Eosinophilic pituitary adenoma (457)

Scattered cells look like cytology

Monomorphism

Normal anterior pituitary

contains different cell types for
different hormones

eosinophilic

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

Parathyroid adenoma (464)

Some tendency to form follicles.

Similar to normal parathyroid
gland but more crowded.

Capsule between
adenoma and
normal tissue.

Usually unilateral

Produce PTH hypercalcemia symptoms

Osteoporosis, depression, seizure, gallstone, nephrolithiasis

Benign tumor

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

Parenchyma

Scallop (or moth eaten) appearance.

Adjacent parenchymal cells use
colloid to produce thyroid hormone,
producing empty space

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

Plummer syndrome:
multinodular goiter
Diffuse, homogenous goiter:

Grave's: hyperthyroidic goiter

Lack of iodine: hypothyroidic

goiter

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)

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.
Psammoma bodies
Cross section through papilla

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

Adrenal cortical adenoma (455)

Smooth border

Intracytoplasmic lipid

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.

Adrenal cortical carcinoma (456)

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

Rare neoplasm. Large, invasive.

Hypercortisolemia Cushing's

Might also cause Conn syndrome (too much aldosterone).

Usually asymptomatic until quite advanced (metastasis)

Pheochromocytoma (265)

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.

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.

Well-differentiated neuroendocrine tumor (islet cell tumor, APUD-oma)

(the pancreas) (458)

Pseudocapsule

Compressed parenchyma
of pancreas which became
fibrotic

Difficult to find on slide

Solid nest. Irregular.

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

-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

VIPoma (Verner Morrison

syndrome)

VIP (vasoactive intestinal

polypeptide)

Induces glycogenenolysis
hyperglycemia

Stimulate GI fluid secretion

secretory diarrhea
Gastrinomas (Zollinger-Ellison syndrome)

Also likely in duodenum and

peripancreatic soft tissue (gastrinoma
triangle)

Extreme gastric acid secretion peptic

ulcer

Jejunal ulcers possible