Endocrine Pathology, UMI

7/30/2019 Endocrine Pathology, UMI

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DEPT PATOLOGI ANATOMI

FK UMI


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THYROID GLAND


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KELAINAN PADA

THYROID GLAND

Congenital

Infection

Neoplasma

Others (Graves Disease


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Thyroid gland The thyroid gland (N):

on the anterior tracheaof the neck.

Has a right lobe & a leftlobe connected by anarrow isthmus.

Weight: 10-30 gr.


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Normal thyroid (microscopic)

Consists of follicles lined by a an epithelium and filled withcolloid.

The interstitium, which may contain "C" cells


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THYROIDITISHashimoto Thyroiditis

(Chonic Lymphocytic Thyroiditis)

Subacute Granulomatous Thyroiditis(De Quervain Thyrooiditis)

Subacute Lymphocytic Thyroiditis

Riedel Thyroiditis


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Hashimoto's Thyroiditis

Thyroid failure because of autoimmune destruction

Microscopis :

extensive infiltration of the parenchym by a

mononuclear inflammtory infiltrat (germinalcenters)

Atrophic follicles thyroid

Hurtle cell (+) metaplastic respon of thenormally low cuboidal follicular epithelium to

ongoing injury


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Thyroid gland (atrophy)

This patient was hypothyroid.

The end result ofHashimoto's thyroiditis.

Hashimoto's thyroiditis

results from abnormal T cell

activation & subsequent Bcell stimulation to secrete a

variety of autoantibodies.


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(low power microscopic)


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(High power microscopic)

Demonstrates the pink Hrthle cells at the center and right.

Initially leads to painless enlargement of the thyroid, followed

by atrophy years later


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Sub-acute granulomatous thyroiditis

(DeQuervain's disease)

Caused by viral infection or postviralinflammatory process

Granulomatous

Multinucleated giant cell

Early stage : microabscess follicles


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Sub-acute granulomatous thyroiditis

(DeQuervain's disease)

Note:the foreign body giant cells with destruction of

thyroid follicles.


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RIEDEL THYROIDITIS

Unknown etiology

Characterized by extensive fibrosis involving thethyroid and contiguous neck structur

May be associated with idiopathic fibrosis inother sites in the body


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This thyroid gland is about normal in size, but there is a larger

colloid cyst at the left lower pole and a smaller colloid cyst at

the right lower pole.

larger colloid cystsmaller colloid cyst


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Diffuse and Multinodular Goiters

Enlargement of the thyroid or goiter

Reflect impaired synthesis of the thyroid hormon,most often caused by dietary iodine deficiency


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This diffusely enlarged thyroid gland is

somewhat nodular.

This represents the most common cause for an enlarged thyroid gland and

the most common disease of the thyroid--a nodular goiter.


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Multinodular goiter

(Low power microscopic)


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Grave's Disease

An autoimmune disorder Diffusely hyperplastic thyroid

The follicles are lined by tall columnar

epithelium The crowded, enlarged epithelial cells project

into the lumens of the follicles

The active cells resorb the colloid in the centers

of the follicles scallopedappearance of the edges of the colloid


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Grave's disease

(low power-autoimmune disease the action of TSI's)


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Grave's disease

(high power, the tall columnar thyroid epithelium)


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Follicular adenoma

The mass is well

circumscribed.

Gross : felt firm.

By scintigraphic scan

"cold."


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Follicular Adenoma

This adenoma is a well- differentiated neoplasm because

it closely resemble normal tissue.


