Endo & reproduction - pathology

What organ is visible and what is wrong?

All mass and volume of thyroid is enlarged but the form is preserved with 2 lobes.

What organ is visible and what is wrong?

Deformed thyroid due to multiple nodules on surface with increased size

What seems to be microscopically wrong? What organ?

Thyroidal Colloidal goiter:

·      Increased amount colloid – pale pink colour.

·      Increased follicules with increased colloid.

What seems to be the pathology? what organ?

Thyroidal Parenchymal goiter:

Increased amount of follicle cells and just relative increase of colloid.

What is hyperpituitarism?

Increased functional activity of tropic hormones of the adenohypophysis

What are the main aetiologies of hyperpituitarism?

Adenoma (common in 40–60 yrs), hyperplasia, hypothalamic injury, non-pituitary neoplasms secreting tropic hormones

On what basis are pituitary neuroendocrine tumours (adenomas) classified?

Expression of transcription factors (PIT1, T-PIT, SF1) and the types of hormones secreted by adenohypophysial cells

Which cell types fall under the PIT1 lineage in pituitary adenomas?

Somatotrophs, lactotrophs, thyrotropes, and plurihormonal (mature and immature) cells

Which cell type is associated with the T-PIT lineage?

Corticotropes

Which cell type is associated with the SF1 lineage?

Gonadotrophs

What does the abbreviation PIT1 stand for?

Pituitary-specific positive transcription factor 1

What does the abbreviation T-PIT stand for?

T-box pituitary-specific positive transcription factor

What does the abbreviation SF1 stand for?

Steroidogenic factor 1

What are the morphological features of a lactotroph adenoma?

Most common adenoma type, microscopically chromophobic or acidophilic cells secreting prolactin, clinically presents with amenorrhea, galactorrhea, and infertility

What are the morphological features of a somatotroph adenoma?

Second most common adenoma type, microscopically chromophobic or acidophilic cells secreting somatotropin, clinically presents with gigantism in children and acromegaly in adults with later cardiac failure and infections.

What are the morphological features of a lactotroph adenoma?

Most common pituitary NET type, microscopically chromophobic or acidophilic cells secreting prolactin, clinically presents with amenorrhea, galactorrhea and infertility

What are the morphological features of a somatotroph adenoma?

Second most common pituitary NET type, microscopically chromophobic or acidophilic cells secreting somatotropin, clinically causes gigantism in children and acromegaly in adults with later cardiac failure and infections

What is hyperthyroidism (thyrotoxicosis)?

Increased thyroid functional activity usually with goiter, most often caused by Graves’ disease, adenoma or toxic nodular thyroid

What is hypothyroidism?

Decreased thyroid functional activity, congenital form is cretinism and acquired form is myxoedema, acquired causes include Hashimoto thyroiditis

What is a goiter?

Enlargement of the thyroid gland

How is goiter classified by cause?

Endemic goiter from iodine deficiency in a geographic area, sporadic goiter from enzyme deficiencies in thyroid hormone production

How is goiter classified by functional activity?

Hypothyrotic (low function), euthyrotic (normal function), hyperthyrotic/thyrotoxic (high function)

What are the macroscopic features of goiter?

Diffuse enlargement or nodular enlargement of the thyroid gland

What are the microscopic features of goiter?

Colloidal goiter pattern or parenchymal (hyperplastic) goiter pattern

What defines Graves’ disease?

Pathological thyroid condition with thyrotoxicosis, diffuse goiter, infiltrative ophthalmopathy in ~40%, elevated T3/T4, decreased TSH, type II hypersensitivity pathogenesis

What are the thyroid gland morphological features in Graves’ disease?

Macroscopically diffuse fleshy goiter, microscopically scant colloid, tall follicular epithelium and focal epithelial proliferation

What cardiovascular changes occur in Graves’ disease?

Secondary systemic hypertension and left ventricular hypertrophy

What lymphoid changes occur in Graves’ disease?

Enlargement of thymus and other lymphoid organs

What is thyroiditis?

Inflammation of the thyroid gland

What are the clinical morphological forms of thyroiditis?

Acute bacterial thyroiditis, autoimmune (Hashimoto), subacute granulomatous (de Quervain), Riedel’s thyroiditis

What are the features of Hashimoto thyroiditis?

Common cause of hypothyroidism, type IV hypersensitivity, macroscopically firm fleshy pale gland, microscopically lymphoplasmacytic infiltration, fibrosis and Hürthle cells

How are thyroid gland neoplasms classified?

