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ENDO > H-P histology and pathology 173 > Flashcards

H-P histology and pathology 173 Flashcards

1
Q

What are the major histologically classified cell types of the anterior pituitary?

A

acidophils: GH and PRL secreting cells
basophils: ACTH, TSH, and FSH/LH secreting cells

poorly staining cells (chromophobe)

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2
Q

What are the cellular components of the posterior pituitary?

A

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

pituicytes (glial cells) that support the axons

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3
Q

What is the pars intermedia?

A

a vestigial structure that lies between the adenohypophysis (anterior pituitary) and neurophyophysis (posterior pituitary)

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4
Q

What is the blood supply of the anterior pituitary? What does it transport?

A

portal vascular system

conduit for transport of hypothalamic releasing hormones from the hypothalamus to the pituitary

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5
Q

What is the blood supply of the posterior pituitary? What does it transport?

A

directly by an artery

artery takes the hormones directly into the systemic circulation

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6
Q

What is the embryological origin of the anterior pituitary?

A

derived from Rathke pouch, an extension of the developing oral cavity

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7
Q

What is the embryological origin of the posterior pituitary?

A

downwward (ventral) outgrowth of the embryonic diencephalon

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8
Q

What is the difference between functional and non-functional pituitary adenomas?

A

functional = produces hormones in excess with related clinical symptoms

non-functional = produces hormones microscopically, but not clinically significant

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9
Q

How might macroadenomas lead to hypopituitarism?

A

large pituitary tumors may have a destructive mass effect on other areas of the pituitary

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10
Q

What tumor syndrome is associated with pituitary adenomas?

A

multiple endocrine neoplasia type I

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11
Q

What are the general histologic findings of pituitary adenomas?

A

can be well-circumscribed or invasive

uniform cells, paucity of reticulin network, low mitotic activity

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12
Q

What is the most frequent type of pituitary adenoma?

A

prolactinomas

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13
Q

What are the symptoms of prolactinomas?

A

females: amenorrhea/galactorrhea
males: loss of libido

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14
Q

What is the “stalk effect” and why might it be confused with prolactinomas?

A

prolactin secretion is tonically inhibited by dopamine

if the pituitary stalk is compressed, less dopamine is delivered to the pituitary which leads to increased prolactin secretion (similar to what’s found in a prolactinoma)

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15
Q

Which type of pituitary adenoma is usually diagnosed earlier in women of reproductive age (rather than older women and men)?

A

prolactinoma

symptoms are more overt in pre-menopausal women

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16
Q

What size (macro or microadenoma) are growth hormone cell adenomas?

A

usually macroadenomas

takes a long time before you see clinical manifestations, so they have lots of time to grow

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17
Q

What type of pituitary adenoma stimulates hepatic secretion of insulin-like growth factor 1?

A

growth hormone cell adenomas

this is the cause of the clinical manifestations of gigantism in children and acromegaly in adults

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18
Q

Which types of pituitary adenomas will be pinker on histology? Purpler?

A

pink: prolactinomas, growth hormone cell adenomas (acidophilic)
purple: ACTH, gonadotroph, thyrotroph

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19
Q

What size are ACTH cell adenomas at the time of diagnosis (micro or macroadenomas)?

A

microadenomas

due to the prominent symptoms of hypercortisolism

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20
Q

Which type of pituitary adenoma stains positive with PAS stain?

A

ACTH cell adneoma

21
Q

What is cushing syndrome vs. cushing disease vs. nelson syndrome?

A

cushing syndrome: hypercortisolism of any cause

cushing disease: hypercortisolism due to excess ACTH production

Nelson syndrome: enlargement of corticotroph microadenoma after removal of adrenal glands

22
Q

What size are gonadotroph adenomas when they are diagnosed?

A

macroadenomas

they don’t often have clinical symptoms beyond mass effect

23
Q

What is pituitary apoplexy? Does it lead to hypo or hyperpituitarism?