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Classification & Incidence of Thyroid Cancer

Follicular cell origin Differentiated

Papillary 80% Follicular 10% Hurthle cell 3-5%

Undifferentiated Anaplastic 1-2%

Parafollicular cell origin Medullary 5%


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Papillary Carcinoma

Accounts for 90% radiation induced cancer

Classified as microcarcinoma, intrathyroidal, and

extrathyroidal Histologic variants: tall-cell, clear-cell, columnar, diffuse

sclerosing

Multicentric in 30-50% of tumors

Spreads via lymphatics with propensity for mid-and lower-anterior cervical chain (Level VI)

20-50% patients have involvement of cervical LN


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Follicular Carcinoma

Only 10% of thyroid cancers in developedcountries, although more prevalent in regions withiodine deficiency

Diagnosis depends on demonstration of vascularor capsular invasion

Classified as minimally or widely invasive Vascular invasion tends to have a more aggressive course

than capsular invasion

Uncommon to have multicentric disease

Hematogenous spread


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Contd

Where does follicular carcinoma tend to metastasize?

Bone

lung


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FOLLICULAR CA THYROID


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Anaplastic Carcinoma

Increasingly rare

Arise within differentiated cancers Pts > 60 years old with rapidly expanding neck

mass

Local invasion very common at time of dx(FNA)

Surgery plays limited role given advanced stageat dx

Radiation and chemotherapy have notdemonstrated any significant improvement insurvival

Median survival ~ 4 - 6 months


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Medullary Thyroid Carcinoma Originates from the parafollicular C cells

Elevation in calcitonin and CEA (50%) 80% have sporadic MTC (unifocal), remainder have

genetic component

75% patients have LN metastasis at time of dx, 20%

distant mets


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Sectioning through a lobe of excised thyroid

gland reveals papillary carcinoma

Multifocal

Because of the propensity

to invade lymphaticswithin thyroid, andlymph node metastasesare common.

The larger mass is cystic

and contains papillaryexcresences.

Most often arise inmiddle-aged females


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Papillary Carcinoma

(Microscopic)

The fronds of tissue have thin fibrovascular cores. The fronds have an

overal papillary pattern.


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Papillary Carcinoma

(Microscopic)

Note the small psammoma body in the center. The cells of the

neoplasm have clear nuclei.


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Medullary Carcinoma

These neoplasms are derived from the thyroid "C" cells and, therefore,

have neuroendocrine features such as secretion of calcitonin


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PARATHYROID GLAND


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Parathyroid hyperplasia


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Parathyroid hyperplasia

There is little or no adipose tissue, but any or all cell types

normally found in parathyroid are present.

Note the pink oxyphil cells here.


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Parathyroid adenoma

A rim of normal parathyroid tissue (with a pink oxyphil cell nodule)

at the upper right, and a small benign parathyroid cyst (an incidental

finding) is at the upper left.


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Parathyroid adenoma

rim of normal

parathyroid

A rim of normal parathyroid tissue admixed with adipose tissue

cells is seen compressed to the right and lower edge of the

adenoma.

Gross appearance of a


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Gross appearance of a

parathyroid carcinoma

Note the large size and irregular cut surface.

These carcinomas have a tendency to invade surrounding tissues in

the neck, complicating their removal.


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Parathyroid carcinoma

The nests of neoplastic cells that are not very pleomorphic.

Note the bands of fibrous tissue between the nests.

Parathyroid carcinomas infiltrate surrounding structures in the neck.


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A normal parathyroid gland for comparison.

Adipose tissue cells are mixed with the parathyroid tissue.

The amount of fat varies somewhat.


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NORMALPARATHYROID

GLAND


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PITUITARY GLAND


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The normal gross appearance of the pituitary

gland removed from the sella turcica


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The normal microscopic appearance of the

pituitary gland

The adenohypophysis is at the right and the neurohypophysis is at the left.


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The normal microscopic appearance of the

adenohypophysis

The adenohypophysis contains three major cell types: acidophils,

basophils, and chromophobes.


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Neurohypophysis

The neurohypophysis shown here resembles neural tissue, with glial

cells, nerve fibers, nerve endings, and intra-axonal neurosecretory

granules


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Microadenoma of the anterior pituitary


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Adenohypophyseal adenomaEndocrine neoplasms are

composed of small round cells

with small round nuclei andpink to blue cytoplasm.

The cells may be arranged in

nests or cords and endocrine

tumors also have prominent

vascularity.


