Histopathology Endocrine Pathology Flashcards
1
Q
thyroid Cellular structure
A
Colloid – filled acini lined by follicular epithelial cells.
2
Q
Thyroid Secretes
A
- Hormone thyroxine which is secreted into the blood. The organ is highly vascular for this reason
3
Q
Thyroid Function
A
- Regulates basal metabolic rate
4
Q
Hypothyroidism: Commonest Cause is
A
Hasimoto’s thyroiditis – chronic lymphocytic thyroiditis
5
Q
Hypothyroidism: Hasimoto’s thyroiditis is
A
An autoimmune: anti-thryoid antibodies: lymphocytic destruction of thyroid – leads to a fibrotic scarred atrophic gland.
6
Q
Hypothyroidism:Epi
A
F:M = 10:1
7
Q
Hypothyroidism: Less often caused by
A
Removal of thyroid
Radioiodine treatment
8
Q
Hypothyroidism: Symptoms
A
Myxoedema slowing of the mind and body • Weight gain, constipation • Cold intolerance • Tiredness, depression • Big tongue, deep voice (deposition of matrix substances in viscera and skin) • Thin Hair • Weak Heartbeat + low BP • Slow reflexes
9
Q
Hypothyroidism: Histologically
A
Lymphocytes destroying follicular cells
Reduced colloid in accini
Active inflammation infiltrate
10
Q
Hyperthyroidism Common causes
A
85% of cases is Grave’s disease Hyperfunctional multinodular goitre (MNG is usually euthyroid) Hyperfunctional adenoma (benign follicular tumour) - rarely
11
Q
Hyperthyroidism Description
A
Increased basal metabolic rate
12
Q
Hyperthyroidism Symptoms
A
- Sweating, heat intolerance
- Weight loss despite incd appetite, diarrhoea
- Tachycardia, arrhythmias (often AF)
- Tremor, anxiety, hyperactivity, brisk reflexes
- Staring gaze, lid lag, exophthalmos
13
Q
Graves’ disease (diffuse toxic goitre) Epi
A
F:M = 10:1
14
Q
Graves’ disease (diffuse toxic goitre) Description
A
Autoimmune
15
Q
Graves’ disease (diffuse toxic goitre) Caused by
A
Thyroid-stimulating autoantibodies (overdrive increased thyroxine production)
16
Q
Graves’ disease (diffuse toxic goitre) Presentation
A
Symmetrical enlargement of thyroid – often a bruit can be heard as there is a vast increased in blood flow
17
Q
Graves’ disease (diffuse toxic goitre) Exopthalamos due to
A
Deposition of connective tissue behind the eyeball = pushed forward
18
Q
Multinodular goitre: Description
A
Usually euthyroid
Large goitre may cause tracheal compression or dysphagia/stridor
Cosmetic effects
19
Q
Multinodular goitre:
Causes
A
Due to iodine deficiency and other reasons.
Endemic in some developing countries w/ chronic iodine deficiency.
20
Q
Adenoma (follicular): Description
A
Benign tumour Usually euthyroid (not overactive) Rarely hyperfunctional (toxic nodule)
21
Q
Adenoma (follicular): Treatment
A
Thyroid lobectomy (can survive with on elobe4)
22
Q
Carcinoma of the thyroid: Types and incidence
A
- Papillary – 80%
- Follicular – 15%
- Anaplastic – 2%
- Medullary – 3%
23
Q
Carcinoma of the thyroid: Epi
A
Female predominance of most types
20-30 yrs old
24
Q
Papillary carcinoma
A
Spread via lympatics
Indolent, often cystic, may be multifocal.
Good prognosis
25
Papillary carcinoma description
Papillae covered by epithelial cells with pale, empty nuclei; psammona bodies
Vesicular appearance.. Cystic (fluid filled)
Well defined lesion
26
Papillary carcinoma Classical presentation
35 yr old woman presents with enlarged cervical lymph nodes: metastatic carcinoma]ultrasound showed a thyroid tumour
Resected thyroid gland: papillary carcinoma.
27
Papillary carcinoma Risk association
Radiation is associated with papillary carcinoma - chernobyl
28
Papillary carcinoma Follicular carcinoma description
Widely invasive. Spreads via bloodstream with metastases to lungs/liver/bones/brain
29
Papillary carcinoma Follicular carcinoma epi
30-50 yrs
| Poorer prognosis due to spread via blood stream
30
Papillary carcinoma Clinical presentation example
45 yr old
Pathological fractures
Metastatic
31
Anaplastic carcinoma
Elderly patients
Aggressive – local invasion, metastases
No response to treatment
Fatal in a few months
32
Adenoma carcinoma histology
Spindly shaped tumour cells
| Osteoclast like multinucleated → not cancer just reacting to process
33
Medullary Carcinoma arises from
C cells of thyroid,, which secrete calcitonin (calcium metabolism)
34
Medullary Carcinoma tumour type
Neuroendocrine tumour
35
Medullary Carcinoma histo
* Amyloid carcinoma – combination of epithelial proliferation and stromal changes in medulla.
