ENDOCRINE PATHOLOGY

ENDOCRINE PATHOLOGY

THYROID PATHOLOGY
 This is the normal
appearance of the
thyroid gland on the
anterior trachea of the
neck. The thyroid gland
has a right lobe and a left
lobe connected by a
narrow isthmus. The
normal weight of the
thyroid is 10 to 30 grams.
It cannot easily be
palpated on physical
examination.
NORMAL THYROID
 Normal thyroid seen microscopically consists of follicles lined
by a an epithelium and filled with colloid. The follicles vary
somewhat in size. The interstitium, which may contain "C" cells,
is not prominent.
 This normal thyroid follicle is lined by a cuboidal
follicular epithelium with cells that can add or subtract
colloid depending upon the degree of stimulation from
TSH (thyroid stimulating hormone) released by the
pituitary gland. As in all endocrine glands, the interstitium
has a rich vascular supply into which hormone is
secreted.
 Normal Thyroid
The section shows numerous follicles.
Pink acellular material is colloid.
The follicles vary somewhat in size normally.
Lines through the follicles artifact of sectioning.
 Normal Thyroid - Close up view of thyroid follicles.
Acellular pink material is colloid.
Follicle lining approximately one cell thick with single row of
nuclei at this power.
Vessels essentially surround the follicle and are filled with red
blood cells.
NORMAL THYROID
 IMMUNOPEROXIDASE STAIN

