epinephrine and norepinephrine).
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There is some residual adrenal cortical tissue at the
lower center right, with the darker cells of
pheochromocytoma seen above and to the left.
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Pheochromocytoma
(Microscopic)Composed of large cells that
are pink to mauve and arranged
in nests with capillaries in
between.Remember 10% when you
think of a pheochromocytoma:
10% are bilateral
10% are in children 10% are malignant.
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Here is a normal pancreatic islet of Langerhans
surrounded by normal exocrine pancreatic acinar tissue.
The islets contain alpha cells secreting glucagon, beta cells
secreting insulin, and delta cells secreting somatostatin.
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Immunoperoxidase staining can help identify the nature
of the cells present in the islets of Langerhans.
On the right, antibody to insulin has been employed to identify the beta cells.
On the left, antibody to glucagon identifies the alpha cells.
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A insulitis of an islet of Langerhans in a patient who will
eventually develop type I diabetes mellitus.
The presence of the
lymphocytic infiltrates in this
edematous islet suggests anautoimmune mechanism for
this process.
The destruction of the islets
leads to an absolute lack ofinsulin that characterizes type
I diabetes mellitus.
This islet of Langerhans demonstrates pink
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hyalinization (with deposition of amyloid) in
many of the islet cells.
This change is common in the islets of patients with type II
diabetes mellitus.
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An islet cell adenoma
Separated from the pancreas by a thin collagenous capsule.