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Endocrine practical 1
By: Shifaa’ Qa’qa’
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Yo *-*, sorry for late sheet,read carefully what is written under the pictures and study the theory first and Histology lab to understand all the concepts. This file is for 2 records. LETS GO!!!
mohammad
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Laith sorour
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colloid
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C-cells have different origin from follicular cells, they are endocrine in origin and they secrete calcitonin. since its hard to see them we use immunohistochemical stain with AB to Calcitonin to see them or we can use other neuroendocrine markers
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with chronic inflamation we can see Hurthle cell metaplasia in thyroid,they are highly eosinophillic because of abundant Mitochindria we normally see them in oxyphil\parietal cells of stomach
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lymphoid follicle
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hurthle cell
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reaction between antigen & antibody under fluorescent light
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anti-TPO
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Other causes of this reaction :-FNA -Sutures after thyredoctomy -Infection (TB\Fungi)
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A 30 year old patient came with PAINFUL thyroid mass, she had recent upper respiratory tract infection(Viral),in biopsy we found granuloma & giant cells(abnormal).
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Will decrease radioactive iodine
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Multinodular goiter(non-neoplastic nodule) \\it have black color because of hemorrhage
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Goiter
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We are afraid of goiter because it can block airway passage or esophagous
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When we have Toxic multi-nodular goiter we call it Plummer syndrome (TSH independent nodule)
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Patient comes with exopthalmous, raised eyelid and other graves dz symptoms
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This looks like papilla but they are not true papilla(psuedopapilli) \\\ other causes of papilla:-papillary carcinoma(fibrovascular in papilla-->true papilla) -multinodular goiter(because of hyperplacisity) (psuedopapilli)
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clear vacuoles
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hyperplastic infoldings
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scalloping of colloid
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To make final diagnosis we need to see it under microscope for invasiveness.
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Tumor, looks like normal but more uniform \\\this is adenoma because didnt invade the capsule To concider it invasive carcinoma it should invade half of the capsule
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normal
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Vascular means follicular because all other carcinomas usually metastase to lymph nodes
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We dont care about the capsule because it may be or not, also we dont care about it because we only have papillary carcinoma(no papillary adenoma) if we have capsule we say capsulated papillary carcinoma(better prognosis)
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calcification
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If we dont see papilla or we cant differentiate if its papillary carcinoma\multinodular goiter\graves dz we look for nuclear features:(these are for papillary cacinoma) -orphan annie nuclei -pseudo-fusion (invagination of nuclear membrane) -nuclear grooves -overloaded cells
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psammoma bodies
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amyloid
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to defferntiate if its amyloid or fibrosis
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necrosis
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min 41
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this is anaplastic carcinoma which means doesnt have a deffenitive shape,it may develop from long standing follicular or papillary carcinoma,it its very invasive to surrounding tissue . mortality usually comes from invasion complication rather than tumor itself
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skeletal muscle invasion
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anaplastic carcinoma of thyroid ,it looks like spindle cells
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stalk
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anterior
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posterior
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because we cant identify each type of cell with H&E
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supporting cells in brain,have long processes
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abnormal in size pituatry, this can b adenoma or carcinoma,because of endocrine atypia we cant defferentiate so we search for invasion and mets
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vessels
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this is adenoma not normal cells, because there is mono-morphism & loss of reticulin . even we find high mitotic index it doesnt mean malignancy and it it may cause destruction to nearby structures but that is not invasion
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it have same symptoms as pituatary adenoma
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benign tumors with mass effect so it may cause bi-temporal heminopia because it compresses optic chiasm
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pituatary apoplexia-->acute hemorrhage in tumor\\\usually in anterior pituaary
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Primary-->herniation of CSF into sella turcica,usually in females secondary-->surgery (he had adenoma so we resected part of it \\\infarction(anything causing shock or sheehan\dic\anemia)
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Autoimmune disease
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end of record 1
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Parathyroid gland is nueroendocrine in origin, and composed of chief cells which produce Parathyroid hormone and oxyphil cells
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Normally we have 4 parathyroid glands ,but we may have less or more .if more we call them accessory or extra. Also, we can find parathyroid glands not in thyroid,usually in mediastenum and find them through nuclear radiological scan
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weight of normal parathyroid glands: 0.1-0.2 gram so the sum of 4 normal glands is less than 1 gram
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Patient came with hypercalcemia and we need to diagnose if he have PT hyperplasia or adenoma or carcinoma. if hyperplasia is more than one gland its just hyperplasia\\if only one it may be adenoma or carccinoma(if invasive and have mets)
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normal with adipose
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adenoma**no adipose
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this white are is fibrosis
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may be suggestive for carcinoma but not always
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if we have renal cancer and we want to spare the adrenal gland,how? adrenal gland is yellow in color because of yellow cortex which contains lipid for steroids
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Normal
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Atrophy :either Addison Dz or Long-term corticosteroid therapy \\hypopituatrism
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Bilateral Cortical Hyperplasia: Can be Pituatary Adenoma secreting ACTH (Cushing DISEASE)\\\ or cushing SYNDROME from ectopic ACTH production \\or idiopathic adrenal hyperplasia
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caseous necrosis
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langhans giant cells
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residual cortex
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patient will develop hypoadrenalism because of destruction of cortex . he may have electrolyte disturbance (hyperkalemia and hyponatremia) since no aldesterone secreted,,,,high ACTH because of negative feedback inhibition
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black because of hemorrhage
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the yellow is adrenal and the white is the tumor
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is adrenal gland is common for mets?nope but lung carcinoma commonly mets to adrenal gland
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For adrenal gland please study the theory,because the doctor talked a lot about the theory and not that much about the histological and gross appearance
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immature tumor
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usually in children and in adrenal medulla but can occur in other places
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atrophic remaining gland
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because it can secrete steroid hormones,in this case cortisol since he have cushing syndrome and the tumor resembles zona fasciculata
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in book its 35% for the conn syndrom while BAH is the rest
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normal
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Adenoma
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capsule
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in tumors resembling zona reticularis in adenoma we have hirruitism but in carcinoma virillizing but this is not a defenitive criteria
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endocrine atypia
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because of catecholamines
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If it occurs outside medulla we call it paragangilioma(comes from paraganglia--small structures around blood vessels)
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Residual adrenal cortical tissue
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Pheochromocytoma
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because chromaffin cells doesnt contain lipid doesnt contain spaces
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In familial cases (MEN syndrome ) its 40%
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first we must exclude pheochromycotoma mets because paraganglioma is benign
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fibrous trabecullae with vascular supply
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we use congo red stain for amyloid ,under polarized light it gives us pale green color
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neuroendocrine low grade malignant tumor
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salt and pepper nuclei and they are organized