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Endocrine > 166. Hypothalamus-Pituitary Histology/Pathology > Flashcards

166. Hypothalamus-Pituitary Histology/Pathology Flashcards

(44 cards)

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1
Q

Lying at interface b/w adeno- and neurohypophysis

Cystic change is frequent

Likely the site of origin of Rathke’s cleft cysts

A

Pars intermedia

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2
Q

Second most common adenoma found

Most are macroadenomas 2 types: - sparsely granulated (~10%) - look for fibrous bodies —> more aggressive

  • Densely granulated (~10%) Prolactin reactivity often present in addition to GH Elevated IGF-1 => gigantism and acromegaly
A

GH-producing (somatotroph cell) adenomas

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3
Q

Often associated w/ systemic sarcoidosis

Preferentially affects structures in the suprasellar region

Produces non-caseating, granulomatous inflammation with multinucleated (Langhans’) giant cells

A

CNS sarcoidosis

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4
Q

Most often in adults

Papillae line by well-differentiated squamous epithelium

Lack keratin, peripheral palisading, calcification, and cysts

Good prognosis

A

Papillary craniopharyngioma

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5
Q

Craniopharyngiomas

Germ cell tumors

A

Hypothalamic suprasellar tumors

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6
Q

Most common variant of pituitary adenoma

Microadenomas or macroadenomas

Amenorrhea/galactorrhea in females; impotence, loss of libido in males

Usually diagnosed earlier in women of reproductive age than in postmenopausal women and in males

Majority are responsive to bromocriptine and relate drugs (cabergoline)

A

Prolactin-producing adenomas

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7
Q

Hypercorticolism due to ACTH adenoma

A

Cushing’s Disease

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8
Q

On histology: - Sparsely granulated (~20-30%) - Densely granulated (~1%) - Dystrophic calcification = pituitary stone

A

Prolactinoma

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9
Q

Most commonly seen in children

Consists of stratified squamous epithelium w/ periphery palisading and compact, lamellar keratin formation = wet keratin

Dystrophic calcification Cysts of the tumor contain “machine oil” Good prognosis

A

Adamantinomatous craniopharyngioma

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10
Q

Derived from Rathke’s pouch

Bimodal age distribution:

  • 5-15yo
  • 65yo and up

Manifestation:

  • headaches
  • visual disturbances
  • growth retardation d/t GH deficiency
A

Craniopharyngiomas

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11
Q

25-30% of pituitary adenomas

Macroadenomas Symptoms d/t mass effect and/or hypopituitarism

Synaptophysin and chromogranin reactive; otherwise minimally or nonreactive - nonfunctioning

A

Null cell adenomas or silent variants

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12
Q

Originate from remnants of the Rathke’s pouch

Simple cyst composed of ciliated cuboidal epithelium

A

Rathke’s cleft cyst

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13
Q

Most common tumors of the anterior pituitary

Most common cause of hyperpituitarism

Manifestations related to:

  • Secretion of excess hormone
  • Hypopituitarism
  • Mass effect
A

Pituitary adenomas

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14
Q

Specialized glial cells that support the axons in the posterior lobe of the pituitary gland

A

Pituicytes

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15
Q

On histology:

  • Populated by epithelial cells containing a variety of trophic hormones
  • Cells compartmentalized into small acini by a reticulin network
A

Anterior pituitary

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16
Q

Results in hyponatremia

Caused by both extra-CNS disorders (most common) and some CNS diseases Extra-CNS causes include neoplasia (small cell carcinoma of the lung), adrenal insufficiency, myxedema, cirrhosis, cardiac disease, certain drugs CNS causes include trauma, CNS infections, CNS neoplasms, etc. - anything w/ blood volume loss really

A

SIADH (Inappropriate ADH secretion)

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17
Q

Diseases referable to abnormalities in ADH release

  • no well-defined syndromes related to oxytocin abnormalities Diabetes insipidus and SIADH
A

Posterior pituitary syndromes

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18
Q

Supplied by an artery and drains into a vein

  • inferior hypophyseal branches Its hormones are released directly into the systemic circulation
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A

