1. Endocrine system SYLLABUS: RBP(Robbins Basic Pathology) Chapter: The Endocrine System

2. Endocrine system 208 Pituitary adenoma 148 Multinodular goiter and thyroid adenoma 244 Papillary thyroid carcinoma 245 Follicular thyroid carcinoma 196 Diabetic nephropathy 186 Insuloma 211 Adrenal hyperplasia

3. Pituitary adenoma -relatively uniform, polygonal cells arrayed in sheets or cords - supporting connective tissue or reticulin sparse -the nuclei of the neoplastic cells uniform or pleomorphic - mitotic activity usually modest - the cytoplasm of the constituent cells acidophilic, basophilic, or chromophobic

4. Pituitary adenoma

6. Multinodular goiter and thyroid adenoma Multinodular goiter: -colloid-rich follicles lined by flattened, inactive epithelium - areas of follicular epithelial hypertrophy and hyperplasia - degenerative changes: areas of hemorrhage, fibrosis, calcification, and cystic change Follicular adenoma: - uniform-appearing follicles that contain colloid - the follicular growth pattern within the adenoma quite distinct from the adjacent non-neoplastic thyroid(feature distinguishing adenomas from multinodular goiters, in which nodular and uninvolved thyroid parenchyma may have similar growth patterns) - epithelial cells composing the follicular adenoma with little variation in cell and nuclear morphology

7. Multinodular goiter and thyroid adenoma

10. Papillary thyroid carcinoma -branching papillae with a fibrovascular stalk covered by a single to multiple layers of cuboidal epithelial cells - the epithelium covering the papillae consists of well- differentiated, uniform, orderly, cuboidal cells (sometimes more anaplastic with variation in cell and nuclear morphology) -the nuclei of papillary carcinoma cells contain finely dispersed chromatin, which imparts an optically clear or empty appearance (ground glass or Orphan Annie eye nuclei) - invaginations of the cytoplasm in cross-sections give the appearance of intranuclear inclusions ("pseudo-inclusions") or intranuclear grooves - the diagnosis of papillary carcinoma is based on these nuclear features even in the absence of papillary architecture - concentrically calcified structures (psammoma bodies) often present

11. Papillary thyroid carcinoma

13. Follicular thyroid carcinoma - fairly uniform cells forming small follicles containing colloid - sometimes follicular differentiation less apparent with nests or sheets of cells without colloid -nuclear features are of little value in distinguishing follicular adenomas from minimally invasive follicular carcinomas - this distinction requires analysis of capsular and/or vascular invasion - the criterion for vascular invasion is applicable only to capsular vessels and vascular spaces beyond the capsule; the presence of tumor plugs within intratumoral blood vessels has little prognostic significance

14. Follicular thyroid carcinoma

15. Diabetic nephropathy Glomerular lesions - diffuse mesangial sclerosis (a diffuse increase in mesangial matrix) - nodular glomerulosclerosis (ball-like, paS postive deposits of a laminated matrix situated in the periphery of the glomerulus) Renal atherosclerosis and arteriolosclerosis Pyelonephritis including necrotizing papillitis (or papillary necrosis)

16. Diabetic nephropathy

18. Insuloma - tumor cells form groups similar to giant islets, with preservation of the regular cords of monotonous cells and their orientation to the vasculature - even the malignant lesions present little evidence of anaplasia, and may be deceptively encapsulated - by immunocytochemistry, hormons eg. insulin can be localized in the tumor cells

19. Insuloma

21. Adrenal hyperplasia Diffuse hyperplasia: - an increase in the size and number of lipid-rich cells in the zonae fasciculata and reticularis - some degree of nodularity is common Nodular hyperplasia: - nodules composed of a mixture of lipid-laden clear cells and lipid-poor compact cells showing some variability in cell and nuclear size with occasional binucleate forms

22. Adrenal hyperplasia