16- Endocrine System Pathology
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Eosinophilic Pituitary Adenoma (457)
description
Slides for endocrine pathology.
Transcript of 16- Endocrine System Pathology
Eosinophilic*Pituitary*Adenoma*(457)*
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-benign neoplasm of the anterior love of the pituitary -common in adults and women-most common cause of hyperpituitarism-pituitary adenomas are classified according to hormone they produce-prolactinoma=most common (amenorrhea, galactorrhea, loss of libido, infertility)-eosinophilic adenoma (acidophil adenoma, somatotrophe adenoma) of the pituitary gland is an adenoma characterized by the tumor cells that have an affinity for eosin-is a specific type of pituitary adenoma that arises from somatrophs and it is usually associated with an overproduction of GH (in adults=acromegaly) -soft, well-circumscribed lesion that may be confined to the sella turcica-adenomas which exceed 10 mm in size are macroadenomas (may compress optic chiasm-loss of central vision)
Monomorphic expansion of usually one cell type which lack reticulin network among neoplastic cells. The growth pattern can be diffuse.
-uniform, polyglonal cells arranged in sheets or cords-supporting connective tissue, or reticulin is sparse-soft, gelatinous consitency
The cytoplasm of the constituent cells may be acidophilic, basophilic, or chromophobic, depending on the type and amount of secretory product within the cells, but it is generally uniform throughout the tumor.
Parathyroid*Adenoma*(464)*
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-uniform, well-circumscribed, with a smooth surface, soft-whitish-yellow to reddish-brown in colour, encapsulated-measuring 1-3cm in diameter and weighs 0.05-200g (normal parathyroid is 1mm, weight is 30-40g)-entire tumor is well demarcated in all areas from the surrounding parathyroid tissue-at the edge of the adenoma is visible a rim of compressed, non-neoplastic parathyroid tissue separated by a fibrous capsule-primary hyperparathyroidism leads to increased blood calcium levels-in more serious cases, the bone density will diminish (osteomalacia) and kidney stones can form-metastatic calcification, ulceration of the GI mucosa-treatment: surgical resection, avoiding calcium rich foods, proper hydration, medications (estrogens) to avoid osteoporosis
-in the tumor there is a proliferation of one of the cell types. Chief cells predominate in most adenomas-the tumor contains sheets of neoplastic chief cells-fat cells are usually absent-in contrast to the normal parathyroid parenchyma, adipose tissue is inconspicuous
-no anaplasia (cells with regular nuclei); uniform, trabecular pattern-the chief cells display a palisaded arrangement around blood vessels. The stroma is richly vascularized
Diffuse'Toxic'Hyperplasia'of'the'Thyroid'(Graves’'Disease)'–'(452)'
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-goiter with diffuse thyroid hyperfunction and thyrotoxicosis due to TSH receptor dysfunction-is an autoimmune disorder characterized by diffuse goiter, hyperthyroidism, exophthalmos, and dermopathy-toxic multinodular goiter-peak incidence between 20 and 40 years of age-female dominant-diagnosis: laboratory findings in Graves disease include elevated free T4 and T3 level and depressed TSH levels-autoimmune disease-autoantibodies are formed against the TSH-receptor resulting in stimulation of thyroid and overproduction of T3 and T4-genetic factor and environmental factors (smoking) increases the risk -classical Grave's triad: -hyperthyroidism (goiter-enlargment of thyroid gland)-ophtalmopathy-dermopathy
Three major presentations:-goiter-exophthalmos (protruding eyeballs)-tachycardia-nonspecific symptoms: nervousness, tremor, intolerance of heat, palpitations, warm skin and heavy sweating (digital swelling)-other symptoms in extra-thyroidal tissue:-skeletal muscle fiber degeneration-cardiac enlargement-diffuse liver fibrosis with fatty infiltration-body weight loss-a mass in the neck-increased vascularity of the conjunctiva-the ophthalmopathy of Graves disease results in abnormal protrusion of the eyeball (exophthalmos). The extra-ocular muscles are often weak.-tissues of orbit are edematous b/c of presence of hydrophilic mucopolysaccharides-the dermopathy is characterized by reddish thickening of the dermis due to deposition of glycosaminoglycans in the dermis.