Posterior lobe of pituitary gland

19
Q

Elevated prolactin levels due to tumor secretion must be distinguished from… Levels < 150 ng/mL may represent this

20
Q

2 hormones secreted by supraoptic and paraventricular nuclei of hypothalamic innervation to the posterior pituitary

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A

Oxytocin and vasopressin (ADH)

21
Q

Most common CNS germ cell tumor

Children and young adults

Usually in the pineal or suprasellar region

Lymphocytic infiltration seen everywhere on slides

22
Q

Defined by the presence of metastasis and/or craniospinal dissemination

Poor correlation with cytological atypia

Most are hormonally active

Extremely rare - clinical diagnosis bc tumor looks like regular adenoma on slides

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A

Pituitary carcinoma

23
Q

Blood supply of the anterior pituitary

Conduit for the transport of hypothalamic releasing hormones from the hypothalamus

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A

Hypophyseal portal system

24
Q

Enlargement of ACTH adenoma after the removal of both adrenal glands

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A

Nelson Syndrome

25
Connects the hypothalamus to the pituitary gland
Pituitary stalk
26
Most common during pregnancy or postpartum period - autoimmune disorder - both cellular and humoral responses in pathogenesis Symmetrical enlargement of pituitary accompanied by pituitary insufficiency May occur in isolation or in conjunction with autoimmune infiltrates in other endocrine organs Destructed gland seen on histology
Lymphocytic hypophysitis
27
Pathogenesis of pituitary adenomas is fairly uncertain in most cases except for the cases in patients with this condition
MEN-1
28
Derived from Rathke pouch From oral ectoderm
Anterior pituitary (adenohypophysis)
29
General morphological features: - Cytoplasm of constituent cells tends to be monomorphous compared to non-neoplastic gland - Paucity of reticulin network - Low mitotic activity - Atypical categorization --\> ki-67 labeling index \> 3% w/ p53 expression
Pituitary adenomas
30
Acidophilic cells of the 5 cell types in anterior lobe of pituitary gland
GH- and prl-secreting cells
31
Represents a downward (ventral) outgrowth of the embryonic diencephalon - ventral outgrowth of the hypothalamic floor From neuronal ectoderm
Posterior pituitary
32
Usually microadenomas at the time of diagnosis Basophilic, densely granulated, strongly PAS, and ACTH-reactive Associated w/ hypercorticolism - Cushing syndrome - Cushing disease - Nelson syndrome
ACTH-producing adenomas
33
Populated by axons originating in neurons in the supraoptic and paraventricular nuclei of the hypothalamus - secrete oxytocin and vasopressin (ADH)
Posterior lobe (neurohypophysis)
34
Cell populations: acidophil (w/ eosinophilic cytoplasm), basophil (w/ basophilic cytoplasm), and chromophobe (poorly staining cytoplasm) Five cell types: - Somatotrophic - GH - Lactotrophic - prolactin, prl - Corticotrophic - ACTH - Thyrotrophic - TSH - Gonadotrophic (FSH, LH)
Anterior lobe (adenohypophysis)
35
Hypercorticolism regardless of cause
Cushing syndrome
36
Confines the pituitary gland
Sella turcica and sellar diaphragm
37
In conjunction with the hypothalamus, plays a central role in modulating the exocrine system Lies in close proximity to the hypothalamus
Pituitary gland
38
Extra-CNS cause of SIADH that is quite common - cancer
Small cell carcinoma of lung
39
Extension of the developing oral cavity Gives rise to anterior lobe
Rathke pouch
40
Excessive urination (polyuria) Can be subdivided into central and nephrogenic variants Central variants include primary = idiopathic or hereditary, trauma, vascular disease, suprasellar/hypothalamic neoplasms, local infections, inflammatory diseases
Diabetes insipidus
41
Axonal expansions found on histology as finely granular round structures that contain ADH and oxytocin
Herring bodies
42
Delicate collagen fibers that hold the anterior lobe together
Reticulin network
43
Elevated IGF-1 from GH-producing adenomas leads to...
Gigantism - children Acromegaly - adults
44
Low pressure blood supply renders this area vulnerable to ischemic insults d/t things like hypotension and elevated ICP
Anterior pituitary

Endocrine (26 decks)

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