Eosinophilic pituitary adenoma (457)

Pituitary gland● Anterior lobe:

● Eosinophilic cell – adenomas secreting prolactin most common, then GH● Excess GH in child → Gigantism. Adult → acromegaly.● Slide: cells don't stick together (scattered cells), looks like cytology instead of

tumor sample. Bright pink (eosinophilic)● Basophilic cells (ACTH, MSH, TSH, FSH&LH) (tumors secreting those are rare)● Chromophobic cells

● Posterior lobe:● Modified glial cells (pituicytes)● Axonal processes of hypothalamic nerve cells

eosinophilic

Scattered cells look like cytology

Monomorphism● Normal anterior pituitary

contains different cell types for different hormones

Parathyroid adenoma (464)

● Usually unilateral● Produce PTH → hypercalcemia → symptoms

● Osteoporosis, depression, seizure, gallstone, nephrolithiasis● Benign tumor

Capsule between adenoma and normal tissue.

Some tendency to form follicles.Similar to normal parathyroid gland but more crowded.

Diffuse toxic hyperplasia of the thyroid (Graves disease) (452)● Autoimmune, more common in

female. Most common cause of hyperthyroidism.

● TSI (thyroid stimulating immunoglobulin) is main antibody. Acts as TSH.● Often autoantibodies cross react

with connective tissue around eye → exophthalmus

● Pretibial edema

Hyperthyroidism● Increase metabolic rate● Increased sympathetic activity● Sweating● Heat intolerance● Weight loss● Flushed skin (to increase heat loss)● Increased cardiac output● Tremor, hyperactivity, anxiety,

insomnia● Pretibial myxedema

Hypothyroidism● Decreased metabolism● Decreased sympathetic activity

○ Decreased sweating and constipation● Cold intolerance● Weight gain● Cold skin (decreased blood flow)● Decreased cardiac output

○ Shortness of breath○ Reduced exercise capacity

● Fatigue, slowed mental activity● Cretinism (in children)● Myxedema (in older children or adult)

● Plummer syndrome: multinodular goiter

● Diffuse, homogenous goiter:○ Grave's: hyperthyroidic goiter○ Lack of iodine: hypothyroidic

goiter

Scallop (or moth eaten) appearance. Adjacent parenchymal cells use colloid to produce thyroid hormone, producing empty space

Scattered follicles with a lot of parenchyma.Lymphocytes (dark purple cells in nodules)Parenchyma

Metastatic papillary carcinoma of the thyroid in the lymph node (461)

Malignant tumors of the thyroid:● Papillary – most common.

75% - 85%● Follicular – 10% - 20%● Medullary – 5%. Bad

prognosis, produces amyloid. Marker is calcitonin.● Scintigraphy with

radioactive iodine shows adenomas as cold areas.

● Anaplastic – <5%. Worst prognosis. Spreads viciously. Least common.

Slide:● small purple cells are

lymphocytes (they are present physiologically)

● cross section through papilla● nuclei appears pale (Orphan

Annie nuclei) (in cells lining the papillary)

● psammoma bodies (small calcification)● meningioma also has

psammoma bodies

Clear nuclei

Psammoma bodies

Cross section through papilla

Adrenal cortical adenoma (455)

● Adrenal cortical adenoma: incidentaloma, usually clinically silent

Slide:● Border is smooth (a thin layer)● Typical benign tumor.● Small islets (like normal

adrenal gland), but more crowded. Uniform nests. Dark pink cytoplasm. Small nuclei.

Intracytoplasmic lipid

Smooth border

Adrenal cortical carcinoma (456)

● Rare neoplasm. Large, invasive.● Hypercortisolemia → Cushing's● Might also cause Conn syndrome (too much aldosterone).● Usually asymptomatic until quite advanced (metastasis)

Slide● no uniform nests.● Sheets of solid cells not

forming structure● Atypia, Pleiomorphism

● some nuclei are much bigger, some with nucleoli. Dark nuclei.

● Mitosis.

mitosis

Pheochromocytoma (265)

● Stays within adrenal gland (medulla tumor). Produce norepinephrine and epinephrine (like normal medulla cells)● mostly benign, rarely malignant (atypical pheochromocytoma)

(metastasis)(10% malignant)● Symptoms related to sudden (or chronic) release of

catecholamines● Most common reason for secondary hypertension.● Catecholamine cardiomyopathy

● Fleshy appearance.

Slide:● Pale cells forming round nests

near border of tumor (“zellballen,” German for “cell balls”)

● Cells look paler than the ones from cortex.

Nuclei with “salt and pepper” chromatin typical for neuroendocrine tumors.

Well-differentiated neuroendocrine tumor (islet cell tumor, “APUD-oma”)(the pancreas) (458)

Well-differentiated neuroendocrine tumor● A lot of them comes from

Langerhans.● Gastrin, somatostatin, VIP

(vasoactive intestinal peptide), insulin, glucagon (rare). Neuroendocrine cells.

● Most islet cell tumors are small except gastrinoma, which grows aggressively.

Insulinoma● Β-cell tumors● Clinical triad of attack:

● Hypoglycemia when glucose level <50 mg/dL

● Confusion, stupor, loss of consciousness

● Precipitated by fasting or exercise, relieved by feeding or parenteral glucose

● Generally benign

Gastrinomas (Zollinger-Ellison syndrome)● Also likely in duodenum and

peripancreatic soft tissue (gastrinoma triangle)

● Extreme gastric acid secretion → peptic ulcer● Jejunal ulcers possible

VIPoma (Verner Morrison syndrome)● VIP (vasoactive intestinal

polypeptide)● Induces glycogenenolysis

→ hyperglycemia● Stimulate GI fluid secretion

→ secretory diarrhea

Pseudocapsule● Compressed parenchyma

of pancreas which became fibrotic

● Difficult to find on slide

Solid nest. Irregular.