* Calcitonin present in tumour (brown stain = positive cells)
36
Medullary Carcinoma Epi/associated with
Sporadic: 70%
| MEN 2A,2B or FMTC: 30%
37
Medullary Carcinoma Diagnostic test
Ret oncogene = overativity of the MEN 2A, 2B
38
Medullary Carcinoma Immuno stain
Confers Calcium secretion confirming medullary carcinoma
39
Normal parathyroid glands
3-4 mm
| 40-60 mg
40
parathyroid Secrete
Parathyroidhormone (PTH) is secreted in response to low serum calcium levels = increased calcium release from resorption
41
Primary hyperparathyroidism causes
Hyper-calcaemia
42
Primary Hyperparathyroidism causes
Adenoma (85-95%) – benign
Hyperplasia (5-25%)
Carcinoma (<1%) 0 rare
43
parathyroidism Epi
Most cases are sporadic
| Hyperplasia or adenoma seen in MEN 1 and 2A (part of these syndromes)
44
Hyper Parathyroidism Symptoms are due to
Hypercalcaemia and increased PTH
45
Hyperparathryoidism Symptoms are
Painful bones – osteoporosis, osteitis, fibrosa cystic
Renal stones – increased calcium
Abdominal groans – various
Pyschic moans – depression, lethargy, seizures
46
Secondary hyperparathyroidism common cause
Chronic renal failure. Hypocalcaemia causes comoensatory overactivity (hyperplasia of all 4 glands)
47
Less common causes of secondary hyperparathyroidism
```
Vit D or calcium deficiency
Malabsorption
Low serum magnesium
Tissue resistance to Vit D
Pseudohypoparathyroidism (genetic resistance to PTH)
```
48
Imaging for diagnosis of hyperparathyroidism
```
Localisation:
1. Sestambi scan: uses radioactive technetium – 99 to look at parathyroids
⇒ Highlightd hyperadctive P/T glands
⇒ 1 = tumour (adenoma more likely)
⇒ 4 or more = hyperplasia
2. Ultrasound
```
49
Hyperplasia, Primary and secondary – four big ones (usually variably sized):
Enlargement to different degrees
• Primary: Take all four as stimulus to hyperplasia still there.
• Secondary: Unsure of cause therefore take 3 ½ to aim to leave some behind – maintains calcium
50
Parathyroid Carcinoma: Incidence
Rare
51
Parathyroid Carcinoma: Features
```
Very high Calcium >3.5 mmol/l
Bone disease
Renal Stones
Metastasis (via bloodstream)
Adherent at surgery - fibrosis difficult to dissect off
```
52
Cortex
Produces 3 types of steroids
• Glucocorticoids, mainly cortisol
• Mineralocorticoids, mainly cortisol
• Sex steroids: oestrogens and androgens
53
Medulla
Produces catecholamines, mainly adrenaline
54
Primary Adrenocortical insufficiency (Addison’s disease):
| Causes
```
Autoimmune destruction
Tuberculosis
Removal
Metastatic Cancer – need both glands involved to have any underactivity
AIDS (CMV, Mycobacterium, Kaposi’s)
Congenital hypoplasia
```
55
Secondary Adrenocortical insufficiency causes
Disorders of hypothalamus or pituitary – reduced output of ACTH
56
Treatment of secondary adrenocortical insufficiency
Steroids, long term
57
Addison’s disease symptoms
Symptoms due to low levels of glucocorticoids and mineralocorticoids:
• Weakness, tiredness
• GI disturbance: nausea, vomiting, wt loss, diarrhoea
• Hyperpigmentation of skin
• Potassium retention and sodium loss; hypotension
• Adrenal cortex atrophy
58
Hyperpigmentation of the skin due to
Pro-opiomelanocortin from pituitary – a precursor of ACTH and melanocyte stimulating hormone – hyperactivity.
59
Acute renal crisis with addison’s disease
• Precipitated by infection, trauma, and surgical procedures.