A

sudden hemorrhage to the pituitary gland –> hypopituitarism

24
Q

What is Sheehan syndrome?

A

postpartum necrosis of the anterior pituitary due to relative anoxia of pituitary secondary to postpartum bleeding

25
Q

What is empty sella syndrome? Does it cause hypo or hyperpituitarism?

A

enlarged and empty sella turcica (primary or secondary cause) that allows arachnoid mater and CSF to herniate in and compress the pituitary

26
Q

What is diabetes insipidus? Major symptom, categories, etc.

A

symptom: excessive urination (polyuria)
categories: central (deficient ADH) or nephrogenic (kidney unresponsive to ADH)

27
Q

What is symptom of inappropriate ADH secretion?

A

a disorder of ADH excess that leads to hyponatremia

caused by extra-CNS disorders (ex. neoplasia, drugs) or CNS disorders (ex. infection, trauma, neoplasm)

28
Q

What are the most common suprasellar tumors?

A

gliomas and craniopharyngiomas

29
Q

What are craniopharyngiomas derived from?

A

Rathke pouch

30
Q

What are the clinical manifestations of craniopharyngiomas?

A

headaches, visual disturbances, growth retardation (GH deficiency)

31
Q

What is the morphology of adamantinomatous craniopharyngioma?

A

stratified squamous epithelium, periphery palisading, compact and lamellar keratin formation (“wet keratin”), and dystrophic calcification

can have “machine oil” cysts

32
Q

What is the morphology of papillary craniopharyngiomas?

A

papillae lined by well-differentiated squamous epithelium

no keratin, peripheral palisading, calcifications, or cysts

33
Q

The anterior pituitary contains the following cell type EXCEPT:

a) acidophils
b) basophils
c) chromophobes
d) pituicytes

A

d) pituicytes

these are glial cells of the posterior pituitary

34
Q

What is the most common microadenoma of pituitary?

a) prolactin-producing adenomas
b) growth hormone-producing adenomas
c) ACTH-producing adenomas
d) gonadotropin-producing adenomas
e) thyrotroph-producing adenomas

A

c) ACTH-producing adenomas

prolactinomas are the most common overall, but ACTH are most likely to present as microadenomas because of the prominent symptoms of hypercortisolism

35
Q

What is the most common cause of SIADH?

a) non-CNS neoplasia
b) trauma
c) CNS neoplasms
d) CNS infections
e) drugs

A

a) non-CNS neoplasia

non-CNS causes of SIADH are the most common, and neoplasms including small cell carcinoma of the lung is the most common subtype

36
Q

What is this?

A

normal histology of anterior pituitary

lower image has a reticulin stain

37
Q

What is this? What features are highlighted with 1 and 2?

A

normal histology of posterior pituitary

1 = herring bodies (axons of hypothalamus)

2 = pituicytes (specialized glial support cells)

38
Q

What is this?

A

pituitary infarct

intact pituitary on the left, central necrosis on the right

39
Q

What types of pituitary adenomas could this be?

A

GH or prolactin

densly tranulated acidophilic tumor

40
Q

What is this?

A

Rathke cell cyst

41
Q

What is this?

A

non-caseating granuloma associated with CNS sarcoidosis

42
Q

What type of tumor is this?

A

adamantinomatous craniopharyngioma

43
Q

What type of tumor is this?

A

papillarycraniopharyngioma

44
Q
A

c) this is an astrocytoma

  • the pink cells are herring bodies*
  • the purple cells are pituicytes*
45
Q
A

c) portal venous circulation from hypothalamus was compromised

the clinical picture is of Sheehan syndrome

46
Q
A

a) it secretes ACTH
* ACTH secreting tumors always cause microadenomas and would not get this big*

47
Q
A

b) null cell type is the most common pituitary adenoma

prolactinomas are

48
Q
A

b) it is a neoplasm

Rathke cysts are non-neoplastic

49
Q
A

d) granulomatous inflammation

CNS manifestation of sarcoidosis

ENDO (19 decks)

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