Endocrine Pathology (Prof.GWT,SpPA(K).ppt

7/29/2019 Endocrine Pathology (Prof.GWT,SpPA(K).ppt

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Thyroid

Prof.dr.Gani W Tambunan,SpPA(K)


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Thyroid gland

The thyroid gland (N):

on the anterior trachea

of the neck. Has a right lobe & a

left lobe connected by

a narrow isthmus.

Weight: 10-30 gr.


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Normal thyroid (microscopic)

Consists of follicles lined by a an epithelium and filledwith colloid.

The interstitium, which may contain "C" cells


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Immunoperoxidase stain(Calcitonin)

Identifies the "C" cells (parafollicular cells)


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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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(low power microscopic)


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(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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Immunofluorescence(Test positive for anti-microsomal antibody)

Note :

The bright green fluorescence in the thyroid epithelial cells

The colloid in the center of the follicles is dark.


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Immunofluorescence

(Positivity for anti-thyroglobulin antibody)

Other autoimmune conditions including:

Grave's disease, SLE, rheumatoid arthritis, pernicious anemia,

and Sjogren's syndrome.


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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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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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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

(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 (histologic)


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Follicular Adenoma

This adenoma is a well- differentiated neoplasm because

it closely resemble normal tissue.


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Sectioning through a lobe of excised thyroid

gland reveals papillary carcinoma

Multifocal

Because of the propensity

to invade lymphaticswithin thyroid, and lymphnode metastases arecommon.

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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The amyloid stroma of the medullary thyroid

carcinoma has been stained with Congo red.


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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 adenoma

Endocrine 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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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

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.


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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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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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ADRENAL GLANDS


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Normal adrenal glands

Each adult adrenal gland weighs from 4 to 6 grams.


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Sectioning across the adrenals reveals a

golden yellow outer cortex and an inner red to

grey medulla.


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The pair of adrenals in the center

are normal.

The adrenals at the bottom represent bilateral cortical

hyperplasia.


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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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The patient with Waterhouse-Friderichsen

syndrome has sepsis with DIC and marked

purpura.


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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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Here are Congo red stained deposits of amyloid in the adrenal

cortex. Amyloid may collect in adrenal as well as other

organs.


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Congenital neuroblastoma

This neoplasm (marked by the white arrow) is

displacing the liver to the left of the body.


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Microscopic appearance of

neuroblastoma One of the "small round

blue cell" tumors.

These neoplasms canreach a large size in the

retroperitoneum before

detection.

They often contain areas

of necrosis andcalcification.


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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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This islet of Langerhans demonstrates pink

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.

A few normal islets are seen in the pancreas at the right for comparison.

Insulinoma


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Insulinoma

(immunohistochemical stain for insulin in the

islet cell adenoma)

Endocrine Pathology (Prof.GWT,SpPA(K).ppt

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