pathology endocrine practical

Pituitary adenoma

massive non functioning

Distorted the overlying brain

(Non functioning adenomas are larger at time of diagnosis than those that secret a hormone )

Pituitary adenoma

absence of the reticulin network

Pituitary adenoma

absence of the reticulin network

Pituitary adenoma

absence of the reticulin network

1- normal

2- hyperplasia

3- adenoma

Primary = nodular hyperplasia

Secondary = diffuse , hyperplasia

Adrenal Adenoma

-small

-solitary

-spherical

-encapsulated, bright yellow

Normal cortex

A- zona reticularis

B- zona fasciculata

C- zona glomerulosa

Adrenal adenoma

Resemble cells of zona fasciculata

Adrenal cortical carcinoma

• Hyperchromatic nuclei

• Necrosis

• Mitotic figures

• Eosinophilic cytoplasm

Adrenal cortical carcinoma

• Hyperchromatic nuclei

• Necrosis

• Mitotic figures

• Eosinophilic cytoplasm

Pheochromocytoma

• attenuated cortex and areas of hemorrhage

• Comma-shaped residual adrenal gland is seen at the bottom

Pheochromocytoma

• zellballen pattern separated by abundant fibrovascular stroma

• Tumor cells are large , polyhedral and pleomorphic with abundant granular amphophilic or basophilic cytoplasm and vesicular nuclei

Pheochromocytoma

A- well demarcated border

B- round oval nuclei with prominent nucleoli

C- vacuoles

D- abundant fine granular red purple cytoplasm

E- nests

F- sustentacular cells

Pheochromocytoma

A- chromogranin in chromaffin cells

B- positive S100 in sustentacular cells

Neuroblastoma (pediatric tumor)

1. Small round and oval with scanty cytoplasm

2. Sheets separated by fibrovascular stroma

3. Homer-wrights rosettes

Neuroblastoma (pediatric tumor)

A. Homer wright rosettes

Hashimoto’s Thyroiditis

• symmetric , firm and rubbery enlargement of the thyroid

Hashimoto’s Thyroiditis

• symmetric , firm and rubbery enlargement of the thyroid

Hashimoto’s Thyroiditis

A. Follicles are atrophied and show no colloid

B. Follicles lined by hurtle cells and also in sheets

C. Lymphoid follicles with germinal center formation

Hashimoto’s Thyroiditis

A. Follicles are atrophied and show no colloid

B. Follicles lined by hurtle cells and also in sheets

C. Lymphoid follicles with germinal center formation

Hashimoto’s Thyroiditis

A. Hurthle cells

Subacute (De Quervain) granulomatous thyroiditis

Granulomatous inflammations with giant cells

Follicular Adenoma

1. solitary nodule

2. Complete encapsulation

3. Clear distinct architecture inside and outside the capsule

4. Compressed thyroid parenchyma outside the capsule

Follicular Adenoma

A. Fibrous capsule

B. Areas of haemorrhage

C. Normal thyroid parenchyma

D. Well circumscribed , encapsulated nodule compressing thyroid parenchyma

Follicular Adenoma

1. Encapsulated

2. Tumor cells are benign follicular epithelial cells

3. Microfollicular (foetal) pattern , no colloid

Nodular Goitre

1. nodularity with poor encapsulation

2. Fibrous scarring

3. Haemorrhages

4. Focal calcification

5. Cystic degeneration

Nodular Goitre

1. nodularity with poor encapsulation

2. Fibrous scarring

3. Haemorrhages

4. Focal calcification

5. Cystic degeneration

Nodular Goitre

1. Incomplete or partial encapsulation

2. Fibrous scarring

3. Areas of Haemorrhage

4. calcification

5. Cystic degeneration

Nodular Goitre

A. Cystic change

B. Fibrosis

C. Small follicles

D. Large follicles

Papillary Carcinoma

1. Poorly delineated

2. Cute surface is grayish white

Papillary Carcinoma

1. Poorly delineated

2. Cute surface is grayish white

Papillary Carcinoma

1. Papillary pattern

2. tumor cells have ground glass appearance and oxyphil cytoplasm

3. Invasion

4. Psammoma bodies

Papillary Carcinoma

1. Papillary pattern

2. tumor cells have ground glass appearance and oxyphil cytoplasm

3. Invasion

4. Psammoma bodies

Papillary Carcinoma

1. Papillary pattern

2. tumor cells have ground glass appearance and oxyphil cytoplasm

3. Invasion

4. Psammoma bodies

Follicular Thyroid Carcinoma

1. uniform follicles invading the capsule

2. Blood vessels ( diagnostic hallmark )

3. No nuclear features of papillary carcinoma

Follicular Thyroid Carcinoma

1. uniform follicles invading the capsule

2. Blood vessels ( diagnostic hallmark )

3. No nuclear features of papillary carcinoma

Medullary Thyroid carcinoma

1. Solid, firm, gray tan mass

2. Bilateral/ can be multi focal in MEN syndromes

Medullary Thyroid carcinoma

1. polygonal to spindle-shaped cells in nests , trabeculae or follicles

2. Amyloid stroma (derived from altered calcitonin) - Congo red positive

Islet of Langerhans , immunohistochemical staining with antibody to insulin and glucagon

A. Glucagon→ identifies alpha cells

B. Insulin → identifies beta cells

Type 1 diabetes mellitus - insulitis of an islet of langerhans

1. Lymphocytic infiltrates

2. Destruction of the islets leads to absolute lack of insulin

Type 2 diabetes mellitus - Amyloid deposition in islet

1. Pink hyalinization

2. deposition of amyloid in many islet cells

Pancreatic neuroendocrine tumor

1. Cells resembling those in islets of langerhans separated from pancreas by thin collagenous capsule

2. Normal islets are on the right

Pancreatic neuroendocrine tumor

1. Round central nuclei , salt and pepper chromatin , scant to moderate eosinophilic granular cytoplasm

   Nucleoli vary depending on grade cells grow in:

   • solid

   • Gyriform

   • Glandular

   • Diffuse patterns