A: Follicular epithelial cell tumours (benign: follicular adenoma, oncocytic adenoma, toxic adenoma

What are the morphological features of a thyroid follicular adenoma?

Encapsulated single nodule in a thyroid lobe with trabecular, tubular or microfollicular architecture.

What is dystrophic calcification?

Normal calcium metabolism with calcium depositing in injured or dead tissue

What is the mechanism of dystrophic calcification?

Crystalline calcium phosphate forms in membrane-bound vesicles or inside mitochondria of injured cells

What is metastatic calcification?

Hypercalcemia leading to calcium deposition in otherwise normal tissues

What are common causes of metastatic calcification?

Hyperparathyroidism, bone destruction, vitamin D disorders, and renal failure

What is a parathyroid gland adenoma?

A benign neoplasm of parathyroid cells with increased functional activity

How does a parathyroid adenoma appear macroscopically?

As an encapsulated, yellowish-brown nodule

What are the clinical morphological features of a parathyroid adenoma?

Bone demineralization (general osteodystrophy/Recklinghausen’s disease), nephrolithiasis and urolithiasis, and increased gastric HCl production causing ulcers

What is parathyroid gland hyperplasia?

Diffuse enlargement of all four parathyroid glands

What are the types of parathyroid hyperplasia?

Primary (idiopathic), secondary (reaction to low calcium), and tertiary (autonomous secretion)

What are the morphological features of parathyroid hyperplasia?

Enlarged glands with decreased fat tissue and changes similar to those seen in hormone-active adenomas

What is Cushing’s syndrome?

A group of symptoms caused by excess glucocorticoids

What are the main aetiologies of Cushing’s syndrome?

Overuse of steroids, adrenal cortical hyperplasia or neoplasms, pituitary neoplasms, or temporary glucocorticoid increases from alcoholism, depression, or anorexia nervosa

What are the morphological and clinical features of Cushing’s syndrome?

“Moon” face, central obesity, muscle weakness and atrophy, hyperglycaemia with polyuria/polydipsia, menstrual and sexual dysfunction, hypertension, and osteoporosis

What is Addison’s disease?

A chronic adrenal insufficiency due to decreased glucocorticoid production

What are common causes of Addison’s disease?

Infections (e.g., tuberculosis), autoimmune attack, neoplasms, or pituitary/hypothalamic pathology

What are the clinical features of Addison’s disease?

Weakness, anorexia and weight loss, skin hyperpigmentation, hypotension, hypoglycaemia, and potential shock in acute failure

What is pheochromocytoma?

A benign adrenal medulla tumour that secretes dopamine, noradrenaline, and adrenaline

What are the morphological features of pheochromocytoma?

An encapsulated, greyish mass with areas of necrosis and haemorrhage

What are the clinical symptoms of pheochromocytoma?

Secondary hypertension, hyperglycaemia, increased lipolysis, and tachycardia.

What are follicle and luteal cysts?

They are cysts that originate from unruptured ovarian follicles or from follicles that immediately seal after rupture

What are complications of follicle and luteal cysts?

Rupture causing intraperitoneal bleeding and possibly increased oestrogen production

What is polycystic ovarian syndrome (Stein–Leventhal syndrome)?

A condition marked by polycystic ovaries, chronic anovulation, menstrual abnormalities, hyperandrogenism, and decreased fertility

What is endometrial hyperplasia?

A disordered proliferation of endometrial glands

What causes endometrial hyperplasia?

Excess estrogenic stimulation of the endometrium with relative progesterone deficiency due to anovulation, prolonged oestrogen therapy without progestin, oestrogen-producing ovarian cysts or tumours, or obesity

What are the complications of endometrial hyperplasia?

Uterine bleeding (metrorrhagia), anaemia with hypoxic lipidosis of the myocardium and bone marrow changes, and progression to uterine adenocarcinoma

What are the main types of benign breast disease due to dyshormonal conditions?

Cyst formation and fibrosis, epithelial hyperplasia with and without atypia, sclerosing adenosis, and fibroadenoma

What characterizes cyst formation and fibrosis in benign breast disease?

Increased fibrous stroma and dilation of ducts with cyst formation but without epithelial proliferation

What is epithelial hyperplasia in benign breast disease?

An increase in the layers of duct-lining epithelium that may occur with or without cellular atypia

What is sclerosing adenosis?

Intralobular fibrosis with proliferation of small ductules or acini

What is a fibroadenoma?

A benign breast tumour composed of both fibrous and glandular tissue.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia is a common prostatic enlargement resulting from proliferation of stromal and glandular elements

What hormone mediates prostatic growth in BPH?