This immunoperoxidase stain with antibody to

calcitonin identifies the "C" cells (parafollicular
cells) of the thyroid interstitium between the follicles or
adjacent to the epithelium of follicles. These cells
secrete calcitonin.
 This symmetrically small thyroid gland demonstrates atrophy.
This patient was hypothyroid. This is the end result of
Hashimoto's thyroiditis. Initially, the thyroid is enlarged and
there may be transient hyperthyroidism, followed by a euthyroid
state and then hypothyroidism with eventual atrophy years later.
Hashimoto's thyroiditis results from abnormal T cell activation
and subsequent B cell stimulation to secrete a variety of
autoantibodies.
 Here is a low power microscopic view of a thyroid with Hashimoto's thyroiditis. Note the
lymphoid follicle at the right center. This is an autoimmune disease and often antithyroglobulin
and antimicrosomal (thyroid peroxidase) antibodies can be detected. Other autoimmune
diseases such as Addison's disease or pernicious anemia may also be present. Both thyroid
growth immunoglobulins (TGI) and thyroid stimulating immunoglobulins (TSI) are present,
though blocking antibodies to TSI mitigate their effect.
 Hashimotos Thyroiditis (Medium Power)
Yellow arrows highlight a germinal center with lymphocyte proliferation.
Red arrows point to the lymphocytic infiltrate in which the germinal center is
embedded.
Blue arrow points to small atrophic follicles lined by Hurthle cells.
 This high power microscopic view of the thyroid with
Hashimoto's thyroiditis demonstrates the pink Hrthle cells at
the center and right. The lymphoid follicle is at the left.
Hashimoto's thyroiditis initially leads to painless enlargement of
the thyroid, followed by atrophy years later.
 Hashimotos Thyroiditis
This is a view of several follicles lined by Hurthle cells.
The nuclei are similar to those of follicle cells but the cytoplasm
is very eosinophilic
 Hashimotos Thyroiditis
There is colloid in the center of these follicles which are small.
The follicle lining cells have very eosinophilic cytoplasm, typical
of Hurthle cells.
There is some variation in nuclear size and shape.
 Hashimotos Thyroiditis (FNAC)
The cells in the center of the field are forming a follicle
They exhibit more cytoplasm than the usual follicle cells.
The cytoplasm is finely granular.
The changes in cytoplasm identify the cells as Hurthle cells.
 Hashimotos Thyroiditis (FNAC)
The group of cells are predominantly small lymphocytes.
A single large cell has essentially no cytoplasm but a prominent
nucleolus.
The large cell is a large transformed lymphocyte.
 Hashimotos Thyroiditis (FNAC)
The cells are predominantly small round lymphocytes.
The yellow arrow points to a plasma cell.
The blue arrow points to a large transformed lymphocyte.
 This is an example of an immunofluorescence test positive for anti-microsomal
antibody, one of the autoantibodies that can be seen with autoimmune diseases of
the thyroid. A major component of the antimicrosomal antigen is thyroid peroxidase
(TPO) which is often measured serologically. Note the bright green fluorescence in
the thyroid epithelial cells, whereas the colloid in the center of the follicles is dark.
 Here is an example of immunofluorescence positivity for
anti-thyroglobulin antibody. Patients with Hashimoto's
thyroiditis may also have other autoimmune conditions
including Grave's disease, SLE, rheumatoid arthritis, pernicious
anemia, and Sjogren's syndrome.
 Graves Disease of Thyroid
Diffusely enlarged red tan thyroid gland.
Slight lobulation but no large cyst formed
 Graves Disease (Low Power)
The arrow points to a follicle showing abundant scalloping of
colloid.
Cellular detail cannot be appreciated at this magnification.
 Graves Disease
A medium-high power view of a thyroid exhibiting hyperactivity.
Notice the tall columnar cells lining the acini.
The colloid is not abundant and tends to be somewhat lighter staining than colloid in the
normal thyroid.
In addition, to the right and above the centrally located green arrow, notice the typical
scalloped appearance of the colloid, typical of thyrotoxicosis
 Graves Disease (Medium Power)
This higher power view again shows the arrow on a vacuole within the
colloid.
The cells are tall and columnar
 Graves Disease (Med Power)
The colloid shows abundant vacuolation.
The cells are cuboidal to tall columnar
 A diffusely enlarged thyroid gland associated with
hyperthyroidism is known as Grave's disease. At low power
here, note the prominent infoldings of the hyperplastic
epithelium. In this autoimmune disease the action of TSI's
predominates over that of TGI's.
 At high power, the tall columnar thyroid epithelium with Grave's
disease lines the hyperplastic infoldings into the colloid. Note
the clear vacuoles in the colloid next to the epithelium where
the increased activity of the epithelium to produce increased
