Pituitary, Parathyroid and Adrenal Pathology Flashcards Preview

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Flashcards in Pituitary, Parathyroid and Adrenal Pathology Deck (28)
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1

What are the two most common types of pituitary adenoma?

Prolactinoma (30%) - acidophil

Null-cell/non-secreting (25%) - mass effect/hypofx

Can be GH or ACTH

2

What are micro characteristics of pituitary adenomas?

One cell type

Reticulin meshwork/clusters gone

All cells stain with one antibody - order panel

3

What symptoms might this present with?

Prolactinoma - galactorhea, amenorrhea, erectile dsyfunction

Null-cell - mass effect, panhypopit, visual disturbances

4

Which of these is a pituitary adenoma?

Left - all one cell type, loss of reticulin meshwork

5

Where are Rathke Cleft Cysts located and what symptoms might it produce?

Sella or suprasellar location

Asymptomatic, or stalk effect 

6

What is this and is it malignant?

Rathke Cleft Cyst

No, its a remenant of rathke's pouch during development

7

Who gets craniopharyngiomas, how does it present, and is it malignant?

Children and adults - bimodal peak

Hemianopsia (commonly suprasellar), Hypopituitarism, Stalk Effect

No - benign

 

8

What is the difference between adamantinomatous and papillary type craniopharyngiomas?

Adamantinomatous: Dark brown fluid filled cysts, basally palisading squamous epithelium, abundant keratin, local invasion w/ chronic inflammatory

Papillary type: Papillary architecture, no keratin formation

9

What is this?

Adamantinomatous Type Craniopharyngioma

10

Which pharyngeal pouches does the parathyroid develop from?

3rd: Inferior and thymus

4th: Superior 

11

What cells is the parathyroid composed of?

Chief cells (PTH) and oxyphil cells

Large amount of intervening stromal fat (30-70%)

12

In this normal parathyroid, which cells secrete PTH?

Chief cells on the left

13

What are the 3 main causes of primary parathyroid hyperfunction?

  1. Parathyroid Hyperplasia | 10-15%
  2. Parathyroid Adenoma | 75-80%
  3. Parathyroid Carcinoma | <5%

14

What are the primary causes of parathyroid hypofunction?

  1. Congenital - DiGeorge (22q11)
  2. Iatrogenic
  3. Familial 
  4. Autoimmune

15

What is this and what causes it? What else might you see in this disease?

Osteitis fibrosa cystica - High PTH (Adenoma, hyperplasia)

Thinned cortex, fibrosis of marrow with hemorrhange and cyst formation.

Brown Tumors

16

What characterizes this tumor and what causes it?

Brown tumor: OC, reactive giant cells, hemorrhage

Hyperparathyroidism

17

How do you distinguish parathyroid adenoma from parathyroid hyperplasia?

Adenomas are larger (.5-5g)

Decrease in stromal fat

May show a rim of normal parathyroid

18

What is this?

Parathyroid Adenoma

19

What are characteristics of parathyroid hyperplasia?

All 4 glands involved

No rim of normal

20

How is parathyroid carcinoma diagnosed?

When they become clearly invasive or malignant

Recurrance, LN

Cellular atypia is not a reliable feature of malignancy!

Difficult to remove due to thick fibrous bands

21

What are characteristics of adrenocortical hyperplasia?

Bilateral thickening of cortex - diffuse or nodular

Predominantly fasciculata cells - clear cells

 

22

What is this? What other characteristics is it likely to have?

Adrenocoritcal Adenoma

Encapsulated

Non-functional (majority, clinical)

Predominantly zona fasciculata cells - clear, lots of cytoplasm, round eccentric nuclei

23

These are to samples from different adrenal gland masses. If the mass is >5cm and is invading through the capsule and into the adrenal vein what is it and what other characteristics does it have?

Adrenocortical Carcinoma

>5cm, capsular invasion, necrosis, hemorrhage, well-poorly differentiated, invades adrenal vein and vena cava, LN mets, pleomorphism

Can't differentiate from adenoma - invasion

24

What are the main causes of ACTH independent hypercortisol?

Adrenocortical adenoma or carcinoma

25

What is the main cause of bilateral adrenal hyperplasia in the setting of hypercortisol?

Pituitary Adenoma - Inc. ACTH

26

A patient presents with headaches, palpitations, and diaphoresis. What does he likely have and what is cell origin, and what is the microscopic appearance? Is it malignant?

Pheochromocytoma - chromaffin cells

Zellballen - nests of cells, very vascular, abundant granular basophilic cytoplasm, variable

Stain with chromogranin and synaptophysin

Stain for synaptophysin and chromogranin

Only if it presents with mets!

27

10% of pheos are extra-adrenal, what are the most common sites are these funcitonal?

Paragangliomas most commonly occur on the sympathetic chain (jugulotympanic, carotid body, vagal, and aorticopulmonary)

No, they look similar to pheos i.e. Zellballen

28

What is the rule of 10 for pheochromocytomas?

10% malignant

10% bilateral

10% extra-adrenal (Paraganglioma, non-functional)