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MD4 Pathology > Endocrine 1 > Flashcards

Endocrine 1 Flashcards

1
Q
A

Normal Pituitary gland

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2
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Normal Pituitary Gland

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3
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Normal anterior pituitary

Red = acidophils

Purple = basophils

Clear = chromophobes

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4
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Normal anterior pituitary

GH Antibody staining

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5
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Normal Posterior Pituitary

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6
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Pituitary Adenoma

Expansion of gland into sella turcica

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7
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Pituitary Adenoma

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8
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Pituitary Adenoma

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9
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Pituitary Adenoma

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10
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Pituitary MacroAdenoma

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11
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Pituitary Adenoma

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12
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Pituitary Adenoma

Monomorphic & arranged in sheets, not acini

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13
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Pituitary Adenoma

Salt & Pepper chromatin

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14
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Normal Thyroid

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15
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Normal Thyroid

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16
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Normal Thyroid

Parafollicular cells only in lateral lobes (from neural crest)

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17
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Hashimoto’s Thyroiditis

“Fish-flesh” and infiltrated by lymphocytes

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18
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Hashimoto’s Thyroiditis

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19
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Hashimoto’s Thyroiditis

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20
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Hashimoto’s Thyroiditis

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21
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Hashimoto’s Thyroiditis

Lymphoid follicle with germinal center

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22
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Hashimoto’s Thyroiditis

Oncocytic Herthle cells

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23
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Hashimoto’s Thyroiditis

Metaplasia

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24
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Thyroid Nodular hyperplasia

Due to iodine deficiency, diet, meds/genetics

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25
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Thyroid nodular hyperplasia

Can compress trachea or recurrent laryngeal -> hoarse voice

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26
Q
A

Thyroid nodular hyperplasia

no capsule, benign

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27
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A

Grave’s Disease

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28
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Grave’s Disease

Resorption vacuoles; Hypertrophic columnar follicular cells

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29
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Grave’s Disease

Resorption vacuoles

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30
Q
A

Radionuclide scan

Top left: Normal, moderate homogeneous uptake

Top right: Grave’s, diffuse increased uptake

Bottom Left: Multi-nodular goiter, heterogeneous uptake

Bottom right: Thyroid neoplasm/cyst; Cold nodule

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31
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A

Papillary Carcinoma

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32
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Papillary Carcinoma

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33
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Papillary Carcinoma

Finger-like projections

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34
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A

Papillary Carcinoma

Nuclear clearing - pale “orphan annie” nuclei

Blood vessels & cuboidal tumor cells

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35
Q
A

Papillary Carcinoma

Nuclear groove “Coffee beans”

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36
Q
A

Papillary Carcinoma

Intra-nuclear pseudo-inclusions (invagination of cytoplasms)

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37
Q
A

Papillary Carcinoma

Calcification - Somoma body

38
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A

Papillary Carcinoma

Calcification

39
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A

Follicular Adenoma

40
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A

Follicular Adenoma

Contained by fibrous capsule (top left is adenoma)

41
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A

Follicular Adenoma

42
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A

Follicular Adenoma

Confined by capsule, no vascular invasion

43
Q
A

Follicular Carcinoma

Widely invasive

44
Q
A

Follicular Carcinoma

45
Q
A

Follicular Carcinoma

Capsule invasion

46
Q
A

Follicular Carcinoma

47
Q
A

Follicular Carcinoma

Vascular invasion

48
Q
A

Left: Follicular adenoma

Middle: Follicular carcinoma

Right: Papillary carcinoma

49
Q
A

Medullary Carcinoma

50
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A

Medullary Carcinoma

51
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A

Medullary Carcinoma

Amyloid composed of pro-calcitonin

52
Q
A

Medullary Carcinoma

53
Q
A

Medullary Carcinoma

54
Q
A

Medullary Carcinoma

Apple-green birefringence

55
Q
A

Medullary Carcinoma

Dense secretory core granules

56
Q

Describe the anterior lobe of the pituitary gland

A

adenohypophysis: Origin from Rathke’s pouch. Produces GH, FSH, LH, ACTH, TSH

Somatotrophs (30%) and Lactotrophs (20%) - lateral regions

Corticotrophs (15%) and thyrotrophs (10%) - central regions

Gonadotrophs (20%) - diffusely distributed

Histology: Mixed population of epithelial cells arranged in acini

Portal blood supply from hypothalamus to anterior pit.

