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Endocrine > 166. Hypothalamus-Pituitary Histology/Pathology > Flashcards

166. Hypothalamus-Pituitary Histology/Pathology Flashcards

1
Q

Lying at interface b/w adeno- and neurohypophysis

Cystic change is frequent

Likely the site of origin of Rathke’s cleft cysts

A

Pars intermedia

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2
Q

Second most common adenoma found

Most are macroadenomas 2 types: - sparsely granulated (~10%) - look for fibrous bodies —> more aggressive

  • Densely granulated (~10%) Prolactin reactivity often present in addition to GH Elevated IGF-1 => gigantism and acromegaly
A

GH-producing (somatotroph cell) adenomas

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3
Q

Often associated w/ systemic sarcoidosis

Preferentially affects structures in the suprasellar region

Produces non-caseating, granulomatous inflammation with multinucleated (Langhans’) giant cells

A

CNS sarcoidosis

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4
Q

Most often in adults

Papillae line by well-differentiated squamous epithelium

Lack keratin, peripheral palisading, calcification, and cysts

Good prognosis

A

Papillary craniopharyngioma

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5
Q

Craniopharyngiomas

Germ cell tumors

A

Hypothalamic suprasellar tumors

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6
Q

Most common variant of pituitary adenoma

Microadenomas or macroadenomas

Amenorrhea/galactorrhea in females; impotence, loss of libido in males

Usually diagnosed earlier in women of reproductive age than in postmenopausal women and in males

Majority are responsive to bromocriptine and relate drugs (cabergoline)

A

Prolactin-producing adenomas

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7
Q

Hypercorticolism due to ACTH adenoma

A

Cushing’s Disease

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8
Q

On histology: - Sparsely granulated (~20-30%) - Densely granulated (~1%) - Dystrophic calcification = pituitary stone

A

Prolactinoma

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9
Q

Most commonly seen in children

Consists of stratified squamous epithelium w/ periphery palisading and compact, lamellar keratin formation = wet keratin

Dystrophic calcification Cysts of the tumor contain “machine oil” Good prognosis

A

Adamantinomatous craniopharyngioma

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10
Q

Derived from Rathke’s pouch

Bimodal age distribution:

  • 5-15yo
  • 65yo and up

Manifestation:

  • headaches
  • visual disturbances
  • growth retardation d/t GH deficiency
A

Craniopharyngiomas

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11
Q

25-30% of pituitary adenomas

Macroadenomas Symptoms d/t mass effect and/or hypopituitarism

Synaptophysin and chromogranin reactive; otherwise minimally or nonreactive - nonfunctioning

A

Null cell adenomas or silent variants

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12
Q

Originate from remnants of the Rathke’s pouch

Simple cyst composed of ciliated cuboidal epithelium

A

Rathke’s cleft cyst

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13
Q

Most common tumors of the anterior pituitary

Most common cause of hyperpituitarism

Manifestations related to:

  • Secretion of excess hormone
  • Hypopituitarism
  • Mass effect
A

Pituitary adenomas

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14
Q

Specialized glial cells that support the axons in the posterior lobe of the pituitary gland

A

Pituicytes

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15
Q

On histology:

  • Populated by epithelial cells containing a variety of trophic hormones
  • Cells compartmentalized into small acini by a reticulin network
A

Anterior pituitary

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16
Q

Results in hyponatremia

Caused by both extra-CNS disorders (most common) and some CNS diseases Extra-CNS causes include neoplasia (small cell carcinoma of the lung), adrenal insufficiency, myxedema, cirrhosis, cardiac disease, certain drugs CNS causes include trauma, CNS infections, CNS neoplasms, etc. - anything w/ blood volume loss really

A

SIADH (Inappropriate ADH secretion)

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17
Q

Diseases referable to abnormalities in ADH release

  • no well-defined syndromes related to oxytocin abnormalities Diabetes insipidus and SIADH
A

Posterior pituitary syndromes

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18
Q

Supplied by an artery and drains into a vein

  • inferior hypophyseal branches Its hormones are released directly into the systemic circulation
A

Posterior lobe of pituitary gland

19
Q

Elevated prolactin levels due to tumor secretion must be distinguished from… Levels < 150 ng/mL may represent this

A

Stalk Effect

20
Q

2 hormones secreted by supraoptic and paraventricular nuclei of hypothalamic innervation to the posterior pituitary

