Download Endocrine practical block

Endocrine Block
Pathology Practical
Prepared by:
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Prof. Ammar Al Rikabi
Dr. Sayed Al Esawy
Dr. Marie Mukhashin
Dr. Shaesta Zaidi
Head of Pathology Department: Dr. Abdulmalik Al Sheikh
1- Multinodular Goiter
Pathology Dept. KSU
Endocrine block
Multinodular Goiter
Huge multiple neck nodules,
Clinically is
Multinodular Goiter or
large multinodular thyroid
mass.
Causes:
• IODINE deficiency
• Goitrogens, e.g., cabbage,
Brussels sprouts, cauliflower,
turnips, cassava)
• Congenital
Pathology Dept. KSU
Endocrine block
Many vegetables are goiterogens, fruits are NOT. Which one is NOT a goiterogen?
Multinodular Goiter - Gross
This diffusely asymmetric enlarged thyroid gland is nodular with haemorrhage
and cystic degeneration.
This represents the most common cause for an enlarged thyroid gland and the
most common disease of the thyroid
Pathology Dept. KSU
Endocrine block
Multinodular Goiter - LPF
Numerous follicles varying in size filled with colloid and lined with
flattened epithelium.
We can also see : Recent haemorrhage , Haemosiderin , Calcification
Pathology Dept. KSU
& Cystic degeneration
Endocrine block
Multinodular Goiter - LPF
The follicles are irregularly enlarged, with flattened epithelium
Pathology Dept. KSU
Endocrine block
2- Hyperthyroidism &
Grave’s Disease
Pathology Dept. KSU
Endocrine block
HYPERTHYROIDISM
CLINICALLY:
• Hypermetabolism
• Tachycardia, palpitations
• Increased T3, T4
• Goiter
• Exophthalmos
• Tremor
• GIT hypermotility
• Thyroid “storm”, life threatening
Pathology Dept. KSU
Endocrine block
Exophthalmos – Sign of Grave’s Disease
Proptosis, Lid lag , Lid retraction , Peri-ocular fat deposition
and Scleral rim above the iris
Pathology Dept. KSU
Endocrine block
Grave’s Disease - Gross
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Pathology Dept. KSU
Symmetrical enlargement of thyroid gland
Cut-surface is homogenous, soft and appear meaty
Hyperplasia and hypertrophy of follicular cells
Endocrine block
Grave’s Disease - LPF
A diffusely enlarged thyroid gland associated with hyperthyroidism is
known as Graves disease.
At low power field, note the prominent infoldings of the hyperplastic
follicular epithelium
Pathology Dept. KSU
Endocrine block
Grave’s Disease - HPF
Section shows thyroid follicles lined by columnar and high cuboidal
cells with evidence of peripheral vacuoles within the intrafollicular
colloid material .
Note the presence of peripheral smaller thyroid follicles devoid of
colloid but lined by similar cells
Pathology Dept. KSU
Endocrine block
3- Hashimoto’s Thyroiditis
Pathology Dept. KSU
Endocrine block
Hashimoto's Thyroiditis, Gross
This symmetrically small thyroid gland demonstrates atrophy. This patient
was hypothyroid. This is the end result of Hashimoto's thyroiditis.
Initially, the thyroid is enlarged and there may be transient
hyperthyroidism, followed by a euthyroid state and then hypothyroidism
with eventual atrophy years later.
Pathology Dept. KSU
Endocrine block
Hashimoto's Thyroiditis - Gross
• Diffuse enlargement.
• Firm or rubbery.
• Pale, yellow-tan, firm & somewhat nodular cut surface
Pathology Dept. KSU
Endocrine block
Hashimoto's Thyroiditis - LPF
This view shows an early stage of Hashimoto thyroiditis with prominent
lymphoid follicles containing large, active germinal centers.
In this autoimmune disease, antithyroglobulin and antimicrosomal (thyroid
peroxidase) autoantibodies can often be detected in serum.
Pathology Dept. KSU
Endocrine block
Hashimoto's Thyroiditis - HPF
This high power field view demonstrates the pink Hürthle cells at the center and
right. The lymphoid follicle is at the left.
Pathology Dept. KSU
Endocrine block
4- Follicular Adenoma
Pathology Dept. KSU
Endocrine block
Solitary Thyroid nodule
Central movable thyroid nodule occupying the thyroid isthmus
Pathology Dept. KSU
Endocrine block
Benign Follicular Adenoma – Gross cut section
 A well circumscribed light brown and circular tumor nodule
 Surrounded by a thick and whitish capsule
 The surrounding thyroid tissue is unremarkable .