thyroid hormone has led to scalloping out of the colloid.
 This is Subacute granulomatous thyroiditis (DeQuervain's disease),
which probably follows a viral infection and leads to a painful enlarged
thyroid. This disease is usually self-limited over weeks to months and the
patients return to a euthyroid state. Note the foreign body giant cells with
destruction of thyroid follicles.
 This thyroid gland is about normal in size, but there is a
larger colloid cyst at the left lower pole and a smaller
colloid cyst at the right lower pole. Such cysts could
appear as "cold" nodules on a thyroid scan. They are
incidental benign lesions but can appear as a mass to be
distinguished from possible carcinoma.
 Multinodular Goiter (Composite View)
Left panel shows thyroid gland with nodular enlargement of the
gland, more prominent on the left.
Cut surface (on right) shows varied appearance from normal
red tan to yellow to hemorrhagic.
 Multinodular Goiter (External view)
Enlarged thyroid with more enlargement on left.
Left lobe also shows multiple nodules
 Multinodular Goiter (Cut Surface)
Cut surface of one lobe of thyroid gland showing ill defined
nodules.
Focus of cystic degeneration seen (blue arrow).
Some hemorrhage (red arrow) and some scarring.
 This diffusely enlarged thyroid gland is somewhat nodular. This
patient was euthyroid. This represents the most common cause
for an enlarged thyroid gland and the most common disease of
the thyroid--a nodular goiter.
 Multinodular Goiter (Low Power)
The red arrow points to an area of scarring.
The blue arrow points to a large and the yellow to a relatively
small follicle highlighting the variability in follicle size in this
lesion.
 Multinodular Goiter (Medium Power)
The blue arrows point to the large follicles filled with colloid.
The yellow arrow points to smaller follicles.
Heterogeneity is typical of this lesion.
 Multinodular Goiter (Medium Power)
Blue arrows highlighting large follicles filled with colloid.
Yellow arrow points to small follicles
 The follicles are irregularly enlarged, with flattened epithelium, consistent with
inactivity, in this microscopic appearance at low power of a multinodular goiter. The
earlier phase of a diffuse (non-toxic) goiter leading up to this point may have resulted
from either "endemic" goiter (seen in parts of the world where dietary deficiency of
iodine may occur) or the uncommon "nonendemic" or sporadic goiter (young adult
women are most often affected). Inborn errors of thyroid hormone biosynthesis
leading to goiter are extremely uncommon.
 Multinodular Goiter (High Power)
Close up of follicles within a multinodular goiter.
The colloid is abundant.
The follicular cells show little atypia.
The follicular cells have round to oval nuclei with small visible nucleoli.
The follicle cell cytoplasm is scant.
 Multinodular Goiter (FNAC)
This is an H&E stained needle aspirate of a thyroid follicle.
The yellow arrow points to the acellular center of the follicle containing colloid,
which does not stain well.
The blue arrow points to a normal follicular cell nucleus.
This corresponds to a normal sized or enlarged follicle, not a microfollicle
 Multinodular Goiter (FNAC)
H&E stained fine needle aspirate of normal follicle.
Yellow arrow points to acellular center containing poorly
visualized colloid.
Blue arrows point to normal follicle nuclei. Not a micro follicle.
 Multinodular Goiter (FNAC- Medium Power)
Air dried Diff-Quick stained fine needle aspirate of the thyroid.
Large follicles (macrofollicular pattern)
 Multinodular Goiter (FNAC- High Power)
Macrofollicle of the thyroid in which normal follicular nuclei
surround colloid center.
Nuclei are similar in size and shape to each other.
 Multinodular Goiter (FNAC Medium Power)
Two follicles, large on left and smaller on right.
These are three dimensional structures compressed by the coverslip, rather than
sectioned through.
The nuclei are small, round and bland.
The colloid is bluish.
 Here is a surgical excision of a small mass from the thyroid gland that has
been cut in half. A rim of slightly darker thyroid parenchyma is seen at the
left. The mass is well-circumscribed. Grossly it felt firm. By scintigraphic
scan it was "cold." This is a follicular adenoma.
 Here is another follicular neoplasm (a follicular adenoma
histologically) that is surrounded by a thin white capsule. It is
sometimes difficult to tell a well-differentiated follicular
carcinoma from a follicular adenoma. Thus, patients with
follicular neoplasms are treated with subtotal thyroidectomy just
to be on the safe side.
 Normal thyroid follicles appear at the lower right. The follicular
adenoma is at the center to upper left. This adenoma is a well-
differentiated neoplasm because it closely resemble normal
tissue. The follicles of the adenoma contain colloid, but there is
