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Exam 1 images Endo

Terms in this set (119)

A cells. make up 20%. Produce glucagon.
what is stained?
B cells. Make up 68%. Produce insulin
what is stained?
Diabetic Retinopathy. Scattered hemorrhages, yellow exudates and neovascularization. Neovascular vessels proliferating from optic disc.
What is seen and what is the disease?
CNIII. "down and out". Often from aneurysm.
Which palsy is this?
FB (needle) and gas bubbles
What are arrows pointing at?
Diabetic Foot ulcer
Rocker bottom deformity in charcot foot.
Lis Franc fx with ulceration under the cuboid.
periosteal reaction, bone is elevating.
what is happening
Necrobiosis lipoidica diabeticorum
XR of transmetatarsal amputation
What surgical intervention?
Normally wouldnt have enhancement of skin. Osteomyelitis with cellulitis.
Charcot foot. Chronic process that is weakening of bones/joints and soft tissue. Diabetic neuropathy leads to becoming insensitive to pain.
Lisfranc fx/dislocation

Fx of 2nd metatarsal base w/dislocation; fall on plantar flexed foot; significant swelling; non-weight bearing and painful
atherosclerotic changes, extensive arterial calcifications
echogenic (too bright) changes in kidney that is common in CKD.
Carotid stenosis. Can calculate degree of stenosis. More prolongued due to plaque buildup.
Carotid Duplex US - consistent with what?
Chronic small vessel disease. Seen in diabetes/HTN-uncontrolled. Bright CSF, ex vacuo,
acute L MCA stroke. cytotoxic edema and acute infarction.
calcification and inflammation. Fat necrosis "egg shell". Probably a patient who is prone due to calcifications posteriorly- where receiving injections.
thyroid follicular adenoma
Tan encapsulated mass excised from the neck
Follicular adenoma
histo of a thyroid gland
Follicular adenoma.

The follicular adenoma is at the center to upper left. This adenoma is a well-differentiated neoplasm because it closely resembles normal thyroid tissue. The follicles of the adenoma contain colloid, but there is greater variability in size of the neoplastic follicles than normal. There is no evidence of invasion into the normal thyroid.
histo of a thyroid gland
Follicular carcinoma. capsular invasion from a follicular gland
H&E from a thyroid gland
Follicular carcinoma
H&E thyroid
Capsule. FC
whats being invaded?
vascular. FC.
whats being invaded?
Papillary carcinoma
Lobe sectioned from an excised thyroid gland
Papillary carcinoma
Thyroid section with foci cystic changes
Papillary Carcinoma. The fronds of tissue have thin fibrovascular cores. The fronds have a papillary finger-like pattern.
Sectioning from thyroid is suspicious for what?
Branching papillae are lined by neoplastic columnar epithelium with clear nuclei. A calcospherite, or psammoma body, is evident.
What cell is depicted in the sectioning of a papillary carcinoma?
Papillary carcinoma.

This is another papillary carcinoma of thyroid. Note the small psammoma body in the center. The cells of the neoplasm have nuclei with a central clear appearance. Papillary carcinomas are indolent tumors that have a long survival, even when metastases occur. The most favorite site of papillary carcinoma metastasis is to local lymph nodes in the neck. In fact, some papillary carcinomas may first be detected as a nodal metastasis.
What is present and what kind of cell is in middle?
Nuclear groove. Papillary carcinoma.
What cell morphology is this? What is it suspicious for?
Medullary carcinoma of thyroid.
These tumors typically show a solid pattern of growth and do not have connective tissue capsules
These tumors typically contain amyloid,
visible here as pink homogenous
extracellular material, derived from
calcitonin molecules secreted by the
neoplastic cells.
What is suspicious for?
Papillary Carcinoma Intranuclear Cytoplasmic Inclusions (INCIs)
What is displayed?
Medullary Carcinoma

At the center and to the right is a medullary carcinoma of thyroid. At the far right is pink hyaline material with the appearance of amyloid. These neoplasms are derived from the thyroid "C" cells and, therefore, can have neuroendocrine features such as secretion of calcitonin or other hormones.
Section of thyroid. What is suspicious for?
Congo red.

