Endocrine Block Pathology Practical Prepared by: Prof. Ammar Al Rikabi Dr. Sayed Al Esawy Dr. Marie Mukhashin Dr. Shaesta Zaidi Head of Pathology Department: Dr. Abdulmalik Al Sheikh

1- Multinodular Goiter Endocrine block Pathology Dept. KSU

Multinodular Goiter Endocrine block Pathology Dept. KSU Huge multiple neck nodules, Clinically is Multinodular Goiter or large multinodular thyroid mass. Causes: IODINE deficiency Goitrogens, e.g., cabbage, Brussels sprouts, cauliflower, turnips, cassava) Congenital

Many vegetables are goiterogens, fruits are NOT. Which one is NOT a goiterogen?

diffusely asymmetric enlarged nodular with haemorrhage and cystic degeneration. This diffusely asymmetric enlarged thyroid gland is nodular with haemorrhage and cystic degeneration. This represents the most common cause for an enlarged thyroid gland and the most common disease of the thyroid Multinodular Goiter - Gross Endocrine block Pathology Dept. KSU

Multinodular Goiter - LPF follicles varying in size filled with colloid and lined with flattened epithelium Numerous follicles varying in size filled with colloid and lined with flattened epithelium. We can also see : Recent haemorrhage, Haemosiderin, Calcification & Cystic degeneration Endocrine block Pathology Dept. KSU

follicles are irregularly enlarged, with flattened epithelium The follicles are irregularly enlarged, with flattened epithelium Multinodular Goiter - LPF Endocrine block Pathology Dept. KSU

2- Hyperthyroidism & Grave’s Disease Endocrine block Pathology Dept. KSU

CLINICALLY: Hypermetabolism Tachycardia, palpitations Increased T3, T4 Goiter Exophthalmos Tremor GIT hypermotility Thyroid “storm”, life threatening HYPERTHYROIDISM Endocrine block Pathology Dept. KSU

Exophthalmos – Sign of Grave’s Disease Proptosis, Lid lag, Lid retraction, Peri-ocular fat deposition and Scleral rim above the iris Endocrine block Pathology Dept. KSU

Symmetrical enlargement of thyroid gland Cut-surface is homogenous, soft and appear meaty Hyperplasia and hypertrophy of follicular cells Grave’s Disease - Gross Endocrine block Pathology Dept. KSU

Grave’s Disease - LPF A diffusely enlarged thyroid gland associated with hyperthyroidism is known as Graves disease. At low power field, note the prominent infoldings of the hyperplastic follicular epithelium Endocrine block Pathology Dept. KSU

Section shows thyroid follicles lined by columnar and high cuboidal cells with evidence of peripheral vacuoles within the intrafollicular colloid material. Note the presence of peripheral smaller thyroid follicles devoid of colloid but lined by similar cells Grave’s Disease - HPF Endocrine block Pathology Dept. KSU

3- Hashimoto’s Thyroiditis Endocrine block Pathology Dept. KSU

This symmetrically small thyroid gland demonstrates atrophy. This patient was hypothyroid. This is the end result of Hashimoto's thyroiditis. Initially, the thyroid is enlarged and there may be transient hyperthyroidism, followed by a euthyroid state and then hypothyroidism with eventual atrophy years later. Hashimoto's Thyroiditis, Gross Endocrine block Pathology Dept. KSU

Hashimoto's Thyroiditis - Gross Diffuse enlargement. Firm or rubbery. Pale, yellow-tan, firm & somewhat nodular cut surface Endocrine block Pathology Dept. KSU

This view shows an early stage of Hashimoto thyroiditis with prominent lymphoid follicles containing large, active germinal centers. In this autoimmune disease, antithyroglobulin and antimicrosomal (thyroid peroxidase) autoantibodies can often be detected in serum. Hashimoto's Thyroiditis - LPF Endocrine block Pathology Dept. KSU

Hashimoto's Thyroiditis - HPF This high power field view demonstrates the pink Hürthle cells at the center and right. The lymphoid follicle is at the left. Endocrine block Pathology Dept. KSU

4- Follicular Adenoma Endocrine block Pathology Dept. KSU

Solitary Thyroid nodule Endocrine block Pathology Dept. KSU Central movable thyroid nodule occupying the thyroid isthmus