greater variability in size than normal.
 Follicular Adenoma (Low Power)
The red arrow points to the predominantly small follicles
contained in the adenoma.
The blue arrows point to compressed normal thyroid.
The yellow arrows points to normal thyroid with much larger
follicles than most of those within the adenoma.
 Follicular Adenoma (Medium Power)
The red arrow is located within the adenoma.
Although composed of follicular cells, little colloid is seen.
The blue arrow points to the capsule of the adenoma, a few strands of
connective tissue.
The yellow arrow points to colloid within a large normal follicle.
 Follicular Adenoma (Medium Power)
This is the center of a follicular adenoma.
The yellow arrows point to two small follicular centers containing colloid.
Overall there is little acellular pink colloid.
This is a macrofollicular pattern.
 Follicular Adenoma (High Power)
This view is of the interior of a follicular adenoma.
The yellow arrows point to colloid within the centers of small
follicles
The follicle cells have round to oval nuclei and small nucleoli.
 Follicular Adenoma of Thyroid (FNAC)
The follicles are composed of small clusters of cells.
The colloid cannot be identified easily in this preparation.
The nuclei are monotonous without obvious atypia.
 Follicular Adenoma of Thyroid (FNAC)
This is a close view of a small thyroid follicle.
It is composed of few cells each with a round nucleus and
inconspicuous cytoplasm.
 Papillary Carcinoma of the Thyroid
On the left is the external surface of a thyroid gland, massively distorted by
carcinoma.
The surface is irregular with many adhesions.
Cut surface on the right is partly red brown (normal)
Large yellow-tan nodules are carcinoma
 Papillary Carcinoma of the Thyroid
The thyroid is massively distorted by a multinodular growth.
Shaggy external surface due to difficulty in dissecting organ
from other structures, a feature which suggests malignancy
 Thyroid Papillary Carcinoma (Sectioned)
The dark reddish brown tissue is characteristic of normal
thyroid.
The large tan nodules represent carcinoma.
No large areas of hemorrhage and necrosis are seen.
 Sectioning through a lobe of excised thyroid gland reveals
Papillary carcinoma. This neoplasm can be multifocal, as
seen here, because of the propensity to invade lymphatics
within thyroid, and lymph node metastases are common. The
larger mass is cystic and contains papillary excrescences.
These tumors most often arise in middle-aged females.
 Papillary Carcinoma of Thyroid (Low Power)
The blue arrow points to a papillary structure.
The center is fibrovascular; the cells covering it are epithelial.
The red arrow shows a similar papillary structure in cross
section
 Papillary Carcinoma of Thyroid (Medium Power)
Sections of several papillary fronds showing central fibrous
cores through which run blood vessels.
Cells covering them range from low columnar to columnar.
Nuclear detail is difficult to appreciate at this power.
 Papillary Carcinoma of Thyroid (High Power)
This close up shows that the cells range from low columnar to
columnar.
The red arrow shows a cell with an Orphan Annie eye nucleus
 Papillary Carcinoma of Thyroid (Medium Power)
These calcifications, some of which are highlighted by arrows,
are not text book examples of psammoma bodies.
They probably arise from the same process
 This is the microscopic appearance of a Papillary carcinoma
of the thyroid. The fronds of tissue have thin fibrovascular
cores. The fronds have an overall papillary pattern. There is no
such thing as a papillary adenoma, and all papillary neoplasms
of the thyroid should be considered malignant.
 This is another Papillary carcinoma of thyroid. Note the small psammoma
body in the center. The cells of the neoplasm have clear nuclei. Papillary
carcinomas are indolent tumors that have a long survival, even with
metastases. The most favorite site of metastasis is to local lymph nodes in
the neck. In fact, some papillary carcinomas may first present as nodal
metastases.
 Papillary Carcinoma of Thyroid (FNAC)
The arrow points to a nucleus with a large pale center.
This is a fine needle aspirate stained with a Pap stain.
The malignant cells including the one at the tip of the arrow are
very loosely arranged
 Papillary Carcinoma of Thyroid FNAC
Blue arrow points to a cell with a clear nucleus.
Red arrow points to a cell with a partially visible nuclear groove.
 Papillary Carcinoma of Thyroid -FNAC
The cells are loosely arranged in a papillary pattern.
The arrows point to two cells with nuclear clearing.
 At the center and to the right is a Medullary carcinoma of
thyroid. At the far right is pink hyaline material with the
appearance of amyloid. These neoplasms are derived from the
thyroid "C" cells and, therefore, have neuroendocrine features
such as secretion of calcitonin.
 CONGO RED