57
Q

Describe the posterior lobe of the pituitary gland

A

Neurohypophysis: origin-floor of 3rd ventricle

Releases vasopressin (ADH) and oxytocin - hormones produced in hypothalamus and travel in axons to posterior lobe)

58
Q

What are the functional classification of pituitary adenomas?

A

Classification of pituitary tumors based on serum hormone levels and/or immunohistochemical staining.

10% Corticotroph adenoma - secrete ACTH and POMC -> Cushing’s syndrome

20% Somatotroph adenoma - secrete GH -> Acromegaly, gigantism

1-3% Thyrotroph adenoma (rare) - secrete TSH -> thyrotoxicosis, usu. asymptomatic

10-15% Gonatotroph adenoma - secrete LH, FSH, & subunits -> usu. asymp.

25% Lactotroph adenoma (prolactinoma) most common - secrete PRL -> galactorrhea, hypogonadism, amenorrhea, infertility, loss of libido & impotence in men

20-30% Null cell adenomas - do not secrete hormones

59
Q

What is the gross and microscopic pathology of a pituitary adenoma?

A

Gross: Enlarged pituitary gland with mass effect (macroadenoma >1cm) or circumscribed nodule within pituitary gland (micro <1cm)

Microscopic: Disruption of normal pituitary architecture (sheets, expanded nests, trabeculae), monomorphous population of cells

60
Q

What are some S/sx of Acromegaly?

A
61
Q

What are some S/Sx of Cushing’s?

A
62
Q

Describe the normal thyroid gland

A

15-25 gm in adults, but variable

Right & left lobes connected by isthmus, may have pyramidal lobe

Follicles lined by follicular epithelial cells (cuboidal/low columnar)

Colloid (stored thyroid hormone, thyroglobulin) appears eosinophilic, acellular material

Parafollicular “C” cells located between follicles

63
Q

What is a goiter?

A

Enlargement of the thyroid gland

Nodular vs. diffuse

Hyper vs. hypofunctioning

64
Q

What is Hashimoto’s thyroiditis?

A

Chronic lymphocytic thyroiditis

Predominantly affects women, usually middle aged-elderly

Anti-TSH receptor Ab (inhibitory), anti-thyroglobulin, anti-thyroid peroxidase Ab

Initially may be thyrotoxic, then become hypothyroid

Increased risk for malignancy, lymphoma, and possibly carcinoma

65
Q

What is the grosss and microscopic pathology of Hashimoto’s thyroiditis?

A

Gross: diffuse firm enlargement of thyroid, well demarcated from adjacent tissue

Microscopic: lymphocytic infiltrate with germinal centers

Oncocytic (Hurthle cell) metaplasia of follicular epithelium

Destruction of follicles, leading to fibrosis in late stages

66
Q

S/Sx of Hashimoto’s Thyroiditis

A
67
Q

Pathogenesis of Hashimoto’s Thyroiditis

A
68
Q

Diffuse Hyperplasia

Who, Pathogenesis, Gross/Histo

A

Grave’s Disease Classic triad: hyperthyroidism, ophthalmopathy (exophthalmos), pretibial myxedema

Who: Young women (20-40 y.o)

Pathogenesis: TSI, anti-TSH Ab, Thyroid growth-stimulating immunoglobulins

Gross: symmetric enlargement of thyroid gland

Histo: Follicular hyperplasia with papillary infoldings, tall/columnar cells, scallping of margins of colloid within follicles

69
Q

Nodular hyperplasia

A

Multinodular goiter

Idiopathic, usually clinicaly euthyroid

Mutliple nodules, often with one dominant nodule

Variable appearances: large/cellular/hyperplastic nodules, hemorrhage, cystic degeneration

70
Q

S/Sx of thyroid hyperplasia

A
71
Q

Graves’ vs. Hashimoto’s Pathogenesis

A
72
Q

Papillary thyroid carcinoma

How common is it?

Who is affect?

How does it present? (Gross/Histo)

Prognosis?

A

Most common type of thyroid carcinoma (75-85% of thyroid carcinoma)

Women more commonly affects, presents with cold thyroid nodule

Gross: solid/cystic, firm, fibrous, often infiltrative appearance

Histo: Papillae lined by cuboidal to columnar cells

Nuclear features characteristic (intranuclear pseudoinclusions; nuclear clearing/grooves)

Psammoma bodies (laminated calcifications)

Prognosis: 95% 10 year survival, commonly metastasize to regional lymph nodes

73
Q

Describe Gross/Histo of Follicular adenoma

A

Euthyroid

Gross: Usually solitary, encapsulated nodule

Histo: Macro/micro follicular, appearance of cells differs from surroudning normal thyroid gland

Neither capsular invasion nor vascular invasion present

74
Q

Follicular carcinoma

Who does this affect?

