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Flashcards in XX - The Endocrine System Deck (105):
1

A benign, well-circumscribed, soft lesion of the pituitary gland that may compress the optic chiasm and adjacent structures. Composed of relatively uniform, polygonal cells arrayed in sheets, cords, or papillae. Most common cause of hyperpituitarism.

Pituitary adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754

2

Most common type of hyperfunctioning pituitary adenoma.

Prolactinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754

3

Microscopically, these are composed of densely or sparsely granulated cells, and immunohistochemical stains demonstrate growth hormone within the cytoplasm of the neoplastic cells.

Growth Hormone-Producing Adenomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 754

4

A condition characterized by excessive urination (polyuria) caused by an inability of the kidney to properly resorb water from the urine.

Diabetes insipidus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

5

Enzyme deficient in central Diabetes insipidus.

Anti-diuretic hormone(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

6

Disease caused by excessive levels of ADH, leading to resorption of excess water, with resultant hyponatremia.

syndrome of inappropriate ADH secretion (SIADH)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

7

The most common cause of hypothyroidism in areas of the world where iodine levels are sufficient. Presents as painless enlargement of the gland, associated with hypothyroidism.

Hashimoto thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 757

8

The thyroid is diffusely and symmetrically enlarged, with intact capsule. Microscopically, reveals a mononuclear inflammatory infiltrate and the presence of Hürthle or oxyphil cells, which are cells with eosinophilic, granular cytoplasm.

Chronic Lymphocytic (Hashimoto) Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 761

9

A rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures. Idiopathic in nature.

Riedel thyroiditis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762

10

Believed to be caused by a viral infection or a postviral inflammatory process, this lesion of the thyroid gland is characterized by unilateral or bilateral enlargement of the thyroid, with disruption of thyroid follicles. Extravasation of colloid leads to a granulomatous reaction. Healing occurs by resolution of inflammation and fibrosis.

Subacute Granulomatous (de Quervain) Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762

11

Also known as "silent" or "painless" thyroiditis n a subset of patients the onset of disease follows pregnancy. Unlike Hashimoto thyroiditis, follicular atrophy or Hürthle cell metaplasia are not commonly seen.

Postpartum thyroiditis/ Subacute Lymphocytic Thyroiditis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 762

12

Thyroid gland is diffusely enlarged due to hyperplasia and hypertrophy of the thyroid follicular cells. The follicular epithelial cells are tall, columnar, and more crowded than usual. These cells actively resorb the colloid in the centers of the follicles, resulting in the "scalloped" appearance of the edges of the colloid.

Graves Disease(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 764

13

Goiter which occurs in areas where the soil, water and food supply contain little iodine.

Endemic goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

14

Diffuse, symmetric enlargement of the gland due to TSH-induced hypertrophy and hyperplasia of thyroid follicular cells.

Diffuse goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

15

Goiter characterized by enlarged, colloid-rich gland. On cut surface, the thyroid is usually brown, glassy and translucent.

Colloid goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

16

Irregular enlargement of the thyroid as a result of recurrent episodes of hyperplasia and involution.

Multinodular goiter(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 765

17

Probability of being benign or malignant.A solitary nodule seen in a 20-yr old male.

Malignant(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

18

Probability of being benign or malignant.Multiple, hot nodules.

Benign(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

19

Probability of being benign or malignant.A solitary, cold nodule.

Malignant(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

20

A solitary, spherical lesion that compresses the adjacent non-neoplastic thyroid. Neoplastic cells are demarcated from the adjacent parenchyma by a well-defined, intact capsule, which is a hallmark of this tumor.

Thyroid adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 766

21

Most common carcinoma of the thyroid.

Papillary carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 767

22

Thyroid carcinoma which may occur at any age and is associated with previous exposure to ionizing radiation. The nuclei of cells contain very finely dispersed chromatin, which imparts an optically clear appearance, giving rise to the designation "ground-glass" or "Orphan Annie eye" nuclei.

Papillary carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 767

23

The second most common form of thyroid cancer. Usually present at an older age a peak incidence in the middle adult years. Microscopically, these are composed of fairly uniform cells forming small follicles, reminiscent of normal thyroid.

Follicular Carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 769

24

Neuroendocrine neoplasms derived from the parafollicular cells, or C cells, of the thyroid, which secrete calcitonin. Associated with MEN 2A and 2B. May be solitary or multicentric, composed of polygonal to spindle-shaped cells, which may form nests, trabeculae, and follicles, contains amyloid.

Medullary carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 770

25

Carcinoma of the thyroid usually seen in the elderly. Associated with high mortality rate. These present as bulky masses that typically grow rapidly beyond the thyroid capsule into adjacent neck structures.