Here the amyloid stroma of the medullary thyroid

carcinoma has been stained with Congo red. Medullary
carcinomas can be sporadic or familial. The familial kind are
associated with multiple endocrine neoplasia syndrome.
ENDOCRINE PATHOLOGY

PARATHYROID
PATHOLOGY
 Here is a Normal parathyroid gland for comparison.
Adipose tissue cells are mixed with the parathyroid tissue.
The amount of fat varies somewhat.
 Parathyroid hyperplasia is shown here. Three and one-half
glands have been removed (only half the gland at the lower left
is present). Parathyroid hyperplasia is the second most
common form of primary hyperparathyroidism, with parathyroid
carcinoma the least common form.
 In parathyroid hyperplasia, there is little or no adipose tissue, but any or all
cell types normally found in parathyroid are present. Note the pink oxyphil
cells here. This is actually "secondary hyperparathyroidism" with
enlarged glands as a consequence of chronic renal failure with impaired
phosphate excretion. The increased serum phosphate tends to drive serum
calcium down, which in turn drives the parathyroids to secrete more
parathormone.
PARATHYROID HYPERPLASIA
PARATHYROID HYPERPLASIA
 Here is a Parathyroid adenoma, which is the most common
cause for primary hyperparathyroidism. A rim of normal
parathyroid tissue admixed with adipose tissue cells is seen
compressed to the right and lower edge of the adenoma.
 Parathyroid Adenoma (External View)
Smooth surface is typical of a benign neoplasm.
Cannot separate hyperplasia from adenoma on the basis of gross
findings in one gland.
Parathyroid carcinoma would probably show adhesions reflecting
difficulty in dissecting it from adjacent invaded structures.
 Parathyroid Adenoma (Cut Surface)
Homogeneous red tan surface of adenoma.
Cannot identify any normal gland compressed to one side.
Cannot predict histologic cell type based on gross.
Cannot prove this is adenoma vs. hyperplasia without seeing
other glands either grossly or microscopically.
 Parathyroid Adenoma (Composite View)
Upper view is external; lower view is cut surface.
Smooth external surface is consistent with benign proliferation.
Homogeneous red tan cut surfaces fail to show any normal
parathyroid
 Parathyroid Adenoma
Cut surfaces of a parathyroid which is enlarged.
Smooth external contour is characteristic of benign parathyroid
enlargement.
Small area of hemorrhage.
Compressed normal parathyroid can not be identified grossly.
 Adjacent to this parathyroid adenoma is a rim of normal parathyroid
tissue (with a pink oxyphil cell nodule) at the upper right, and a small benign
parathyroid cyst (an incidental finding) is at the upper left. Patients with this
form of primary hyperparathyroidism are usually picked up with routine
chemistry panels in which a high serum calcium is noted. A parathormone
(PTH) assay reveals a high normal to elevated level of PTH.
 This is the gross appearance of a Parathyroid
carcinoma. The serum calcium can be quite high.
Note the large size and irregular cut surface. These
carcinomas have a tendency to invade surrounding
tissues in the neck, complicating their removal.
 This is a Parathyroid carcinoma seen at medium power on the left and
higher power on the right. The nests of neoplastic cells that are not very
pleomorphic. Note the bands of fibrous tissue between the nests.
Parathyroid carcinomas infiltrate surrounding structures in the neck.
ENDOCRINE PATHOLOGY

ADRENAL PATHOLOGY
 A Normal right adrenal gland is shown here positioned between the liver
and the kidney in the retroperitoneum. Note the amount of adipose tissue,
some of which has been reflected to reveal the upper pole of the kidney and
the adrenal.
 Here are Normal adrenal glands. Each adult
adrenal gland weighs from 4 to 6 grams.
 Sectioning across the adrenals reveals a golden
yellow outer cortex and an inner red to grey medulla.
 1

4
3

5
6

1 - PERIADRENAL FAT 4 - ZONA FASICULATA

2 - CAPSULE 5 ZONA RETICULARIS
3 ZONA GLOMERULOSA 6 - MEDULLA
NORMAL ADRENAL
NORMAL ADRENAL CORTEX
 The pair of adrenals in the center are normal. Those at the top come from a
patient with adrenal atrophy (with either Addison's disease or long-term
corticosteroid therapy). The adrenals at the bottom represent bilateral
cortical hyperplasia. This could be due to a pituitary adenoma secreting
ACTH (Cushing's disease), or Cushing's syndrome from ectopic ACTH
production, or idiopathic adrenal hyperplasia.
 Cyst (External View)
This is an adrenal which is massively distorted.
The external surface is smooth and glistening with prominent blood vessels.
No normal adrenal can be seen.
 Adrenal Cyst (Cut Surface)
This is the interior of an adrenal cyst.
The wall is thin. Vivid golden yellow tissue in the wall is
thinned adrenal cortex.
The cyst is unilocular (only one cavity).
 Adrenal Cyst (Composite View)
The left panel is the external surface of an adrenal gland.
Adrenal is enlarged massively.
The right panel shows interior of unilocular cyst. Golden yellow
tissue is adrenal cortex.
 These adrenals are black-red from extensive
hemorrhage in a patient with meningococcemia. This
produces the Waterhouse-Friderichsen syndrome.
 This is the microscopic appearance of the adrenals with
Meningococcemia. There is marked hemorrhagic
necrosis with acute adrenal insufficiency.
 The patient with Waterhouse-Friderichsen syndrome has
sepsis with DIC and marked purpura.
 These sections
through an enlarged
adrenal gland
demonstrate tan-
white metastatic
carcinoma
infiltrating in and
around the residual
golden yellow
cortex. The most
common primary
site for adrenal
metastases is lung.
 This is a Caseating granuloma of tuberculosis in the adrenal
gland. Tuberculosis used to be the most common cause of
chronic adrenal insufficiency. Now, idiopathic (presumably
autoimmune) Addison's disease is much more often the cause
for chronic adrenal insufficiency.
 Here are Congo red stained deposits of amyloid in the
adrenal cortex. Amyloid may collect in adrenal as well as other
organs.
 Adrenal Cortical Adenoma
(Composite External and Cut Surfaces)
Left panel shows smooth surfaced external view of adenoma.
Right panel shows large, vividly yellow mass with focal
hemorrhage.
 Adrenal Cortical Adenoma (Cut section)
View of yellow cortical adenoma with focal hemorrhage.
No recognizable normal cortex or medulla.
Smooth external contour of the neoplasm
 This adrenal gland removed surgically in a patient with Cushing's syndrome has
been sectioned in half to reveal an adenoma. Some remaining atrophic adrenal is
seen at the right. The adenoma is composed of yellow firm tissue just like adrenal
cortex. This neoplasm is well-circumscribed. Histologically, it is composed of well-
differentiated cells resembling cortical fasciculata zone. It is benign.