A

Oxytocin and vasopressin (ADH)

21
Q

Most common CNS germ cell tumor

Children and young adults

Usually in the pineal or suprasellar region

Lymphocytic infiltration seen everywhere on slides

A

Germinoma

22
Q

Defined by the presence of metastasis and/or craniospinal dissemination

Poor correlation with cytological atypia

Most are hormonally active

Extremely rare - clinical diagnosis bc tumor looks like regular adenoma on slides

A

Pituitary carcinoma

23
Q

Blood supply of the anterior pituitary

Conduit for the transport of hypothalamic releasing hormones from the hypothalamus

A

Hypophyseal portal system

24
Q

Enlargement of ACTH adenoma after the removal of both adrenal glands

A

Nelson Syndrome

25
Q

Connects the hypothalamus to the pituitary gland

A

Pituitary stalk

26
Q

Most common during pregnancy or postpartum period - autoimmune disorder

  • both cellular and humoral responses in pathogenesis

Symmetrical enlargement of pituitary accompanied by pituitary insufficiency

May occur in isolation or in conjunction with autoimmune infiltrates in other endocrine organs

Destructed gland seen on histology

A

Lymphocytic hypophysitis

27
Q

Pathogenesis of pituitary adenomas is fairly uncertain in most cases except for the cases in patients with this condition

A

MEN-1

28
Q

Derived from Rathke pouch

From oral ectoderm

A

Anterior pituitary (adenohypophysis)

29
Q

General morphological features:

  • Cytoplasm of constituent cells tends to be monomorphous compared to non-neoplastic gland
  • Paucity of reticulin network
  • Low mitotic activity
  • Atypical categorization –> ki-67 labeling index > 3% w/ p53 expression
A

Pituitary adenomas

30
Q

Acidophilic cells of the 5 cell types in anterior lobe of pituitary gland

A

GH- and prl-secreting cells

31
Q

Represents a downward (ventral) outgrowth of the embryonic diencephalon

  • ventral outgrowth of the hypothalamic floor

From neuronal ectoderm

A

Posterior pituitary

32
Q

Usually microadenomas at the time of diagnosis

Basophilic, densely granulated, strongly PAS, and ACTH-reactive

Associated w/ hypercorticolism

  • Cushing syndrome
  • Cushing disease
  • Nelson syndrome
A

ACTH-producing adenomas

33
Q

Populated by axons originating in neurons in the supraoptic and paraventricular nuclei of the hypothalamus

  • secrete oxytocin and vasopressin (ADH)
A

Posterior lobe (neurohypophysis)

34
Q

Cell populations: acidophil (w/ eosinophilic cytoplasm), basophil (w/ basophilic cytoplasm), and chromophobe (poorly staining cytoplasm)

Five cell types:

  • Somatotrophic - GH
  • Lactotrophic - prolactin, prl
  • Corticotrophic - ACTH
  • Thyrotrophic - TSH
  • Gonadotrophic (FSH, LH)
A

Anterior lobe (adenohypophysis)

35
Q

Hypercorticolism regardless of cause

A

Cushing syndrome

36
Q

Confines the pituitary gland

A

Sella turcica and sellar diaphragm

37
Q

In conjunction with the hypothalamus, plays a central role in modulating the exocrine system

Lies in close proximity to the hypothalamus

A

Pituitary gland

38
Q

Extra-CNS cause of SIADH that is quite common

  • cancer
A

Small cell carcinoma of lung

39
Q

Extension of the developing oral cavity Gives rise to anterior lobe

A

Rathke pouch

40
Q

Excessive urination (polyuria)

Can be subdivided into central and nephrogenic variants

Central variants include primary = idiopathic or hereditary, trauma, vascular disease, suprasellar/hypothalamic neoplasms, local infections, inflammatory diseases

A

Diabetes insipidus

41
Q

Axonal expansions found on histology as finely granular round structures that contain ADH and oxytocin

A

Herring bodies

42
Q

Delicate collagen fibers that hold the anterior lobe together

A

Reticulin network

43
Q

Elevated IGF-1 from GH-producing adenomas leads to…

A

Gigantism - children Acromegaly - adults

44
Q

Low pressure blood supply renders this area vulnerable to ischemic insults d/t things like hypotension and elevated ICP

A

Anterior pituitary

Endocrine (26 decks)

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