Week 1: Pathology of the pancreas-islet of langerhans

Question 1

macrovascular disease in DM- pathology

Answer 1

• hyaline arteriolosclerosis
• affects aorta and large to medium sized arteries
• includes MI, stroke, LE gangrene

Question 2

Histology of diabetic nephropathy

Answer 2

• thickening of basement membrane associated with leakiness of capillary wall
• leakage of plasma protein into glomerular filtrate leads to proteinuria and occasionally nephrotic syndrome
• eosinophilic coagulated fibrin deposition on surface of glomeruli
• mesangial matrix formation
• Kimmelstiel Wilson nodules

Question 3

Diabetic retinopathy pathology

Answer 3

1. Non proliferative
   - exudates
   - microaneurysms
   - hemorrhage
2. Proliferative
   - neovascularization
   - fibrosis and hemorrhage
   - detachment

Question 4

Pathology of diabetic neuropathy

Answer 4

• results of microangiopathy and direct axonal damage by persistent hyperglycemia
• PNS more than CNS
• symmetric neuropathy of LE
• sensor more than motor
• autonomic neuropathy

Question 5

Insulinoma (beta cells)

Answer 5

• most common type of PanNet (pancreatic neuroendocrine tumor)
• high circulating insulin and c-peptide
• clinical: hypoglycemia, confusion, convulsions, coma
• 70% solitary adenomas, 10% multiple adenomas, <10% carcinomas, 10% diffuse hyperplasia

Question 6

Gastrinoma (G cells): zollinger-Ellison Syndrome

Answer 6

• ZE syndrome: pancreatic/duodenal gastrinoma hypergastrinemia, gastric acid secretion, peptic ulceration
• diarrhea and steatorrhea due to hyperacidity that may cause difficulty in fat absorption
• gastrinoma triangle: pancreas, peripancreas, duodenum
• mostly malignant

Question 7

Multiple endocrine neoplasia (MEN) syndromes

Answer 7

• autosomal dominant, variable penetrance, uncommon, appear simultaneously or sequentially
  1. Type 1: Wermer Syndrome
• Pituitary adenoma,
• Parathryoid primary hyperparathryoidism (hyperplasia or adenoma),
• Pancreas (insulinoma or gastronoma)
• 11q13 gene
  2. Type 2A Sipple Syndrome
• Thyroid medullary carcinoma
• Adrenal: medullary hyperplasia or pheochromocytoma
• Parathyroid primary hyperparathyroidism: Adenoma or hyperplasia
• RET gene on chrome10
  3. TYPE 2B: william syndrome
• Thyroid: medullary carcinoma
• Adrenal: same as above
• Mucocutaneous neuromas