Endocrine Histopathology Flashcards
What are: Hyperplasia? Hypertrophy? Atrophy? Metaplasia?
Hyperplasia - increase in cell #
Hypertrophy - increase in cell size
Atrophy - decrease in size and number
Metaplasia - different cell type
What are the relative shapes of the adrenal glands?
The L is more crescent shaped
Blood supply to adrenals and venous drainage?
Blood from renal arteries, aorta and inferior phrenic arteries
Veins form a single adrenal vein from the medulla
Where do the L/R adrenal veins drain to?
L: L renal vein
R: IVC
What do each of the 3 adrenal cortex layers secrete?
Glomerulosa: aldosterone
Fasciculata: cortisol
Reticularis: sex steroids
Histology of zona glomerulosa
- Clusters of cells Eosinophilic to amphophilic cytoplasm - Cytoplasm can be vacuolated - Round nuclei - High N/C ratio
Histology of zona fasiculata
- Broad bands of large cells arranged in 2-cell-wide cords
- Parallel capillary network
- Lipid-filled cytoplasm: spongy, vacuolated and clear
- Vesicular nuclei with a single small nucleolus
- Low N/C ratio
Histology of zona reticularis
- Sponge-like network of anastomosing one-cell wide rows (trabeculae)
- Separated by dilated capillaries
- Granular, eosinophilic cytoplasm
Histology of the medulla
- Phaeochromocytes and chromaffin cells
- Basophilic, granular, occasionally vacuolated sytoplasm
- Large cells with mild nuclear pleomorphism
- Stippled chromatin
Most common neoplasias in the cortex (benign/malignant) and the medulla?
Cortex - benign (adenoma) and malignant (carcinoma)
Medulla - phaeochromocytoma, neuroblastoma in childhood
What is adrenal cortical hyperplasia?
Non-neoplastic, bilateral enlargement of adrenal glands.
Conn syndrome has hyperplasia with hyperaldosteronism 30% of the time (rest is adenoma)
Define as ACTH-independent (primary) or dependent (secondary)
What is an adrenal cortical adenoma?
Can be functional or non-functional Typically unilateral, solitary and rarely >5cm Heterogenous appearance Most non-functional Round and well-defined Nil necrosis or haemorrhage
What is an adrenal cortical carcinoma?
Rare, often genetically linked tumour with haemorrhage and necrosis.
Functional in 50-60%, usually cushingoid
Graded on necrosis and pleomorphism
What are features of malignancy and which ones are useful to distinguish a carcinoma?
Pleomorphism, hyperchromasia, mitotic activity (either)
Invasion and metastases (carcinoma)
Unpredictable nuclei suggest carcinoma but are non-confirmatory
What is a phaeochromocytoma?
Tumour of the adrenal medulla with areas of haemorrhage
10% bilateral, 10% in children, 10% malignant, 10% familial.
Histology: cells are large and arranged in nests with capillaries in between
What is Waterhouse-Friderischsen syndrome?
Rapid-onset adrenal insufficiency due to haemorrhagic necrosis, usually bilateral
Caused by bacterial infections, shock, DIC or haemorrhage
What are the parathyroid glands?
Usually 4 but up to 12, detect serum Ca levels and produce serum PTH to control.
What happens to the parathyroid gland as we age?
Gets proportionally more fat cells
What type of cells are in the parathyroid glands?
Chief: round nuclei, granular chromatin and eosinophilic to clear cytoplasm (secrete PTH)
Oxyphil: abundant, brightly eosinophilic and granular cytoplasm. (unknown)
What are the causes of hyperfunctioning parathyroid with %s?
Hyperplasia 10-15% Benign neoplasia (adenoma) 75-80% Malignant neoplasia (carcinoma) <5%
What is parathyroid hyperplasia?
> 95% of cases are sporadic
Secondary hyperparathyroidism due to depressed serum Ca so increased PTH in response
What is a parathyroid adenoma?
Usually in a single gland, benign tumour with a compressed rim of normal parathyroid tissue.
Can lead to hyperparathyroidism
Parathyroid carcinoma?
Rare, causes clinically profound hyperparathyroidism.