 Here is a 1.3 cm left adrenal adenoma found in a patient with

hypertension. She had hypokalemia on a routine chemistry panel. Further
workup revealed a high serum aldosterone and a low serum renin, findings
consistent with an aldosterone secreting adrenal adenoma (Conn's
syndrome). This lesion accounts for about two-thirds of cases of Primary
hyperaldosteronism (PHA), while bilateral adrenal hyperplasia accounts
for about 30% of PHA. Such adenomas are typically less than 2 cm in size
and yellow on cut surface.
 Microscopically, the adrenal cortical adenoma at the right
resembles normal adrenal fasciculata. The capsule is at the left.
There may be some cellular pleomorphism.
 This is a large
Adrenal cortical
carcinoma which is
displacing the left
kidney downward.
Such neoplasms are
usually functional
(secreting
corticosteroids or
sex steroids). They
have a poor
prognosis.
 There is residual adrenal at the right, and an
adrenal cortical carcinoma is at the left.
 This high power microscopic appearance of an adrenal cortical carcinoma
demonstrates that the neoplasm closely resembles normal adrenal cortex. It
is difficult to determine malignancy in endocrine neoplasms based upon
cytology alone. Thus, invasion (as seen here in a vein) and metastases are
the most reliable indicators. Luckily, most endocrine neoplasms are benign
adenomas.
 Here is an Adrenal cortical carcinoma seen microscopically at high power
to demonstrate cellular pleomorphism with nuclear hyperchromatism. Both
benign and malignant endocrine neoplasms demonstrate some degree of
cellular pleomorphism, so it is not easy to tell benign from malignant on
histologic grounds alone. The larger the neoplasm, the more likely it is
malignant, but the best indicators are invasion and metastasis.
 This large adrenal neoplasm has been sectioned in half. Note
the grey-tan color of the tumor compared to the yellow cortex
stretched around it and a small remnant of remaining adrenal at
the lower right. This patient had episodic hypertension. This is a
tumor arising in the adrenal medulla--a Pheochromocytoma.
 Pheochromocytoma (Cut Surfaces)
Arrows point to normal adrenal gland on each side of large
neoplasm.
Gray tan surface with areas of brown red hemorrhage is
typical.
 Pheochromocytoma (Cut Surface)
Mottled brown tan mass is the neoplasm filling up the adrenal medulla.
Blue arrow points to residual normal medulla.
Yellow arrows point to golden yellow adrenal cortex.
Black discoloration around the specimen is india ink applied to assess
the margins of the specimen.
 This Pheochromocytoma demonstrates the chromaffin reaction. This
neoplasm of the adrenal medulla contains catecholamines (epinephrine and
norepinephrine). The section of tumor at the bottom has been placed into a
dichromate fixative which turns the tissue brown as the catecholamines are oxidized.
Compare to the section of pink to yellow tumor at the top which has not been placed
in dichromate fixative.
 There is some residual adrenal cortical tissue at
the lower center right, with the darker cells of
pheochromocytoma seen above and to the left.
 Microscopically, a Pheochromocytoma is composed of large cells that
are pink to mauve and arranged in nests with capillaries in between.
Remember 10% when you think of a pheochromocytoma: 10% are
bilateral, 10% are in children, 10% are malignant.
 By electron microscopy, the neoplastic cells of the Pheochromocytoma
contain neurosecretory granules. It is these granules that contain
the catecholamines. The granules seen here appear as small black round
objects in the cytoplasm of the cell. The cell nucleus is at the upper left.
 This neonate had a Congenital neuroblastoma of the right
adrenal. This neoplasm (marked by the white arrow) is
displacing the liver to the left of the body.
 Neuroblastoma (Cut Surfaces)
Entire adrenal has been replaced by large,
hemorrhagic fleshy, friable neoplasm
 Neuroblastoma (Cut Surface)
Much of this neoplasm is hemorrhagic (dark areas).
Much of this neoplasm is necrotic (white arrows)
The remainder (blue arrows) is fleshy and typical of
neuroblastoma.
 This is a microscopic appearance of neuroblastoma, which is
one of the "small round blue cell" tumors. These neoplasms
can reach a large size in the retroperitoneum before detection.
They often contain areas of necrosis and calcification.
 Ganglioneuroblastoma (External View)
External view of a ganglioneuroblastoma found in the adrenal gland or
sympathetic ganglia.
Smooth external surface
No normal adrenal recognizable.
 Adrenal Ganglioneuroblastoma (Cut Surface)
No recognizable adrenal gland.
Partially cystic neoplasm containing bloody fluid.
Central core of red tan soft tumor
 Ganglioneuroblastoma (Composite View of External and Cut Surface)
Left panel is external view of a smooth surfaced neoplasm completely
replacing adrenal gland.
Right panel is cut surface which shows extensive hemorrhage and cyst
formation.
Ganglioneuroblastoma (Composite External and Cut Surface)
Left panel shows smooth external surface of organ markedly
distorted by neoplasm.
Right panel is cut surface which shows gray fleshy neoplasm
with small focal hemorrhage.
 Ganglioneuroblastoma (External View)
Adrenal gland distorted by large mass.
Relatively smooth external surface
 Ganglioneuroblastoma (Cut Surfaces)
No normal adrenal gland can be seen.
Neoplasm shows some fleshy gray areas and other areas with
hemorrhage.
Mature and immature neurons are scattered throughout and cannot be
identified in separate areas grossly.
 Ganglioneuroma (Cut Surface)
No recognizable adrenal.
The neoplasm is yellow tan to gray tan.
No hemorrhage or necrosis is seen
 Metastatic Adenocarcinoma in Adrenal
The gray white nodules which obliterate normal architecture are
metastatic carcinoma.
Yellow tissue is normal cortex; brown gray normal medulla.
 Metastatic Adenocarcinoma in Adrenal(Cross Section)
The arrows point to a gray white area obscuring the normal
architecture of cortex and medulla.
The gray white area is metastatic carcinoma.
The cortex is vivid yellow.
The medulla is brown to gray.
ENDOCRINE PATHOLOGY

