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Endocrine gland
Hormone categories
Left: a steroid (lipid) hormone (1) enters a cell (2) binds to a receptor protein (3)
causes
mRNA
synthesis,
the
first
step
of
protein
synthesis.
Right: protein hormones (1) bind with receptors which (2) trigger a transduction
pathway. (3) transcription factors are activated in the nucleus: protein synthesis
starts. In both diagrams, a is the hormone, b is the cell membrane, c is the
cytoplasm, and d is the nucleus
Endocrine pathology
1. Impaired synthesis :
Underproduction/overproduction of
hormones
2. Disease associated with mass lesions
Nonfunctional/underproduction/overpro
duction
Pituitary
Pituitary
Neurohypophysis
Hypopituitarism
Pituitary adenoma
Lloyd RV, Kovacs K, Young WF, Farrel WE, Asa SL. Pituitary tumour. In : DeLellis
RA, Lloyd RV, Heitz PU, Eng C, editors. Pathology and genetics of tumours of
endocrine organs. France: Llyon; 2004.
Pituitary adenoma
Well circumscribed
30% unencapsulated, infiltrate bone, dura and brain
invasive adenoma
Microscopically :
Uniform polygonal cells arrange in sheets, cord or
papilae
Nuclei : uniform/pleomorphic
Mitotic activity scanty
This cellular monomorphism and absence of a
significant reticulin network distinguish adenoma
from non neoplastic lesion
Adenohypophysis adenoma
Tipe
Prolactinoma (lactotroph adenomas) (chromophobe or weakly acidophilic)
GH (somatotroph cell) adenomas (eosinofil)
ACTH-secreting (corticotroph cell) adenoma (basofil)
Lainnya: Thyrotroph (TSH-producing) adenomas, Nonfunctioning
pituitary adenomas (null cell adenomas)
Prolactinoma
Pituitary carcinoma
Thyroid
Penyakit tiroid
Hyperthyroidism
Hyperthyroidism
Causes of thyrotoxicosis
Not associated with hyperthyroidism:
Subacute granulomatous thyroiditis
(painful)
Subacute lymphocytic thyroiditis (painless)
Struma ovarii (ovarian teratoma with
thyroid)
Factitious thyrotoxicosis (exogenous
thyroxine intake)
Hypothyroidism
Cretinism
Myxedema
= Gulls disease
Clinical feature :
Apathy and mental sluggishness early
state mimic depression
Listless, cold intolerant, obese
Mucopolysaccharide-rich edema
accumulates in skin, subcutaneous tissue
& visceral sites
30-50 y
Caused by viral infection/postviral inflammatory
process, majority of patients have history upper
respiratory infection
Clinical feature :
Pain (particularly when swallowing), fever,
malaise & enlargement of thyroid
Transient hyperthyroidism, with progression of
disease a transient hypothyroid phase may ensue
Self limited (return to euthyroid 6-8 wk)
Riedel thyroiditis
Graves disease
Thyrotoxicosis
Infiltrative ophthalmopathy exophthalmus
Infiltrative dermopathy/pretibial myxedema
Graves disease
Infiltrative ophthalmopathy :
Marked infiltration of the retroorbital space by
mononuclear cells, predominantly T cells
Inflammatory edema & swelling of extra-ocular
muscles
Accumulation of extracellular matrix, specifically
hydrophilic glycosaminoglycans such as hyaluronic
acid & chondroitin sulfate
Increase number of adipocytes
Graves disease
Clinical feature:
Thyrotoxicosis
Diffuse hyperplasia of thyroid
Ophtalmopathy
Dermatopathy
Thyroid enlargement usually smooth & symmetric,
but sometimes asymmetric
Increase blood flow to the thyroid audible bruit
Increase serum free T4&T3, depressed serum TSH
Radioactive iodine uptake is increased
Radioiodine scan show diffuse uptake of iodine
Graves disease
Clinical features :
Mass effect of enlarged gland
Airway obstruction
Dysphagia
Compression of large vessels in the neck & upper
thorax
Minority : hyperthyroidism without
ophthalmopathy & dermopathy Plummers
syndrome
Thyroid adenoma
Thyroid adenoma
Here is a surgical excision of a small mass from the thyroid gland that has been cut in
half. A rim of slightly darker rim normal surrounding thyroid parenchyma is seen at the
left. The mass is well-circumscribed.