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The circumscribed mass lesion present here in

the sella turcica is a pituitary adenoma


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The microscopic appearance of the pituitary

adenoma


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Craniopharyngioma


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ADRENAL GLANDS

Sectioning across the adrenals reveals a golden


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Sectioning across the adrenals reveals a golden

yellow outer cortex and an inner red to grey

medulla (Normal adrenal glands )

Each adult adrenal gland weighs

from 4 to 6 grams.


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These adrenals are black-red from extensive

hemorrhage in a patient with meningococcemia.

This produces the Waterhouse-Friderichsen syndrome.


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This is the microscopic appearance of the

adrenals with meningococcemia.

There is marked hemorrhagic necrosis with acute adrenal

insufficiency.


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An enlarged adrenal

gland

Demonstrate tan-white

metastatic carcinomainfiltrating in and around the

residual golden yellow cortex

. The most common primary

site for adrenal metastases is

lung.


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This is a caseating granuloma of

tuberculosis in the adrenal gland.

Tuberculosis used to be the most

common cause of chronic adrenalinsufficiency.

Now, idiopathic (presumably

autoimmune) Addison's disease is

much more often the cause for

chronic adrenal insufficiency.


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This adrenal gland removed surgically in a patient with

Cushing's syndrome

Some remaining atrophic adrenal is seen at the right.

The adenoma is composed of yellow firm tissue just like

adrenal cortex.


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Adrenal adenoma

Here is a 1.3 cm left adrenal adenoma found in a patient with

hypertension.

Such adenomas are typically less than 2 cm in size and yellow

on cut surface.


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Microscopically, the adrenal cortical adenoma at the

right resembles normal adrenal fasciculata.

The capsule is at the left. There may be some cellular

pleomorphism.


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Adrenal cortical

carcinoma

Such neoplasms are

usually functional (secretingcorticosteroids or sex

steroids).

They have a poor

prognosis.


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Adrenal cortical carcinoma (microscopically

at high power)

The larger the neoplasm, the more likely it is malignant, but

the best indicators are invasion and metastasis.


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This high power microscopic appearance of an

adrenal cortical carcinoma

It is difficult to determine malignancy in endocrine

neoplasms based upon cytology alone.


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This large adrenal neoplasm has been

sectioned in half.

Note the grey-tan color of the tumor compared to the

yellow cortex stretched around it and a small remnant

of remaining adrenal at the lower right.


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This pheochromocytoma demonstrates the

chromaffin reaction.

This neoplasm of the adrenal medulla contains catecholamines

(epinephrine and norepinephrine).


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There is some residual adrenal cortical tissue at the

lower center right, with the darker cells of

pheochromocytoma seen above and to the left.


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Pheochromocytoma

(Microscopic)Composed of large cells that

are pink to mauve and arranged

in nests with capillaries in

between.Remember 10% when you

think of a pheochromocytoma:

10% are bilateral

10% are in children 10% are malignant.


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Here is a normal pancreatic islet of Langerhans

surrounded by normal exocrine pancreatic acinar tissue.

The islets contain alpha cells secreting glucagon, beta cells

secreting insulin, and delta cells secreting somatostatin.


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Immunoperoxidase staining can help identify the nature

of the cells present in the islets of Langerhans.

On the right, antibody to insulin has been employed to identify the beta cells.

On the left, antibody to glucagon identifies the alpha cells.


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A insulitis of an islet of Langerhans in a patient who will

eventually develop type I diabetes mellitus.

The presence of the

lymphocytic infiltrates in this

edematous islet suggests anautoimmune mechanism for

this process.

The destruction of the islets

leads to an absolute lack ofinsulin that characterizes type

I diabetes mellitus.

This islet of Langerhans demonstrates pink


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hyalinization (with deposition of amyloid) in

many of the islet cells.

This change is common in the islets of patients with type II

diabetes mellitus.


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An islet cell adenoma

Separated from the pancreas by a thin collagenous capsule.

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Endocrine Pathology, UMI