Here the amyloid stroma of the medullary thyroid carcinoma has been stained with Congo red, imparting a reddish-orange appearance. Medullary carcinomas can be sporadic or familial. The familial cases can be multifocal and are associated with multiple endocrine neoplasia syndromes.
What stain is used here to depict medullary carcinoma?
close to 100! Anaplastic thyroid carcinoma.
What is the mortality rate with this etiology of the thyroid?
This immunohistochemical stain with antibody to calcitonin identifies the "C" cells (parafollicular cells) of the thyroid interstitium between the follicles, or adjacent to the epithelium of follicles. These parafollicular cells secrete calcitonin, which has minimal impact upon calcium regulation.
Calcitonin has some opposing effects to PTHG
Inhibit osteoclasts
Inhibit gut CA absorption
Inhibit renal CA reabsorption
What cells are highlighted in this stain?
Thyroglossal duct cyst. Remnant of thyroid embryological pathway of development. Can appear anywhere along pathway. Mostly found near hyoid.
whats ddx? What causes it?
Lingual thyroid.
whats ddx?
Goiter
ddx?
Cause hypothyroid. It blocks I+ uptake into thyroid. Interupting thyroid synthesis.
What could excess of this bad boy do to you?
Graves.

colloid eaten, colloid stores thyroid hormone, diffusely enlarged thyroid gland associated with hyperthyroidism is known as Graves disease. At low power microscopically, note the prominent infoldings of the hyperplastic epithelium. In this autoimmune disease the action of thyroid stimulating immunoglobulins (TSI's) predominates over that of thyroid growth immunoglobulins (TGI's). Typical laboratory findings with Graves disease include an increased serum thyroxine but decreased TSH.
Thyroid section suspicious for what?
Scalloping out of colloid in the follicle.
What is term for this finding?
Anterior.


The normal microscopic appearance of the adenohypophysis is shown here. The adenohypophysis contains three major cell types: acidophils, basophils, and chromophobes. The staining is variable, and to properly identify specific hormone secretion, immunohistochemical staining is necessary.
Anterior or posterior pituitary?
early stage of Hashimoto thyroiditis shows prominent lymphoid follicles. This is an autoimmune disease, and often antithyroglobulin and antimicrosomal (thyroid peroxidase) antibodies can be detected in serum. Other autoimmune diseases such as Addison disease or pernicious anemia may also be present. Both thyroid growth immunoglobulins (TGI) and thyroid stimulating immunoglobulins (TSI) are present, though blocking antibodies to TSI mitigate their effect.
What is ddx?
pink Hürthle cells at the center and right. A lymphoid follicle is at the left. Hashimoto thyroiditis initially leads to painless enlargement of the thyroid, followed by progressive atrophy over following years. Aside from surgery, this is the most common cause for hypothyroidism in adults.
What cell is in center? What is it pneumonic for?
anti-thyroid peroxidase.

Note the bright green fluorescence in the thyroid epithelial cells, whereas the colloid in the center of the follicles is not staining and is dark.
What is this immunofluoresence staining positive for in this patient with Hashimotos?
immunofluorescence positivity for anti-thyroglobulin antibody. Patients with Hashimoto thyroiditis may also have other autoimmune conditions including Graves disease, SLE, rheumatoid arthritis, pernicious anemia, and Sjögren syndrome.
What is this immunofluoresence staining positive for in this patient with Hashimotos?
This is subacute granulomatous thyroiditis (DeQuervain disease),


which probably follows a viral infection and leads to a painful enlarged thyroid. This disease is usually self-limited over weeks to months, with transient hyperthyroidism and/or hypothyroidism, and affected patients return to a euthyroid state. Note the presence of large foreign body giant cells with inflammatory destruction of thyroid follicles
What is ddx in this section of thyroid?
posterior.

The neurohypophysis shown here resembles neural tissue, with glial cells, nerve fibers, nerve endings, and intra-axonal neurosecretory granules. The hormones vasopressin (antidiuretic hormone, or ADH) and oxytocin made in the hypothalamus (supraoptic and paraventricular nuclei) are transported into the intra-axonal neurosecretory granules where they are released from the neurohypophysis
Anterior or posterior pituitary?
Craniopharyngioma.


It is derived from remnants of Rathke's pouch and forms an expanding mass arising in the sella turcica that erodes bone and infiltrates into surrounding structures. They are difficult to eradicate, even though they are composed of histologically appearing squamoid and columnar epithelium lining cystic spaces filled with oily fluid.
Epithelium and cystic
what pituitary tumor? What is it derived from?
Angiofibromas. MEN 1
What is this? What is it seen in?
Osteitis fibrosa cystica. Primary hyperparathyroidism.
What are bone changes? What are they commonly seen in?
Brown tumor of bone.