 A well circumscribed light brown and circular tumor nodule  Surrounded by a thick and whitish capsule  The surrounding thyroid tissue is unremarkable. Benign Follicular Adenoma – Gross cut section Endocrine block Pathology Dept. KSU

The red arrow is located within the adenoma. Thyroid follicle cells with scant colloid The blue arrow points to the thick fibrous capsule of the adenoma The yellow arrow points to colloid within a large normal follicle containing colloid. Benign Follicular Adenoma – LPF Endocrine block Pathology Dept. KSU

Benign Follicular Adenoma – HPF Normal thyroid follicles appear at the lower right. The follicular adenoma is at the center to upper left. Features which if present may indicate malignant behavior in this benign lesion are: - Vascular invasion. - Capsular penetration and invasion. Endocrine block

5- Papillary Thyroid Carcinoma Endocrine block Pathology Dept. KSU

Papillary Thyroid Carcinoma Huge thyroid swelling due to papillary thyroid carcinoma Endocrine block Pathology Dept. KSU

A relatively well circumscribed pale and firm nodule showing a whitish cut surface with vague scattered papillary areas. Papillary Thyroid Carcinoma– Gross Endocrine block Pathology Dept. KSU

Papillary Thyroid Carcinoma– LPF papillary fronds lined by overlapping clear nuclei Sections show a papillary neoplasm consisting of papillary fronds lined by overlapping clear nuclei ( Orphan Annie nuclei ). Calcified Psammoma bodies are also seen (not seen here) Endocrine block Pathology Dept. KSU

Papillary Thyroid Carcinoma– HPF Endocrine block Pathology Dept. KSU High power microscopic field showing a classical papillary carcinoma of the thyroid gland. Note the presence of intranuclear inclusion (red arrow) and coffee bean nucleus with prominent nuclear groove (black arrow)

ADRENAL GLAND Endocrine block Pathology Dept. KSU

Pheochromocytoma Endocrine block Pathology Dept. KSU

Normal Adrenal Gland Histology – Periadrenal fat 2- Adrenal Capsule 3- Zona Glomerulasa 4- Zona Fasiculata 5- Zona Reticularis 6- adrenal Medulla Endocrine block Pathology Dept. KSU

A single partly pale and partly hemorrhagic adrenal medullary mass. Note the grey-tan color of the tumor compared to the yellow cortex stretched around it and a small remnant of remaining adrenal at the lower right ( arrow ) Pheochromocytoma – Gross cut section Endocrine block Pathology Dept. KSU

Pheochromocytoma – LPF There is some residual adrenal cortical tissue at the lower center right, with the darker cells of the pheochromocytoma seen above and to the left. Endocrine block Pathology Dept. KSU

Pheochromocytoma – LPF Endocrine block Pathology Dept. KSU circular balls of cells with trabecular areas Microscopic view of pheochromocytoma consisting of circular balls of cells with trabecular areas. Note the presence of numerous blood vessels between the tumor cells

Pheochromocytoma – Electron Microscopy view Endocrine block Pathology Dept. KSU catecholamines. By electron microscopy, the neoplastic cells of the pheochromocytoma contain neurosecretory granules. It is these granules that contain the catecholamines.

Cushing Syndrome Endocrine block Pathology Dept. KSU

Cushing Syndrome – Clinical Case A patient with Cushing syndrome. Note the truncal obesity and purple striae. Endocrine block Pathology Dept. KSU A child with Cushing syndrome as a result of Long-term corticosteroids treatment. Note the classical Moon face appearance

Causes of Cushing Syndrome ACTH –DEPENDENT 1. Cushing disease (eg. pituitary adenoma ) 2. Ectopic corticotrophin syndrome ACTH-INDEPENDENT 1. Adrenal adenoma 2. Adrenal carcinoma 3. Macro nodular hyperplasia 4. Primary pigmented nodular adrenal disease

Cushing syndrome with Cortical Adenoma - Gross Endocrine block Pathology Dept. KSU  Well-circumscribed tumor  The adenoma is composed of yellow firm tissue  Some remaining atrophic adrenal is seen

Cortical Adenoma - MPF Histologically, it is composed of well-differentiated cells resembling the normal cortical fasciculata zone. There may be minimal cellular pleomorphism within adenomas. Occasional enlarged hyperchromatic nuclei with one or more prominent nucleoli can be seen. The capsule of this benign neoplasm is at the right. It is benign. Endocrine block

GOOD LUCK