1. ENDOCRINE PATHOLOGY Cases

2. Case 1 20-year-old female presented with increasing enlargement and discomfort in her neck together with palpitation, weight loss and heat intolerance. Physical examination revealed tachycardia, exophthalmos and palpable diffuse, symmetrical enlargement in the region of the thyroid gland. Thyroid function tests revealed low TSH level with high T3 and T4 and positive anti-TSH receptor antibodies.

3. Gross picture

4. M/E

5. What is the most probable diagnosis in this case? Mention the name of autoantibody which is responsible for this condition? Mention the important gross features? Mention the important microscopic features and identify the feature marked with an arrow?

6. Case 2 40-year-old female presented with a large, painless swelling in her neck. She also complained of fatigue, weight gain and increased sensitivity to cold. On examination, her thyroid was diffusively enlarged and had a rubbery consistency. Thyroid function tests revealed high TSH level with low T3 and T4, positive anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies. Subtotal thyroidectomy was performed.

7. Gross appearance

8. M/E

9. What is the most likely diagnosis? Mention the microscopic features that would support your diagnosis Enumerate other types of thyroiditis?

10. Case 3 A 35-year-old man develops severe headaches and is found to have a blood pressure of 200/120 mm Hg. He also notes anxiety, palpitations, and sweating. He has been in good health and has had normal blood pressure readings on several occasions. Further evaluation reveals a left suprarenal mass that subsequently is removed. Grossly, it appeared well circumscribed, dusky red brown with areas of hemorrhage.

11. Gross picture

12. M/E

13. What is the most likely diagnosis? Describe the characteristic microscopic findings of this tumor? What is the cause of hypertension in this case? Mention the types of MEN syndrome with which this tumor is associated?