Anaplastic carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 771

26

A solitary lesion of the parathyroid gland which are composed predominantly of chief cells almost invariably confined to a single gland. A rim of compressed, non-neoplastic parathyroid tissue, generally separated by a fibrous capsule, is often visible at the edge of the adenoma.

Parathyroid adenoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 773

27

These tumors of the parathyroid glands are usually firm or hard tumors, adhering to the surrounding tissue as a result of fibrosis or infiltrative growth. May weigh >5 grams. The cytologic features and mitotic activity are variable.

Parathyroid carcinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 773

28

Inadvertent removal of parathyroids during thyroidectomy.

Surgical ablation(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 775

29

An autoimmune disease characterized by progressive destruction of islet β cells, leading to absolute insulin deficiency.

Type 1 diabetes mellitus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 781

30

Caused by a combination of peripheral resistance to insulin action and an inadequate compensatory response of insulin secretion by the pancreatic β cells.

Type 2 diabetes mellitus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 781

31

Vascular lesion associated with hypertension, which is more prevalent in diabetics.

Hyaline arteriolosclerosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 781

32

A diffuse increase in mesangial matrix along with mesangial cell proliferation and is always associated with basement membrane thickening of the glomerulus. Seen in patients with diabetes mellitus.

Diffuse mesangial sclerosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783

33

A glomerular lesion made distinctive by ball-like deposits of a laminated matrix situated in the periphery of the glomerulus .

Nodular glomerulosclerosis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783

34

The ball-like deposit seen in nodular glomerulosclerosis.

Kimmelstiel-Wilson lesion(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 783

35

A special pattern of acute pyelonephritis seen more often in diabetics.

Necrotizing papillitis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 784

36

Most common pancreatic endocrine neoplasms.

β-cell tumors (insulinomas) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788

37

These benign tumors look remarkably like giant islets, with preservation of the regular cords of monotonous cells and their orientation to the vasculature.

Insulinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788

38

What syndrome is described by the association of pancreatic islet cell lesions with hypersecretion of gastric acid and severe peptic ulceration?

Zollinger-Ellison syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 788

39

Tumors associated with increased serum glucagon and a syndrome consisting of mild diabetes mellitus, a characteristic skin rash (necrolytic migratory erythema), and anemia.

α-Cell tumors (glucagonomas) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789

40

Most common cause of Cushing syndrome.

Administration of exogenous glucocorticoids(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789

41

Primary hypothalamic-pituitary disease associated with oversecretion of ACTH. The adrenal glands characterized by variable degrees of bilateral nodular cortical hyperplasia.

Cushing disease(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 789

42

In this condition, the normal granular, basophilic cytoplasm of the ACTH-producing cells in the anterior pituitary is replaced by homogeneous, lightly basophilic material. This results from high levels of endogenous or exogenous glucocorticoids.

Crooke hyaline change(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 790

43

Lung cancer associated with a paraneoplastic syndrome leading to excessive production of ACTH.

Small-cell lung cancer(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 792

44

Caused either by an aldosterone-producing adrenocortical neoplasm, usually an adenoma, or by primary adrenocortical hyperplasia, resulting in suppression of the renin-angiotensin system and decreased plasma renin activity.

Primary hyperaldosteronism/ Conn syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 792

45

A characteristic feature of aldesterone-producing adenomas which is the presence of eosinophilic, laminated cytoplasmic inclusions. These are typically found after treatment with the anti-hypertensive drug which is the DOC for primary hyperaldosteronism.

Spironolactone bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 792

46

The adrenals are hyperplastic bilaterally, sometimes expanding to 10 to 15 times their normal weights,due to sustained elevation in ACTH. The adrenal cortex is thickened and nodular, and on cut section, the widened cortex appears brown as a result of depletion of all lipid

Congenital adrenal hyperplasia(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 793

47

Acute adrenal insufficiency caused by severe bilateral adrenal hemorrhage in an infant with overwhelming sepsis. The adrenals are grossly hemorrhagic and shrunken; microscopically, little residual cortical architecture is discernible

Waterhouse-Friderichsen syndrome(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 794

48

An uncommon disorder resulting from progressive destruction of the adrenal cortex. May be due to autoimmune adrenalitis, tuberculosis, AIDS, or metastatic cancers.

Addison disease/ chronic adrenocortical insufficiency(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 794

49

The adrenals are reduced to small, flattened structures that usually retain their yellow color because of a small amount of residual lipid. Histologically, there is atrophy of cortical cells with loss of cytoplasmic lipid, particularly in the zonae fasciculata and reticularis, due to decreased ACTH stimulation.