Dihydrotestosterone (DHT) mediates prostatic growth

How is DHT synthesized in the prostate?

DHT is synthesized from circulating testosterone by the enzyme 5α-reductase type 2

How does DHT promote prostatic cell growth?

DHT binds to nuclear androgen receptors, regulating gene expression that supports growth of prostatic epithelial and stromal cells

What are the morphological features of BPH?

The prostate is enlarged (60–100 g) with well-circumscribed nodules, which may be solid or contain cystic spaces

How is BPH classified histologically?

BPH is classified into glandular, fibromuscular, and mixed types

What complications of BPH can lead to morbidity and death?

Complications include urethral compression, urocystitis, ascending pyelonephritis, urosepsis, and renal failure with septicopyemia

What is the most common type of prostate carcinoma?

About 95% of prostate carcinomas are adenocarcinomas

Where can prostate adenocarcinoma invade locally?

It can invade adjacent soft tissues such as the urinary bladder and rectum

To which organs does prostate carcinoma metastasize hematogenously?

Prostate carcinoma can metastasize to the lungs and bones via the bloodstream

To which lymph nodes does prostate carcinoma spread?

It spreads lymphogenously to paraaortic and pelvic lymph nodes

What causes most cervical neoplasms?

Most cervical tumours are epithelial in origin and caused by human papillomavirus (HPV)

Where are cervical neoplasms most commonly located?

They are most commonly at the junction of endocervical columnar epithelium and exocervical squamous epithelium

What is the precursor lesion for HPV-induced cervical cancer?

Squamous intraepithelial lesion (SIL)

What defines low-grade SIL?

Low-grade SIL (CIN I) is associated with HPV but does not directly progress to invasive carcinoma

What defines high-grade SIL?

High-grade SIL (CIN II and CIN III) carries a high risk of progression to invasive carcinoma (carcinoma in situ)

What is the most common histologic type of cervical carcinoma?

Squamous cell carcinoma of the exocervix

What rare type of cervical carcinoma arises from the endocervix?

Adenocarcinoma

How are cervical squamous cell carcinomas classified morphologically?

They can be non-invasive (carcinoma in situ) or invasive

To which lymph nodes does cervical carcinoma metastasize?

To inguinal, pelvic, and paraaortic lymph nodes

What complications arise from cervical carcinoma infiltration?

Infiltration into the bladder and rectum can cause uterovesical and uterorectal fistulas

What benign tumours arise from the myometrium?

Benign myometrial tumours are leiomyomas, which can be intramural, submucosal, or subserosal

What is the malignant smooth muscle tumour of the uterus?

Myosarcoma

What benign tumours arise from the endometrium?

Endometrial polyps

What malignant tumours arise from the endometrium?

Endometrial adenocarcinoma and choriocarcinoma.

What are the two main categories of breast carcinoma?

In situ carcinoma and invasive carcinoma

What defines carcinoma in situ in the breast?

Neoplasia confined to ducts and lobules by the intact basement membrane

What are the types of breast carcinoma in situ?

Intraductal carcinoma, intraductal carcinoma with Paget disease, and lobular carcinoma in situ

What are the main types of invasive breast carcinoma?

Invasive ductal carcinoma, invasive ductal carcinoma with Paget disease, invasive lobular carcinoma, medullary carcinoma, and colloid carcinoma

Which receptors are assessed by immunohistochemistry in breast carcinoma?

Oestrogen receptors, progesterone receptors, and HER2/neu receptors

How does the spread of breast carcinoma depend on tumour location?

Outer quadrants to axillary nodes

What are the two main categories of ovarian neoplasms?

Primary ovarian neoplasms and metastases to the ovaries

From which sites do ovarian metastases commonly originate?

Uterus, fallopian tubes, contralateral ovary, breast, and gastrointestinal tract (colon, stomach, biliary tract, pancreas)

What is a Krukenberg tumour?

Metastatic gastrointestinal or breast carcinoma in the ovary

How are primary ovarian tumours classified by tissue of origin?

Surface epithelial tumours, sex cord-stromal tumours, and germ cell tumours

What are examples of surface epithelial ovarian tumours?

Serous cystadenoma, serous cystadenocarcinoma, mucinous cystadenoma, mucinous cystadenocarcinoma, endometrioid cystoma, endometrioid carcinoma, and Brenner tumour

What are examples of sex cord-stromal ovarian tumours?

Granulosa cell tumour (folliculoma), thecoma, and Sertoli-Leydig cell tumour (androblastoma)