Pathology Dept. KSU
Endocrine block
Benign Follicular Adenoma – LPF
The red arrow is located within the adenoma. Thyroid follicle cells with scant
colloid
The blue arrow points to the thick fibrous capsule of the adenoma
The yellow arrow points to colloid within a large normal follicle containing
colloid.
Pathology Dept. KSU
Endocrine block
Benign Follicular Adenoma – HPF
Normal thyroid follicles appear at the lower right. The follicular adenoma
is at the center to upper left.
Features which if present may indicate malignant behavior in this benign
lesion are:
- Vascular invasion.
- Capsular penetration and invasion.
Endocrine block
5- Papillary Thyroid
Carcinoma
Pathology Dept. KSU
Endocrine block
Papillary Thyroid Carcinoma
Huge thyroid swelling due to papillary
thyroid carcinoma
Pathology Dept. KSU
Endocrine block
Papillary Thyroid Carcinoma– Gross
A relatively well circumscribed pale and firm nodule showing a whitish
cut surface with vague scattered papillary areas .
Pathology Dept. KSU
Endocrine block
Papillary Thyroid Carcinoma– LPF
Sections show a papillary neoplasm consisting of papillary fronds
lined by overlapping clear nuclei
( Orphan Annie nuclei ).
Calcified Psammoma bodies are also seen (not seen here)
Pathology Dept. KSU
Endocrine block
Papillary Thyroid Carcinoma– HPF
Pathology Dept. KSU
High power microscopic field showing a classical papillary carcinoma
of the thyroid gland. Note the presence of intranuclear inclusion
(red arrow) and coffee bean nucleus with prominent nuclear groove
(black arrow)
Endocrine block
ADRENAL GLAND
Pathology Dept. KSU
Endocrine block
Pheochromocytoma
Pathology Dept. KSU
Endocrine block
Normal Adrenal Gland Histology
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1 – Periadrenal fat
3- Zona Glomerulasa
5- Zona Reticularis
Pathology Dept. KSU
5
4
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2 1
2- Adrenal Capsule
4- Zona Fasiculata
6- adrenal Medulla
Endocrine block
Pheochromocytoma – Gross cut section
A single partly pale and partly hemorrhagic adrenal medullary mass . 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 ( arrow )
Pathology Dept. KSU
Endocrine block
Pheochromocytoma – LPF
There is some residual adrenal cortical tissue at the lower
center right, with the darker cells of the pheochromocytoma
seen above and to the left.
Pathology Dept. KSU
Endocrine block
Pheochromocytoma – LPF
Pathology Dept. KSU
Microscopic view of pheochromocytoma consisting of circular
balls of cells with trabecular areas.
Note the presence of numerous blood vessels between the
tumor cells
Endocrine block
Pheochromocytoma – Electron Microscopy view
By electron microscopy, the neoplastic cells of the pheochromocytoma contain
neurosecretory granules. It is these granules that contain the catecholamines.
Pathology Dept. KSU
Endocrine block
Cushing Syndrome
Pathology Dept. KSU
Endocrine block
Cushing Syndrome – Clinical Case
A child with Cushing syndrome
as a result of Long-term
corticosteroids treatment. Note
the classical Moon face
appearance
Pathology Dept. KSU
A patient with Cushing syndrome.
Note the truncal obesity and
purple striae.
Endocrine block
Causes of Cushing Syndrome
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ACTH –DEPENDENT
Cushing disease (eg. pituitary adenoma )
Ectopic corticotrophin syndrome
ACTH-INDEPENDENT
Adrenal adenoma
Adrenal carcinoma
Macro nodular hyperplasia
Primary pigmented nodular adrenal disease
Cushing syndrome with Cortical Adenoma - Gross
 Well-circumscribed tumor
 The adenoma is composed
of yellow firm tissue
 Some remaining atrophic
adrenal is seen
Pathology Dept. KSU
Endocrine block
Cortical Adenoma - MPF
Histologically, it is composed of well-differentiated cells resembling the
normal cortical fasciculata zone. There may be minimal cellular
pleomorphism within adenomas. Occasional enlarged hyperchromatic
nuclei with one or more prominent nucleoli can be seen.
The capsule of this benign neoplasm is at the right. It is benign.
Endocrine block
GOOD LUCK