Endocrine Histopathology

Question 1

What are:
Hyperplasia?
Hypertrophy?
Atrophy?
Metaplasia?

Answer 1

Hyperplasia - increase in cell #
Hypertrophy - increase in cell size
Atrophy - decrease in size and number
Metaplasia - different cell type

Question 2

What are the relative shapes of the adrenal glands?

Answer 2

The L is more crescent shaped

Question 3

Blood supply to adrenals and venous drainage?

Answer 3

Blood from renal arteries, aorta and inferior phrenic arteries
Veins form a single adrenal vein from the medulla

Question 4

Where do the L/R adrenal veins drain to?

Answer 4

L: L renal vein
R: IVC

Question 5

What do each of the 3 adrenal cortex layers secrete?

Answer 5

Glomerulosa: aldosterone
Fasciculata: cortisol
Reticularis: sex steroids

Question 6

Histology of zona glomerulosa

Answer 6

- Clusters of cells
Eosinophilic to amphophilic cytoplasm
- Cytoplasm can be vacuolated
- Round nuclei
- High N/C ratio

Question 7

Histology of zona fasiculata

Answer 7

• 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

Question 8

Histology of zona reticularis

Answer 8

• Sponge-like network of anastomosing one-cell wide rows (trabeculae)
• Separated by dilated capillaries
• Granular, eosinophilic cytoplasm

Question 9

Histology of the medulla

Answer 9

• Phaeochromocytes and chromaffin cells
• Basophilic, granular, occasionally vacuolated sytoplasm
• Large cells with mild nuclear pleomorphism
• Stippled chromatin

Question 10

Most common neoplasias in the cortex (benign/malignant) and the medulla?

Answer 10

Cortex - benign (adenoma) and malignant (carcinoma)

Medulla - phaeochromocytoma, neuroblastoma in childhood

Question 11

What is adrenal cortical hyperplasia?

Answer 11

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)

Question 12

What is an adrenal cortical adenoma?

Answer 12

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

Question 13

What is an adrenal cortical carcinoma?

Answer 13

Rare, often genetically linked tumour with haemorrhage and necrosis.
Functional in 50-60%, usually cushingoid
Graded on necrosis and pleomorphism

Question 14

What are features of malignancy and which ones are useful to distinguish a carcinoma?

Answer 14

Pleomorphism, hyperchromasia, mitotic activity (either)
Invasion and metastases (carcinoma)
Unpredictable nuclei suggest carcinoma but are non-confirmatory

Question 15

What is a phaeochromocytoma?

Answer 15

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

Question 16

What is Waterhouse-Friderischsen syndrome?

Answer 16

Rapid-onset adrenal insufficiency due to haemorrhagic necrosis, usually bilateral
Caused by bacterial infections, shock, DIC or haemorrhage

Question 17

What are the parathyroid glands?

Answer 17

Usually 4 but up to 12, detect serum Ca levels and produce serum PTH to control.

Question 18

What happens to the parathyroid gland as we age?

Answer 18

Gets proportionally more fat cells

Question 19

What type of cells are in the parathyroid glands?

Answer 19

Chief: round nuclei, granular chromatin and eosinophilic to clear cytoplasm (secrete PTH)
Oxyphil: abundant, brightly eosinophilic and granular cytoplasm. (unknown)

Question 20

What are the causes of hyperfunctioning parathyroid with %s?

Answer 20

Hyperplasia 10-15%
Benign neoplasia (adenoma) 75-80%
Malignant neoplasia (carcinoma) <5%

Question 21

What is parathyroid hyperplasia?

Answer 21

> 95% of cases are sporadic

Secondary hyperparathyroidism due to depressed serum Ca so increased PTH in response

Question 22

What is a parathyroid adenoma?

Answer 22

Usually in a single gland, benign tumour with a compressed rim of normal parathyroid tissue.
Can lead to hyperparathyroidism

Question 23

Parathyroid carcinoma?

Answer 23

Rare, causes clinically profound hyperparathyroidism.