Parenchyma has a soft meaty appearance resembling normal muscle
-the gland is diffusely hyperplastic and highly vascular -irregular follicles-lymphocytic infiltration throughout the interstitium (suggesting immunological nature of the disease)
-there is just a tiny amount of colloid in every follicle-the epithelial columnar cells are tall and more crowded than usual and are often arranged as papillae that project into the follicular lumen -activation of the thyroid cells results in colloid absorption into vacuoles at the periphery of the follicle (absorption vacuoles)-the colloid within the follicular lumen in pale, with scalloped margins (the colloid substance seems to have little open spaces along its edges)
Metastatic(Papillary(Carcinoma(of(the(Thyroid(in(the(Lymph(Node((461)(
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-papillary carcinoma is the MOST common form of thyroid cancer* [exam]-occurs more frequently in women b/w ages 25-50, and are associated with previous exposure to ionizing radiation of head and neck -dysphagia, cough or dyspnea because of a mass in a cervical lymph node suggests advanced disease-a high tendency to metastasize locally to adjacent cervical lymph nodes-good prognosis, with a 10 year survival rate-on cut surface, calcification and fibrosis may be detectable. Foci of papillary projections are possible
-encapsulated with well defined margins as well as poorly circumscribed with invasion-surrounded by fibrous capsule-prominent papillae with fibrovascular cores
-the papillae have fibrovascular cores, they are lined by rims of either high cuboidal or low columnar cells, they have abundant cytoplasm-often some of these papillae dry up and form little calcified bodies-psammoma bodies (concentrically calcified structures present within the cores of papillae)The diagnostic nuclear features:-ground glass nuclei (the nuclei contain dispersed chromatin, which gives optically clear or empty appearance- Orphan Annie eye nuclear inclusions)-nuclear grooves such nuclei resemble coffee beans-intranuclear inclusions ("vacuoles")-nuclear polymorphism (there are no 2 identical nuclei)
Adrenal(Cortical(Adenoma((455)(
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-benign tumor arising from cortex of adrenal gland-commonly occurs in adults, but it can be found in persons of any age-can present with Cushing's syndrome or primary aldosteronism (Conn's syndrome)-overproduction of cortisol or mineralocorticoid hormone
-tumor cells arranged in nests and cords-mitotic activity and necrosis are not seen-a rim of compressed normal adrenal tissue
-the cytoplasm of the neoplastic cells ranges from eosinophilic to vacuolated, depending on their lipid content-the tumor is composed mainly of compact lipid-depleted, eosinophilic cytoplasm and small compact round nuclei-clear, lipid-laden (fasciculata type) cells arranged in sheets
Adrenal(Cortical(Carcinoma((456)(
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-marked anaplasia, nuclear pleomorphism is seen-sheets of atypical cells-vascular spaces, necrosis
-nuclear hyperchromasia, diffuse pattern of growth, mitotic activity-tumor cells have abundant eosinophilic cytoplasm and enlarged nuclei with prominent nucleoli
Pheochromocytoma+(265)+
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-is a neoplasm of neural crest origin arising in the adrenal medulla and is usually benign-uncommon neoplasm composed of chromaffin cells: synthesize and release catecholamine (hypertension, tachycardia, palpitations, headaches, sweating, tremor, catecholamine cardiomyopathy-10% tumor: 10% malignant, 10% bilateral, 10% extra-adrenal-in adults-circumscribed large lesions 5-6cm in diameter-multinodular, fleshy tumor-encapsulated, spongy mass with central necrosis & hemorrhage (vascular tumor)
-polyglonal chromaffin cells arranged in nests ("zellballen" pattern) which may contain amyloid surrounded by a delicate fibrovascular stroma-rich vascular network
-cells with abundant cytoplasm, (granules containing catecholamine particles)-cellular and nuclear pleomorphism can be present as well as capsular and vascular invasion. It does not indicate the malignant character of the tumor (only metastases)
Well$Differentiated-Neuroendocrine-Tumor-(Islet-Cell-Tumor,-“APUD$oma”)-(the-Pancreas)-–-(458)-
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-Islet cells commonly are referred to as APUD cells (neuroendocrine cells), a name derived from their high amine content and capacity for amine precursor uptake with decarboxylation -pancreatic islet cell tumors may secrete 2 or more polypeptide hormones-types of islet cell tumors:insulinoma-beta cellsgastrinoma-delta cellssomatostatinoma-delta cellsglucagonoma-alpha cellsVIPomas-delta cellsnonfunctional-insulinomas are the MOST common of islet cell tumors neoplastic beta cells induce severe hypoglycemia-symptoms depend on which hormone is made by the tumor
-a family history of multiple endocrine neoplasia, type I (MEN I) is a risk factor for islet cell tumors-rare in comparison with the exocrine pancreatic tumors-most common in adults-single or multiple-benign or malignant
-encapsulated tumor, cells are arranged in cords or trabculae-nests of tumor cells are surrounded by numerous capillaries (cords separated by vascular stroma)
-abundant hyaline material separates the tumor cells-uniform cuboidal cels with centrally located nuclei and acidophilic cytoplasm arranged in anastomosing cords-the neoplastic cells are monotonous and demonstrate minimal pleomorphism or mitotic activity