Secondary hypoadrenalism (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 795

50

Characterized by irregularly shrunken glands, which may be exceedingly difficult to identify within the suprarenal adipose tissue. Histologically, the cortex contains only scattered residual cortical cells in a collapsed network of connective tissue.

Primary autoimmune adrenalitis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 795

51

Neoplasms composed of chromaffin cells which synthesize and release catecholamines and other peptide hormones. Composed of polygonal to spindle-shaped chromaffin cells compartmentalized intonests, or "Zellballen," by a rich vascular network.

Pheochromocytomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 797

52

Most common extra-cranial solid tumor of childhood. Occur most commonly during the first 5 years of life and may arise during infancy.

Neuroblastoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 798

53

Components of MEN1?

Parathyroid: Primary hyperparathyroidismPancreas: ZES, insulinoma, etc.Pituitary: prolactin-secreting macroadenoma, somatotrophin-secreting tumors(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 798

54

Components of MEN2A?

Thyroid: Medullary carcinomaAdrenal medulla: pheochromocytomasParathyroid: parathyroid gland hyperplasia (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 799

55

Components of MEN2B?

Thyroid: Medullary carcinomaAdrenal medulla: pheochromocytomaExtraendocrine manifestations: ganglioneuromas of mucosal sites (gastrointestinal tract, lips, tongue) and marfanoid habitus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 799

56

All individuals carrying germ-line RET mutations are advised to undergo prophylactic thyroidectomy to prevent the development of what type of carcinoma?

Medullary Carcinoma (TOPNOTCH)

57

What is the most common site of gastrinomas in individuals with MEN-1?

Duodenum (TOPNOTCH)

58

What is the most frequent anterior pituitary tumor encountered in individuals with MEN-1?

Prolactinoma (TOPNOTCH)

59

Morphology: demonstrates characteristic nests of cells (zellballen) with abundant cytoplasm

Pheochromocytomas (TOPNOTCH)

60

Morphology: the adrenals are grossly hemorrhagic and shrunken with little residual cortical architecture discernable

Waterhouse Friederichsen Syndrome (TOPNOTCH)

61

What is the most common cause of primary adrenal insufficiency in developed countries?

Autoimmune adrenalitis (TOPNOTCH)

62

Spirinolactone bodies are seen in what tumor?

Aldosterone producing adenomas (TOPNOTCH)

63

Crook hyaline change is seen in?

Cushing syndrome (TOPNOTCH)

64

Watery Diarrhea, hypokalemia, achlorhydria or WDHA syndrome is seen in?

VIPoma (TOPNOTCH)

65

Syndrome of mild DM, characteristic rash (necrolytic migratory erythema), and anemia is seen in what tumor?

Glucagonomas or alpha cell tumors (TOPNOTCH)

66

Syndrome of DM, cholelithiasis, steatorrhea, and hypochlorhydria is seen in what tumor?

Somatostatinoma or delta cell tumor (TOPNOTCH)

67

Approximately 60%-80% of patients with DM will develop some form of diabetic retinopathy after how many years from the time of diagnosis?

15-20 years (TOPNOTCH)

68

The fundamental lesion of DM retinopathy

neovascularization (TOPNOTCH)

69

What special pattern of acute pyelonephritis is common in diabetics compared to non diabetics?

Necrotizing papillitis or papillary necrosis (TOPNOTCH)

70

These are PAS positive glomerular lesions made distinctive by ball like deposits of laminated matrix situated in the periphery of the glomerulus

Nodular glomerulosclerosis or Kimmelstiel Wilson lesion (TOPNOTCH)

71

What are the three most important glomerular lesions seen in DM?

Basement membrane thickening, diffuse mesangial sclerosis, and nodular glomerulosclerosis (TOPNOTCH)

72

What is the hallmark of diabetic macrovascular disease?

Accelerated atherosclerosis (TOPNOTCH)

73

What is the most common cause of death in diabetics?

Myocardial Infarction (TOPNOTCH)

74

What morphological change seen in pancreas is more commonly associated with DM Type 2 than DM Type 1?

Amyloid replacement of islets (TOPNOTCH)

75

What is the hallmark of hypocalcemia?

Tetany (TOPNOTCH)

76

The most common cause of clinically apparent hypercalcemia

Malignancy (TOPNOTCH)

77

The most common cause of asymptomatic elevated blood calcium

Primary hyperparathyroidism (TOPNOTCH)

78

A peculiar feature of this type of thyroid carcinoma is the presence of multicentric C cell hyperplasia

Familial Medullary Cancers of the thyroid (TOPNOTCH)

79

Acellular amyloid deposits are seen in what type of thyroid cancer?