• Causes vomiting, abdo pain, hypotension, coma
Rapidly fatal unless treated promptly with corticosteroids
60
Cushing’s Syndrome – Definition
Most commonly iatrogenic due to glucocorticoid administration
61
Cushing’s Syndrome – overactive adrenal cortex Causes
Iatrogenic –due to glucocorticoid administration.
| Endogenous
62
Cushing’s Syndrome – overactive adrenal cortex Endogenous
ACTH dependent
| ACTH independent
63
Cushing’s Syndrome – overactive adrenal cortex ACTH dependent
```
Pituitary adenoma (Cushing’s disease) (70%)
Ectopic ACTH production e.g. small cell Carcinoma (10%)
```
64
Cushing’s Syndrome – overactive adrenal cortex ACTH independent
```
Adrenal adenoma (10%)
Adrenal carcinoma (5%)
Nodular hyperplasia (<3%)
```
65
Cushings Syndrome
Excessive cortisol
| Adrenal cortical hyperplasia, nodular (involves both glands)
66
Hyperaldosteronism
Excessive aldosterone
67
Adrenogenital or virilising synromes
Excess androgens
68
Conn’s syndrome
Adrenal cortical adenoma: often non-functional or function = Cushing’s Syndrome or hyperaldosteronism
69
Adrenal Cortical Carcinoma –
* Most are functional and usually cause virilism.
* Often large and invasive.
* Venous and lymphatic spread.
70
Pheochromocytoma
Tumour arising in adrenal medullar
71
medullar Produces
Catecholamines, mainly adrenaline
72
Pheochromocytoma Treatment
Surgically correctable hypertension
73
Pheochromocytoma Main feature
Hypertension is often paroxysmal (not continuous therefor in spurts)
74
Pheochromocytoma Diagnosis
Raised level of catecholamines excreted in urine (24 hr screen)
75
Pheochromocytoma Macroscopic changes
Haemorrhagic and necrotic areas
76
Pheochromocytoma Rule of 10’s
* 10% Extra-adrenal (paragangliomas)
* 10% Bilateral
* 10% Malignant (no histological features predict behaviour)
* 10% NOT associated with hypertension
77
Multiple Endocrine Neoplasia (MEN) Syndrome → Inheritance
Genetically inherited diseases
78
Multiple Endocrine Neoplasia (MEN) Syndrome → Features
Proliferative lesions (hyperplasia, adenoma or carcinoma)
79
Multiple Endocrine Neoplasia (MEN) Syndrome → Involves
Multiple endocrine organs
80
Multiple Endocrine Neoplasia (MEN) Syndrome → Types
1, 2A, 2B, FMTC
81
Multiple Endocrine Neoplasia (MEN) Syndrome
MEN 1 (Wermer)
MEN 2 A (Sipple)
MEN 2B
82
MEN 1 (Wermer)
features
Genetic Abnormality
Parathyroid adenoma or hyperplasia/adenoma or hyperplasia o other endocrine glands/carcinoid tumours.
Chromosome 11q, tumour suppressor gene
83
MEN 2 A (Sipple)
Features
Genetic abnormality
Medullary Carcinoma of the thyroid// phaeochromocytoma/parathyroid adenoma or hyperplasia
Chromosome 10q, ret oncogene
84
MEN 2B
Features
Genetic Abnormality
Medullary carcinoma of the thyroid/phaeochronocytoma
| Chromosome 10q, ret oncogene
85
Hypothyroidism: causes
Hasimoto’s thyroiditis
Thyroidectomy
Radioiodine treatment
86
Hypothyroidism Symptoms
```
Slowing of the mind and body
Weak Heartbeat
Constipation
Myxoedema
High LDL
Slow reflexes
Hair thinning
Depression “schizophrenia” irritability
Big Tongue
Croaky voice
Dry Skin
Cold Skin
Cold intolerance
```
87
Hyperthyroidism: causes
Graves
Nodular goitre
Follicular Adenoma
88
Hyperthyroidism: Symptoms
```
‘Lid Lag”
Hot Adenoma
Graves
Factitous
Rapid “I” replacement
Ectopic tSH
Sweating “Neurotic anxiety”
Fine Tremor (Paper test)
Brisk Reflexes
Low LDL
Diarrhoea
Wt loss despite increased appetite
Osteoporosis
Atrial fibrillation
```
89
Hyperplastic epithelium causes
Graves
Iodine deficiency
Goitrogen/ PUT effect
90
Colloid-filled follicles
Idiopathic nodular goitre
91
Anaplastic cells
Cancer
92
Lymphocytes
Hashimoto’s
93
Foreign-body granulomas
DeQuervain’s
94
Fibrous tissue
Riedel’s