Carcinoma thyroid
Carcinoma thyroid
Pathogenesis
Genetic variables
Papillary thyroid carcinoma : chromosomal
rearrangement RET gene
Follicular thyroid carcinoma : mutation in the RAS
family (HRAS, NRAS & KRAS) or PAX8-PPAR1
fusion
Medullary thyroid carcinoma : RET proto-oncogene
mutation activation of receptor
Anaplastic carcinoma : inactivating point mutation in
the p53 tumor supressor gene
Enviromental variables
Ionizing radiation (first 2 decades of life)
Long standing multinodular goiter
Papillary carcinoma
Clinical features
Nonfunctional tumor : painless mass in the neck
Minority, hematogenous metastases present at the
time diagnosis, most common in the lung
Indolent lesion, 10 ysr >95%
Prognosis less favorable among elderly or with
invasion of extrathyroidal tissue or distant metastases
Morphology
Diagnosis based on nuclear features : ground glass,
intranuclear inclusion, groove
Psammoma bodies
Follicular carcinoma
Morphology :
May be grossly infiltrative/minimally invasive
Diagnosis require capsular/vascular invasion
Capsular invasion
Vaskular invasion
Medullary carcinoma
Medullary carcinoma
Clinical feature
Mass in the neck compression effect
Effect from peptide hormone : diarrhea
Morphology :
Solitary nodules/multiple, may involving both lobes
Muticentricity is common in familial cases
Composed of polygonal to spindle shaped cells
nest, trabeculae & follicles
Acellular amyloid deposits distinctive feature
Anaplastic carcinoma
Anaplastic carcinoma
Parathyroid
Hyperparathyroidism
Primary hyperparathyroidism
Clinical feature
F:M = 3:1
In the most common cause of clinically silent
hypercalcemia
Symptoms : painful bones, renal stones, abdominal
groans & psychic moans, pain (fracture of bones).
Secondary hyperparathyroidism
Morphology
Parathyroid adenoma
Parathyroid adenoma
Parathyroid adenoma
Parathyroid hyperplasia
Parathyroid carcinoma
Pancreas
Pancreas
Pancreas consist of :
Exocrine : secrete digestive enzymes into the
duodenum
Islet of Langerhans : act as endocrine gland
The islet consist of clusters of compact cells,
contain at least four distinct cell types
according to their hormone content (detected
by immunohistochemistry)
Cell type
% in islets
hormone
actions
Beta
70
Insulin
Alpha
20
Glucagon
Delta
Somatostatin
PP
Pancreatic
polypeptide
Diabetes mellitus
Pancreas tumor
Jain
D.
Ductal
adenocarcinoma
NOS.
2012.
access
from
http://www.pathologyoutlines.com/topic/pancreassuperpagetumor.html
Adrenal cortex
Adrenocortical hyperfunction
Clinical feature :
Insidious onset, except if associated with small cell
carcinoma of the lung
Early manifestation : hypertension & weight gain
Centripetal distribution of adipose tissue truncal
obesity, moon face & buffalo hump
Glucocorticoid gluconeogenesis hyperglycemia,
glucosuria & polydipsia
Glucocorticoid supress immune response
Morphology
Pituitary changes : Crooke hyaline change glassy
hyaline appearance result of the accumulation of
intermediate keratin filamen in the cytoplasm
Adrenocortical hyperplasia
Adrenocortical adenoma
Adrenocortical adenoma
Adrenocortical adenoma
Adrenocortical carcinoma
Rare neoplasm
Gross : poorly demarcated, contain areas of necrosis,
hemorrhage & cystic change
Microscopic :
Well differentiated cells or bizarre, pleomorphic cells
Hyperaldosteronism
Secondary hyperaldosteronism
Aldosterone release in reponse to activation of reninangiotensin system increased levels of plasma renin
Associated with : decrease renal perfusion, arterial
hypovolemia&edema, pregnancy
Adrenal insufficiency
Acute
Waterhouse-Friderichsen syndrome
Sudden withdrawal of longterm corticosteroid therapy
Stress in patients with underlying chronic adrenal
insufficiency
Chronic
Major contributors
Autoimmune adrenalitis
Tuberculosis
Acquired immunodeficiency syndrome
Metastatic disease
Minor contributors
Systemic amyloidosis
Fungal infection
Hemochromatosis
Sarcoidosis
Acute adrenocortical
insufficiency
Exogenous
corticosteroid
Atrophic
adrenal
Rapid
withdrawal of
steroid
Acute stress
Failure to
increase
steroid
Adrenal crisis
Chronic adrenocortical
insuffiency (Addison disease)
Infections
Particularly tuberculosis & fungi
Metastatic neoplasm
Fairly common site for metastases
Ca of the lung & breast are the source of majority of
metastases in adrenal
Adrenal medulla
Pheochromocytoma
Pheochromocytoma
MEN, type 2B
Thyroid and adrenal medulla commonly
involved
Unlike MEN-2A, patients with MEN-2B :
Do not develop primary hyperparathyroidism
Develop extraendocrine organism :
ganglioneuroma of mucosal sites
(gastrointestinal tract, lips, tongue) &
marfanoid habitus
Thank You
Normal
parathyroid
Parathyroid gland
The four small parathyroid glands are
located in the neck, right next to the
thyroid gland. The parathyroid glands are
endocrine organs producing a hormone
called parathormon (PTH) and are
involved in calcium blood level regulation.
In the low power magnification a round,
encapsulated organ is seen. Within the
gland there is a lot of adipose tissue and
numerous venules, which run through the
gland that are filled with red blood cells.
These are seen either in cross section or
longitudinal section.
The parathyroid gland has two cell types,
chief cells and oxyphil cells. Chief cells are
more numerous and have a round nucleus
surrounded by a small amount of
cytoplasm. Chief cells produce PTH. The
oxyphil cells are seen in scattered groups
among the chief cells. They have a slightly
smaller nucleus and eosinophillic
cytoplasm. The function of the oxyphil
cells is unknown.
Adrenal cortex
Consist of 3 layers :
Z. glomerulosa (beneath the capsule)
Z. fasciculata (75% total cortex)
Z. reticularis (abut the medulla )
Adrenal medulla
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