PANCREAS PATHOLOGY
 Here is the normal gross appearance of the adult pancreas; a small portion
of duodenum is at the left next to the head; the tail of the pancreas is at the
right. The pancreas has a tan, lobular architecture. Adjacent adipose tissue
and lymph nodes are closely apposed.
 Normal Pancreas
The arrows outline the superior margin of the pancreas
The serosal surface has a delicate lobular appearance
The upper left contains opened duodenum
 Normal Pancreas
The pancreas has been hemisected revealing a delicate tan lobular cut surface
A thin pancreatic duct (arrows) runs centrally through the pancreas
NORMAL PANCREATIC ACINI AND ISLETS
 Here is a Normal pancreatic islet of Langerhans surrounded by normal
exocrine pancreatic acinar tissue. The islets contain alpha cells secreting
glucagon, beta cells secreting insulin, and delta cells secreting somatostatin.
 Immunoperoxidase staining can help identify the nature of
the cells present in the islets of Langerhans. On the right,
antibody to insulin has been employed to identify the beta cells.
On the left, antibody to glucagon identifies the alpha cells.
 This is an Insulitis of an islet of Langerhans in a patient who will eventually
develop type I diabetes mellitus. The presence of the lymphocytic infiltrates in this
edematous islet suggests an autoimmune mechanism for this process. The
destruction of the islets leads to an absolute lack of insulin that characterizes type I
diabetes mellitus.
 This Islet of Langerhans demonstrates pink hyalinization (with
deposition of amyloid) in many of the islet cells. This change is
common in the islets of patients with type II diabetes mellitus.
 Pancreatic Islet Cell Tumor
Normal pancreas in this panel is represented by the section of
the far right.The lobulated appearance is typical. The neoplasm
is reddish brown in these sections and obliterates the normal
architecture.
 An Islet cell adenoma is seen here, separated from the
pancreas by a thin collagenous capsule. A few normal islets are
seen in the pancreas at the right for comparison
 The Islet cell adenoma at the left contrasts with the normal pancreas with
islets at the right. Some of these adenomas function. Those that produce
insulin may lead to hypoglycemia. Those that produce gastrin may lead to
Multiple gastric and duodenal ulcerations (Zollinger-Ellison syndrome).
 ISLET CELL ADENOMA
The neoplastic cells of the islet cell adenoma at high magnification demonstrate
very little pleomorphism. Note the vascularity of this neoplasm, similar to
normal islets.
 This is an Immunohistochemical stain for insulin in
the islet cell adenoma. Thus, it is an Insulinoma.
 Cut surface of an islet cell carcinoma of the pancreas.
There is no diagnostic gross feature to this tumor
Note the firm looking, yellow-tan tissue at the black arrow.
The arrow points to the location of the tumor
 ENDOCRINE PATHOLOGY