The high parathormone levels increase osteoclast activity in bone and produce irregular bone resorption with microfractures and hemorrhage and macrophage proliferation and fibrous connective tissue proliferation
What is seen in patient with primary hyperparathyroidism?
Parathyroid adenoma.

which is the most common cause for primary hyperparathyroidism. A rim of normal parathyroid tissue admixed with adipose tissue cells is seen compressed to the right and lower edge of the adenoma.
Chief and oxyphil
What parathyroid pathology is seen?
parathyroid hyperplasia. Little or no adipose tissue. Pink oxyphil cells in nodule seen here.
What parathyroid pathology is seen?
Parathyroid carcinoma.

Not pleomorphic, invading between collagen bundles in neck
What parathyroid pathology is seen?
Tumor in neck. Unsure what it is, can do PTH stain indicates parathyroid origin
What does this stain tell you? From a patient with a tumor in neck.
Hands of patient with pseudohypoparathyroidism and brachymetacarpals.
What is ddx?
Pineoblastoma, under 20, poor.
Tumor of pineal gland. What age group? Survival?
Adrenal adenoma
What is most likely tumor?
N. Meningitidis.



These adrenals have a black-red color from extensive hemorrhage in a patient with meningococcemia and disseminated intravascular coagulopathy. This is known as the Waterhouse-Friderichsen syndrome. Infection with Neisseria meningitidis can start initially as a mild pharyngitis, but become a florid septicemia within hours.
What is most likely causative agent in this pathology of adrenals?
Lymphocytic infiltration
What is seen on biopsy of adrenals?
Adrenocortocal adenoma.

Microscopically, the adrenal cortical adenoma at the right resembles normal adrenal fasciculata. The capsule of this benign neoplasm is at the left. There may be minimal cellular pleomorphism within adenomas.
What is happening in adrenal biopsy?
Adrenocortical carcinoma.

Marked anaplasia.
biopsy of adrenal demonstrates what?
Mets to skin from neuroblastoma.
"blueberry muffin baby"
What is this? What is it suspicious for?
Neuroblastoma.
What adrenal pathology could cause this in child?
Homer wright rosette.

Halo of tumor cells arranged around central neutrophil.
What is seen in this patient with neuroblastoma?
Zellballen. Seen in pheochromochytoma.
What is this spindle cell nests called? What is it indicative of?
probably a lot... but ...

Allan Herndon-Dudley Syndrome

Very high serum T3 due to mutation in MCT8, X-linked.
Pt presents with severe mental retardation, dysarthria, atheoid movements, muscle hypoplasia and spastic paraplegia. What mutation would you consider?
Insulin
what is produced in the cells that are stained?
Glucagon
what is produced in the cells that are stained?
Somatostatin
what is produced in the cells that are stained?
DMI. Lymphocytic infiltration in an islet of Langerhans --> INSULITIS.

Islet is edematous with infiltrates suggests an autoimmune mechanism.

Destruction leads to lack of insulin.
What is this suggestive of?
DMII. HYALINIZATION!!!!!

Deposits of amyloid in many of the islet cells.
Staining of a pancreas indicates what.
Congo Red Stain- Amyloid.
This patient with DMII has what kind of stain? What does it show?
Insulinoma. Tumor cells with interspersed amyloid deposition.
Staining from a pancreas is indicative of what?
Necrolytic migratory erythema. Often hands, face, groin.
Sx of glucagonoma.
What is term of this skin change? What does it possibly indicate?
Necrolytic migratory erythema.

Necrosis of superficial epidermis can lead to bullae.

Parakeratosis appears as scale.
Parakeratosis with necrosis is histopathology of what skin condition?
Aspergillus.

Diabetics more susceptible to infections. This can cause severe ENT disease.

Acute angle (<45)
What infection in diabetics?
Mucormycosis.

Nonseptate, larger angle branching

Note the infection spreads rapidly from the nasal cavity and can affect flanking tissue. Ocular infections can occur as a complication, leading to blindness. Mortality is greater than 50% even with treatment.
What infection in diabetics?
Port wine hemangioma. Sturge-weber.

First or second trigeminal division.

Pts have seizures and intellectual disabilities.
what is this? What is it seen in?
Cafe au lait spots. NF.
what is this? What is it seen in?
Ash Leaf Spots
what is this? What is it seen in?
Monoplegia, hemiplegia, diplegia (Can be legs or arms), quadriplegia
Left to right name the types of cerebral palsy.
Macular red cherry spot, seen in 50% Niemann-pick disease.
What is this called? What is it seen in?
Angelman syndrome.

Maternal deletion of 15th chromosome.

Tongue thrusting!
What disorder?
Bottom- axon end swellings called Herring bodies- neurosecretory. Either ADH or oxytocin is released.