Medullary Carcinoma (TOPNOTCH)

80

Morphology: fairly uniform cells forming small follicles containing colloid, quite reminiscent of normal thyroid

Follicular Carcinoma of the thyroid (TOPNOTCH)

81

These are concentrically calfcified structures that are often present in papillary carcinoma of the thyroid

Psamomma bodies (TOPNOTCH)

82

Morphology: the nuclei of these tumor cells contain finely dispersed chromatic which imparts an optically clear or empty appearance, giving rise to the designation ground glass or Orphan Annie eye

Papillary Carcinoma of the thyroid (TOPNOTCH)

83

The major risk factor predisposing to thyroid cancer

Ionizing radiation, particularly in the first two decades of life (TOPNOTCH)

84

Morphology: diffuse hypertrophy and hyperplasia of thyroid follicular epithelial cells with scalloping of the margins

Graves disease (TOPNOTCH)

85

Morphology: lymphocytic infiltration with hyperplastic germinal centers within the thyroid parenchyma and patch disruption and collapse of thyroid follicles

Subacute lymphocytic or Painless thyroiditis (TOPNOTCH)

86

Morphology: thyroid parenchyma contains a chronic inflammatory infiltrate with multinucleate giant cells enclosing naked pools and fragments of colloid

Subacute or granulomatous thyroiditis (TOPNOTCH)

87

Morphology: the thyroid parenchyma contains a dense lymphocytic infiltrate with germinal centers and deeply eosinophilic Hurthle cells line the residual thyroid follicles

Hashimoto Thyroiditis (TOPNOTCH)

88

What variant of craniopharyngoma frequently contains radiologicaly demonstrable calcifications?

Adamantinomatous craniopharyngoma (TOPNOTCH)

89

What is the most common cause of hyperpituitarism?

Adenoma (TOPNOTCH)

90

Hypofunction of the anterior pituitary occurs when approximately how much of the parenchyma is lost?

75% (TOPNOTCH)

91

These cysts are lined by ciliated cuboidal epithelium with occasional goblet cells and anterior pituitary cells, can accumulate proteinaceous fluid and expand, compromising the normal gland

Rathke Cleft Cyst (TOPNOTCH)

92

The craniopharyngomas are thought to arise from what structure?

Vestigial remnants of Rathke pouch (TOPNOTCH)

93

What is the earliest and most consistent feature of hyperthyroidism?

Cardiac manifestations (TOPNOTCH)

94

This condition presents with impaired developments of the skeletal system and central nervous system, manifested by severe mental retardation, short stature, coarse facial features, a protruding tongue, and umbilical hernia

Cretinism (TOPNOTCH)

95

These are epithelial cells with abudant eosinophilic, granular ctyoplasm seen in Hashimoto thyroiditis

Hurthle cells (TOPNOTCH)

96

This is a rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures

Riedel thyroiditis (TOPNOTCH)

97

What is the most important feature in making the distinction between a thyroid adenoma and a multinodular goiter?

In adenoma, the neoplastic cells are demarcated from the adjacent parenchyma by a well defined intact capsule. In multinodular goiters, they lack a well formed capsule (TOPNOTCH)

98

What is the hallmark of all follicular adenomas?

Well formed capsule encircling the tumor. So, careful evaluation of the integrity of the capsule is therefore critical in distinguishing follicular adenomas from follicular carcinomas which demostrate capsular and or vascular invasion (TOPNOTCH)

99

What is the most common clinically significant congenital anomaly of the thyroid?

Thyroglossal duct or cyst (TOPNOTCH)

100

Lamellar keratin formation or "wet keratin" is a diagnostic feature of what tumor?

Adamantinomatous craniopharyngoma (TOPNOTCH)

101

Morphology: extensive infiltration of the parenchyma by a mononuclear inflammatory infiltrate containing small lymphocytes, plasma cells, and well developed germinal centers

Hashimoto thyroiditis (TOPNOTCH)

102

Morphology: lymphocytic infiltration with hyperplastic germinal centers within the thyroid parenchyma and patch disruption and collapse of thyroid follicles. Fibrosis and Hurthle cells are not commonly seen

Subacute lymphocytic or painless thyroiditis (TOPNOTCH)

103

Morphology: in its hyperplastic phase, they thyroid gland is diffusely and symmetrically enlarged and the follicles are lined by crowded columnar cells, which may pile up and form projections similar to those seen in Grave's disease

Diffuse nontoxic (simple) goiter (TOPNOTCH)

104

Morphology: Variant of papillary carcinos ma that is marked with tall columnar cells with intensely eosinophilic cytoplasm lining the papillary structures. The cells are at least twice as tall as they are wide.

Tall cell variant (TOPNOTCH)

105

Morphology: nuclei are usually round to ovoid, with stippled "salt ang pepper" chromatin

Pheochromocytoma (TOPNOTCH)