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Endocrine Block Pathology Practical Prepared by: • • • • 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 • • • 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 6 1 – Periadrenal fat 3- Zona Glomerulasa 5- Zona Reticularis Pathology Dept. KSU 5 4 3 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 • 1. 2. • 1. 2. 3. 4. 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