Endocrine Pathology Slides

K E-1

Section of normal pituitary gland.  The more cellular area represents the anterior pituitary, while the pale pinkish fibrillar area represents the posterior pituitary.  In the anterior pituitary area, acidophils are stained red while the basophils are blue.  The chromophobes are pale.

K E-2

An electron micrograph showing the various secretory granules of the different hormones of the anterior pituitary.  Look at the sides of the slide for proper identification of the granules.

K E-3

This is an anti-ACTH immunoperoxidase stain to demonstrate the ACTH positive cells - brown color.

K E-5

This shows the base of the brain.  At the centre is a large round lobulated pituitary adenoma which is compressing the optic chiasm anteriorly.  Its posterior relation is the pons, while it is straddled laterally by the third nerves.

K E-6

K E-7

This is an acidophil adenoma of the pituitary.  The cells are stained red using special stains. This lesion can cause acromegaly in the adult and gigantism in the young.

K E-13

Subacute thyroiditis, granulomatous thyroiditis, or de Quervain's thyroiditis.  Some thyroid follicles contain pinkish material (colloid), associated with multinucleated cells, chronic inflammatory infiltration, and fibrosis.

K E-14

Riedel's thyroiditis.  Note the marked pinkish hyaline fibrosis, lymphocytic infiltration, and absence of follicles.  If the fibrosis is extensive, neck organs may be bound down and thyroid will be woody hard on palpation.  This feature can be confused with anaplastic carcinoma of thyroid.

K E-15

Gross picture of Hashimoto's thyroiditis.  Note the lobular tan coloration of the thyroid gland.  The gland is usually rubbery firm and enlarged.  Cut sections appear tan, yellow or grey.

K E-16

Microscopic features of Hashimoto's thyroiditis.  Note the lymphoid follicles,

K E-17

acidophilia of the cytoplasm of the thyroid follicles, some fibrosis, and diffuse infiltration of lymphocytes and plasma cells.

K E-18

Diffuse thyroid hyperplasia (Graves' disease).  Note the hypercellularity of the follicles and resorption of the colloid, giving the scalloping effect.  Also note the total absence of colloid in some hyperplastic follicles.  Lymphoid infiltrate is present with formation of lymphoid follicles.  The presence of lymphoid infiltrate and follicle formation in the thyroid gland of Graves' disease suggests a very close relationship between Graves' thyroiditis.

K E-19

Gross picture of follicular adenoma.  The mass is encapsulated.   Cut surface is tan. Dark areas represent hemorrhages.  It is important to examine the capsular areas in order to exclude invasion.  Invasion of the capsule and blood vessels will indicate follicular carcinoma.

K E-20

Microscopic features of a follicular adenoma.  Note the capsule separating the adenoma from the compressed and atrophic thyroid follicles.

K E-21

Gross picture of cut surfaces of a papillary carcinoma of the thyroid.  Cystic areas are present, and a small projection can be discerned projecting into the cystic cavity.

K E-22

Microscopic features of papillary carcinoma.  Slide 22 shows psammoma bodies;

K E-23

these are calcospherites.  They can be seen in other tumors, such as serous cyst

K E-24

adenoma and carcinoma of ovary, renal cell carcinoma, and in meningiomas.  Slide 24 shows metastatic papillary carcinoma of thyroid in a lymph node.  Note the pale nucleus of the tumor (K E-23), similar to "Orphan Annie's eye."

K E-25

Both slides show follicular carcinomas of thyroid gland.  Follicular pattern is well K E-26 illustrated in Slide 25 while Slide 26 shows capsular invasion.

K E-26

K E-27

These illustrate medullary carcinoma of the thyroid.  Note the fibrous tissue     

K E-28

dividing the tumor tissue in small compartments.  Tumor cells are fairly uniform.

K E-29

No follicles.  In Slide 28, note the amorphous pale pinkish masses of amyloid in the stroma.  Amyloid can be stained by Congo Red, Thioflavin, or identified by EM.  Medullary carcinoma arises from parafollicular C-cells which originate from neural crest.  Medullary carcinoma does not take up iodine.  Slide 29 shows a special stain which demonstrates the calcitonin in medullary carcinoma cells by immunoperoxidase method.

K E-30

Anaplastic carcinoma of the thyroid.  Note multinucleation, pleomorphism, absence of follicles, no papillary features.  Tumor cells are bizarre.  This tumor has the worst prognosis of all thyroid malignancies.

K E-31

Normal parathyroid gland.  Note the fatty infiltrate and the chief cells.  The fatty infiltrate increases with the age of the patient.

K E-32

Gross picture of a parathyroid adenoma.

K E-33

Microscopic features of a chief cell parathyroid adenoma. Note the diffuse dense cellularity of the adenoma as contrasted with the remnant of partially compressed normal parathyroid gland tissue.  Both are separated by a thin fibrovascular capsule.

K E-34

Microscopic features of clear cell hyperplasia of parathyroid gland.  Note the distinct cytoplasmic membranes, large size of cells, uniform nuclei, and absence of any other type of cell.  The cytoplasm contains small vacuoles.

K E-35

Parathyroid hyperplasia.  All four glands are uniformly enlarged.  Three and about 3/4 of the fourth gland were removed.

K E-37

Photograph shows adrenal and kidney.  There is hemorrhage in the adrenal gland.

K E-38

Photograph illustrates case of Waterhouse-Friderichsen's syndrome.  Note the multiple blotchy areas in the skin.  These are skin hemorrhages.  Patient is in shock with low blood pressure.

K E-39

Adrenal cortical hyperplasia.  Note the thickness of the adrenal cortex.  Adrenal hyperplasia can be due to stimulatory effect of ACTH from the pituitary or due to ACTH-like material produced by some neoplasms, especially oat cell carcinoma of the lung.  Adrenal cortical hyperplasia could lead to Cushing's syndrome.

K E-40

Conn 's adenoma.  Note the rounded circumscribed nature of this yellow adenoma.  K E-41  Slide 41 shows the microscopy.  Note the large clear cells with distinct cytoplasm.

K E-42

Picture of patient with Cushing's Syndrome.

K E-44

Gross picture of pheochromocytoma of adrenal gland.  Pheochromocytoma range in weight is between 1 gram and 4000 grams.  It is encapsulated, and cut surface is usually lobulated due to the presence of the fibrous trabecula extending from the capsule.  Cut surface is light brown to pale.  Areas of hemorrhage are present.

K E-46

Microscopic features of pheochromocytoma.  Note the trabecular pattern separated by thin walled sinusoids.  Hemorrhage is present in these sinusoids, thereby obliterating the wall.  Pheochromocytoma can take various patterns.  Giant and bizarre cells are commonly seen.  These, however, are not indicative of malignancy.  Six to 9% of pheochromocytomas of the adrenal gland are malignant.  This diagnosis is made when there is metastasis.