his to pathology 2
TRANSCRIPT
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Histopathology of EndocrineSystem
by
Dr. Irene Suryahudaya
Pathologist-dermatologist
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Endocrine system
Primary function : control ofHOMEOSTASIS .
Endocrine disease ---- result frompathogenetic mechanism----inclabnormality :in the synthesis and
secretion of hormonal stimulation.
Homeostasis ??-------------.
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In general;endocrine
disorder Production of
hormone :
Underproduction
Overproduction
Clinical apearance
Hypofungtional
Hyperfungtionalstate
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Pituitary gland
Embryology and anatomy of pituitary gland
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Diseases of pituitary gland
Hyper pituitarism.
Increased production.
And releasehormones.
Gen; Cause byadenomaof theanterior pituitary.
Microscopic:monomorphadenoma ,in rutin
section HE can app aseosinophilic,basophilicor chromophobicappearance.
Hypopytuitarism. May result fr hypothalamic
/primary pitutari disorder.
Lesion ascraniopharyngioma
or,glioma.
Primary pit disordersunderline most cases ;causes include a; Nonsecretory
adenomas,sheehanssyndrome,empty sellasyndrome.
Radiation and accident.
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Non secretory pituitary
adenomas Present as space occupying lesions
Grossly indistinguishable fr
fungtional adenomas
Microscopic:
App is variable,incl some poorlygranulated,chromophobicadenomas
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Sheehanss yndrome
Usually causes by infarction of theanterior pituitary
Ass: with obtetrichemorrhage/shock It may also occur in male ?and non
pregnant woman ? (trauma, vascularaccident, DIC, sickle cell anemia)
Gen ass with destruction of 90 to 95 %of the gland
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Empty sella syndrome
Primary lessions : herniation of arachnoidand CSF through a defect in thediafragma sellae,----result compression
of the pituitary Secondary lesions following destruction
of normal gland via ischemicinjury,infarction of adenoma or radiation
Enlargement of the sella may bemistaken radiolographically for a pituitaryneoplasm
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Craniopharyngioma 5% of intracranial neoplasm
Most are found in patients during 2-3 decades
Characteristic: cystic ,calsification 75%
Microscopically: composed of a mixture ofsquamous apithelial elements and delicatereticular stroma
Appearance of the enamel organ of a developingtooth
Gliosis is common at the perifer Malignancy is rare
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THYROID GLAND
Embryologi and anatomi
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Diseases of thyroid gland
Thyroiditis
Goiter
Neoplasm
Congenital lesions
Hyperthyroidism
hypothyroidism
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Congenital lesions
Thyroglossal duct cysts
Represent persistence of thyroid anlage
extending from the foramen cecum Midline cysts anterior to the trachea
Histopatologic : varying mixtures of
squqmous and columnar epithelialandlymphoid cells
May become secondary infection
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Hyperthyroidism
A hypermetabolic state secondary toincreased levelsof circulating T3 andt4
Clinical : nervousness,heat intoleranceexcessive perspiration, fatigue,palpitation, tachycardi, weight lossdespite good appetite.Wide-eyed
Laboratory:elevated T3 and T4
Thyroid storm
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Hypothyroidism
A hypometabolic state caused bydeficiency of thyroid hormones
Clinic: Cretinism if thyroiddefisiency develops duringperinatal period or infancy,and
myxedema in older chidren andadults
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Thyroiditis
Infectious thyroiditis
Hashimotos Thyroiditis
Subacute granulomatous thyroiditis Lymphocytic thyroiditis
Riedel thyroiditis
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Infectious thyroiditis
Agents: staphylococusaureus,streptococci,sarmonella,ent
erobacter,mycobacteria and fungi May be hematogenous or
associated with local trauma RRR
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Hashimoto thyroiditis
Autoimun disorder
Female predominance(10:1)
Peak incidence is 30 to50 years of age Associated with HLA-DR5 and other
autoimun disorders eg: SLE
Clinical:symmetric or focal rubbery
enlargementof the gland with an intakecapsule
Microscopic:exuberant lympocyticinfiltrate with germinal centers.
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Subacute granulomatous
thyroiditis De QuervainS Thyroiditis
An inflamatory disorder of uncertain
etiology;viral origin is sugested Female predominance
Clinical : fever,painfull enlargement ofthe gland ,trancient T3-T4are elevated
Micoscopic:enlargement of thegland,evokes neutophilicinfiltrates,macrophagesandmultinucleated giant cells
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Subacute
lymphocyticthyroiditis An inflamatory disorder of
unknown etiology defined
histologically by nonspesificlymphoid infiltrationof the thyroidparenchyma
No germinal center formation
No significantplasma cell infiltrate
No clear with viral infection
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Riedels thyroiditis(struma)
An uncommon fibrosing process ofunknown etiology
Replacement of thyroid parenchyma bydense fibrous tissue penetrating thecapsule and extending into contiguousneck structures
Female predominance(3:1) Peak incidence fourth to seventhdecades
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Diffuse nontoxic
goiter(simple goiter) The gland is diffusely enlarged
No evidence of hyper or hypothyroidism
Occurs in endemic and sporadic forms Endemic goiter is most prevalent in
areas with dietary iodine deficiencye.g;Alps,himalaya)
Sporadic goiter is less common thanendemic goiter
Female predominance(8:1)
Peak incidence in puberty/young adultlife
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Neoplasms
Adenomas
Multiple histologic allrepresenting
follicular neoplasms Mic: fibrous capsule
Architecture distinctfrom the ajacent
gland Abcence ofmultinodularity inthe remaining gland
Carcinomas
Femalepredominance
Causes 7000 U.Sdeaths annually
Morphologicvariants:
Papillary.follicular,medullary,others(sarcoma,lymphomas)
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Papillary carcinoma
Most common form of thyroid cancer in children &adults
All thyroid neoplasms with papillary architecture
Typically infiltratif;fibrosis and calcification arecommon,often multifocal
Clearground-glassnuclei are common and
diagnostic of papillary carcinomaPsamomas bodies are found in papillaein one half of
patients
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Follicular carcinoma
One fourth of thyroid malignancies
Peak incidence in the fith to sixth decades
Gross resembling follicularadenoma.fibrosis,hemorhage,necrosis and cyst
formation are relatively common
Ground glass nuclei and psamomas bodies are
absent
Clinical features,more aggressive than papillary ca
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Medllary carcinoma
Rare tumor
Arising from calcitonin producing cells of
the thyroid
Blood calcitonin is high
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Parathyroid glands
Hyperfunction :
a. primary---due to
hyperplasia b.Secondary----
reaction to
hypocalcemia
Hypoparathyroidsm
-accidental surgical
removal of theparathyroid
duringthyroidectomi
-autoimun disease
-conggenital
defisiency
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Adrenal cortex
Developmental
anomalies
Hypofunction ofadrenal cortex
(hypoadrenalism)
Hyperfungtion of
adrenal cortex
Hyperadrenalism Cushings disease
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Hypofungtion of adrenal cortex
Cused by anatomic ormetaboliclesions in
the adrenal cortex(primaryadrenocortical
insuffisiency) Caused by hypothalamicpituitary disease
(secondary)
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Cushings syndrome
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Pheochromocytoma
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Thymus
Thymic agenesis and hypoplasia
Thymic hyperp[lasia
tumors
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The skin
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