Gross/Histo

Metastasizes to ___

Prognosis

A

15-20% of thyroid carcinomas

Women predominantly affected, older age group

Gross: Widely invasive or encapsulated nodule

Histo: Widely invasive-extensive infiltration of normal thyroid or vascular invasion

“Minimally invasive”-capsuclar or vascular invasion present

Hematogenous metastasis to lungs/bones

Prognosis: Widely invasive (50% 10yr survival); minimally invasive (90% 10yr survival)

75
Q

Medullary carcinoma

How common is it

Associations

Produces ____

Due to ____

Histo

Metastasis

A

5-10% of thyroid carcinomas, some associated with MEN2A/2B

Derived from parafollicular cells (neuroendocrine tumor)

Produce calcitonin (hypocalcemia uncommon)

Due to activating mutations of RET proto-oncogene (familial and some sporadic tumors)

Histo: Marked variation in appearances

Commonly has neuroendocrine appearance with nests & trabeculae of uniform cells

Amyloid within stoma common (calcitonin deposition)

Tumor cells stain from chromogranin and synaptophysin (neuroendocrine markers)

Spreads via lymphatics/blood to lymph nodes, lungs, liver, bones

76
Q

Pathogenesis of various carcinomas

A
77
Q

What drug can be given for a prolactinoma?

A

Bromocriptine:

Dopamine agonist that inhibits PRL secretion and shrinks lactotrophs

78
Q

What is the stalk effect?

(in terms of excess prolactin)

A

Mildly elevated PRL is a common phenomenon, related to “stalk effect” rather than direct secretion by a pituitary adenoma. Any mass in the site can interfere mechanically with hypothalamic-hypophyseal connections and disrupt the steady-state inhibitory effect of the hypothalamus on PRL secretion by the AP gland. Does not justify a diagnosis of PRL-secreting pituitary adenoma.

79
Q

What explains visual defecits in AP adenomas?

A

Compression of the optic chiasm causes bitemporal loss of peripheral vision.

80
Q

What HLA types are strongly associated with Graves disease?

A

HLA-B8

HLA-DR3

81
Q

What is the most important screening test to determine functional status of the thyroid gland?

A

TSH assay: elevated in hypo, close to zero in hyperthroidism.

82
Q

What form of hyperthyroidism shows exopthalmos?

A

Graves Disease. Only.

Treatment of graves focuses on reducing T4 secretion. This does not affect exophthalmos because it is an autoimmune problem (with TSI).

83
Q

What causes enlargement of the thyroid gland in Hashimoto’s thyroiditis?

A

Infiltration by lymphoid cells.

84
Q

What HLA types are associated with Hashimoto’s?

A

HLA-DR5

HLA-DR3

85
Q

Patient has Hashimoto’s.

Patient takes oral contraceptives.

Patient has slightly elevated total T4 (with decreased free T4).

Why?

A

OCPs can increase the quantitiy of binding proteins and drive up the total T4 without changing the free fraction.

86
Q

What mutagenic agent increase the incidence of papillary thyroid carcinoma?

A

Radiation

87
Q

What genetic alteration can be found in papillary thyroid carcinoma?

A

Rearragement of the tyrosine kinase portion of RET proto-oncogene (chromosome 10) to put the tyr kin portion under the promotor of a gene that is constitutively expressed by follicular cells. Normally, tyr kin receptor is not normally expressed by thyrocytes.

[Causes high-level expression of tyrosine kinsase portion of the receptor as an unregulated growth signal)

88
Q

What cells give rise to medullary carcinoma of the thryoid?

A

C cells

89
Q

Do medullary carcinomas arise in the thyroid isthmus or thyroglossal duct remnants?

A

No. C cells migrate from neural crest to lateral thyroid lobes.

90
Q

What hormone does medullary thyroid carcinoma most commonly secrete?

A

Calcitonin

(ACTH also possible)

91
Q

Function of calcitonin?

A

Help lower serum calcium

92
Q

What is the origin of amyloid in medullary thyroid carcinoma?

A

Excess procalcitonin deposition

MD4 Pathology (6 decks)

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