Above, green, is blood capillaries.
What cells are seen in the neurohypophysis?
Hormones made in hypothalamus enter fenestrated capillary bed formed by inferior hypophyseal artery a branch of the IC.

Leave via the hypophyseal vein.
What artery do neurohypophyseal hormones enter and how do they leave?
p: pituicytes
NB: neurosecretory bodies (oxytocin, or ADH)
C: capillaries, pick them up and distribute.

Other-unmyelinated axons.
What cells are seen in pars nervosa?
Hypothalamic hormones are secreted into fenestrated capillary bed (PRIMARY CAPILLARY PLEXUS) formed in the median eminence by the superior hypophyseal artery a branch of the internal carotid artery.

Hypothalamic hormones travel thru portal veins to a SECONDARY CAPILLARY PLEXUS located in the anterior pituitary

Hypothalamic hormones leave the secondary capillary plexus and interact with hormone receptors on specific target cells of the anterior pituitary.

The target cells in the anterior pituitary release their pituitary hormone in response.
What is blood supply to anterior pituitary?
Secretory granules in adenohypophysis. This is actually of a somatotroph producing GH.
Electron microscope of what in pituitary?
Chromophobes

No secretory granules

Probably undifferentiated cells or supportive cells
What cell in adenohypophysis?
Chromophils contain granules which stain either basophilic (blue) and are called basophils (or beta cells), or
What cell in adenohypophysis?
Acidophils. Alpha cells. A type of chromophil.
What cell in adenohypophysis?
Pars distalis
What part of adenohypophysis produces several hormones?
Endocrine cells are organized as cords.
How are cells arranged in pars distalis?
Pars intermedia.

Has colloid cysts which are a remnant of Rathke's pouch.

Basophils produces MSH (melanocyte stimulating hormone);
What part of adenohypophysis?
Gonadotropins. Arranged in cords.
What is secreted in pars tuberalis?
Colors cytoplasm of acidophils yellow.
Brooks stain of pituitary helps show what.
Its an acidophilic adenoma. Immunoperoxidase method using a specific antibody to growth hormone
What is shown in the acidophilic staining of the pituitary?
Astrocytes-darker staining, small, elongated nuclei.
Pinealocytes- sharply defined nucleoli, basophilic, lobated. Smaller cells. produce melatonin.


Brain sand (corpora arenacea): characteristicand diagnostic feature of the pineal gland.

Calcified, useful radiographic landmark.
What cells seen in pineal gland?
Cuboidal or simple squamous epithelium.
what cells line the follicles of thyroid?
Oxyphil- to the right. function unknown. •Larger very distinctive cell.

•Strongly acidophilic cytoplasm due to an abundance of elongated mitochondria.

•Chief Cells small polygonal cells with centrally placed nuclei and a pale, slightly acidophilic cytoplasm.

•contain cytoplasmic granules of parathyroid hormone (PTH; protein).
what are two cell types of parathyroid?
Inferior suprarenal artery. (renal artery branch)
middle suprarenal (from abd aorta)
superior suprarenal (from inferior phrenic A)
what is blood supply to adrenal glands?
Branches of capsular penetrate cortex forming cortical arteriole that break up into subcapsular plexus that form sinusoidal vessels then continue as deep plexus and as medually plexus in medulla.
what is blood flow thru adrenal? Path 1 (more complex)
capsular arteries give off medullary arterioles that go thru cortex and empty into medullary plexus in medulla
what is blood flow thru adrenal? Path 2 (less complex)
all aterial blood drains into medullary veins that empty into suprarenal veins. On R ends in SVC. On L go to L renal or L phrenic vein.
How does blood drain thru adrenals?
Zona Reticularis. Contains less lipid droplets and more lipofuscin pigment.
which cell layer of adrenal cortex stains the heaviest?why?
Trypsin, amylase, lipase, bicarb.
exocrine functions of pancreas?
Para-vagus
symp-Greater splanchnic (T6-T9)
innervation of pancreas?
Splenic A from Celiac trunk.
what branches supply pancreas body and tail?
Common Hepatic. (from celiac)
Gives off Gastroduodenal A - which gives off A/P superior pancreaticoduodenal arteries
Neck and superior head of pancreas blood supply?
SMA- gives off inferior pancreaticoduodenal (a/p)
blood supply to Uncinate process and lower head of pancreas?
Tubules are endoderm and surrounded by mesoderm.
Development of tubules for exocrine function?
Increases secretion glucagon. Inhibits insulin.
sympathetic activation of pancreas?
increases both glucagon and insulin.
parasympathetic activation of pancreas?
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