2.5.1 Hypothalamus-Pituitary Pathology Flashcards
Where do these three histological images come from within the pituitary?
Top: Anterior (glandular)
Middle: Intermediate zone - Cleft
Bottom: Posterior (neural tissue)
What is pituitary apoplexy?
Sudden enlargement of adenoma due to hemorrhage/infarction
Leads to emergency decompression of optic system
Usually from a nonfunctional adenoma
What are some of the inherited genes linked to adenomas?
MEN1, CDKN1B, PRKAR1A, AIP
Identify the three cell types in the anterior pituitary.
Circle: acidophil; Square: basophils; Thick oval: chromophobes
What is used to differentiate b/t different cell types found in the anterior pituitary?
Hormonal evaluation (IHC)
If Sean could start a farm with only one type of animal, what type of animal would he choose?
Goat. There is nothing Sean likes more in this world than a nice warm glass of goat milk before bed.
Disclaimer: This may or may not be accurrate, but he seems pretty darn happy with this goat.
Wat dis b?
Craniopharyngioma
What occurs as a result of optic nerve compression?
Bitemporal hemianopia (lateral field defects)
Why does the diagram help us understand the visual deficits found in bitemporal hemianopia?
This image shows the nasal side of retinal optic neurons have axons that pass accross the optic chiasm. When these are compressed, the retinal neurons on the nasal side are damaged leading to poor lateral vision.
What is the #1 pediatric sellar tumor?
Craniopharyngioma (Rathke’s pouche remnant)
Name 4 mutations that are associated with “aggressive” adenomas.
Cyc D1 overexpression
TP53 mutation
RB
HRAS (pituitary carcinomas)
Which lobe of the pituitary? Identify two structures in this image. What is the arrow pointing at?
Posterior lobe
2 structures: Glia (pituicytes) and axons from hypothalmus
Arrow: Herring body
What is another name for corticotroph adenoma? What hormone is excessively expressed?
Cushing’s dz; excess ACTH
More common in women (5:1)
What are some consequences of prolactinemia?
Amenorrhea, galactorrhea, loss of libido, infertility
What are the three main types of adenomas?
Prolactinoma (30%)
Growth hormone adenoma (10-20%)
Corticotroph cell adenoma (Cushing’s dz)
Type of stain? What does it bring out? Which side is tumor tissue?
Reticulin stain
Stains the connective tissue
The left side is tumorous and devoid of connective tissue
What are the two structures covered in blue?
Optic Chiasm
Pituitary Gland
What are the 2 arrows pointing at? These are present in what condition?
Top: Kidney-shaped nuclei
Bottom: Birbeck granules
Langerhans’ Cell Histiocytosis
This is an example of what optic change?
Bitemporal hemianopia
What is required in the demonstration of pituitary carcinomas?
Distant metastases
What are some of the symptoms associated with craniopharyngioma?
Headache, visual loss, hormonal deficits
Name some of the patholgoic lesions involving the sella turcica and pituitary gland.
Pituitary adenoma, pituitary carcinoma, craniopharyngioma, inflammatory lesions, metastases, tumor-like lesions, developmental cysts
What is the standard route to the pituitary gland during surgery?
Through the mouth or nasal cavity
Identify these structures
What are the possible presentations of pituitary GH adenoma in adults? Children?
Adults: acromegaly
Children: Gigantism
Describe the microscopic pathology
Sheets of monotonous cells
Uniform staining
Sparse intervening connective tissue
Pituitary adenoma
What percentage of intracranial neoplasms are pituitary adenomas? When in life do they often occur?
10%
Age: 30-50s
What is a common alteration in pituitary adenomas?
G-protein mutations
Who is most readily diagnosed with prolactinoma?
20-40 y/o women
These non-cancerous lesions can compress or destroy the pituitary gland and adjacent structures. Comprised of ciliated cuboidal epithelium.
Rathke cleft cyst
What are some of the findings in pituitary adenomas?
Endocrine excess/deficit
Mass effects
Increased intracranial pressure
Ischemic injury
Hypopituitarism
Optic nerve compression
What type of lesion is Langerhans’ cell histiocytosis?
Inflammatory, reactive lesion