PITUITARY PATHOLOGY
 The Normal gross appearance of the pituitary gland removed from the sella turcica is shown
here. The larger portion, the anterior pituitary (adenohypophysis), is toward the top. The
image at the left shows the superior aspect of the pituitary with the stalk coming from the
hypothalamus entering it. The inferior aspect of the pituitary is shown at the right. The posterior
pituitary (neurohypophysis) is the smaller portion at the bottom.
 The Normal microscopic appearance of the
pituitary gland is shown here. The adenohypophysis
is at the right and the neurohypophysis is at the left.
 The Normal microscopic appearance of the adenohypophysis is shown
here. The adenohypophysis contains three major cell types: acidophils,
basophils, and chromophobes. The staining is variable, and to properly
identify specific hormone secretion, immunohistochemical staining is
necessary
 A simplistic classification is as follows:
The pink Acidophils secrete Growth hormone (GH)
and Prolactin (PRL)
The dark purple Basophils secrete Corticotrophin
(ACTH), Thyroid stimulating hormone (TSH), and
Gonadotrophins Follicle stimulating hormone-
luteinizing hormone (FSH and LH)
The pale staining Chromophobes have few
cytoplasmic granules, but may have secretory
activity.
 The Neurohypophysis shown here resembles neural tissue, with glial cells,
nerve fibers, nerve endings, and intra-axonal neurosecretory granules. The
hormones Vasopressin (antidiuretic hormone, or ADH) and oxytocin
made in the hypothalamus (supraoptic and paraventricular nuclei) are
transported into the intra-axonal neurosecretory granules where they are
released.
 This is a Microadenoma of the anterior pituitary.
Such microadenomas may appear in 1 to 5% of
adults. These microadenomas rarely have a significant
hormonal output that leads to clinical disease.
 Here is a high power microscopic view of an Adenohypophyseal
adenoma. Endocrine neoplasms are composed of small round cells with
small round nuclei and pink to blue cytoplasm. The cells may be arranged in
nests or cords and endocrine tumors also have prominent vascularity
 The circumscribed mass lesion present here in the sella turcica is a
Pituitary adenoma. Though pituitary adenomas are benign, they can
produce problems either from a mass effect (usually visual problems from
pressing on the optic chiasm and/or headaches) or from production of
hormones such as prolactin or ACTH.
 Pituitary Adenoma
Base of brain as it is lifted out of the skull with frontal lobes at the left.
A mass is protruding from the sella turcica (at arrows) which is a tan, soft
pituitary adenoma
 The microscopic appearance of the Pituitary adenoma is
shown here. Note the monotonous appearance of these small
round cells.
 A Craniopharyngioma is seen here at medium and high power. It is derived
from remnants of Rathke's pouch and forms an expanding mass arising in
the sella turcica that erodes bone and infiltrates into surrounding structures.
They are difficult to eradicate, even though they are composed of
histologically appearing squamoid and columnar epithelium lining cystic
spaces filled with oily fluid.
 This head CT scan
demonstrates a mass
with irregular margins
in the region of the
Sella. Such a mass
may impinge upon
the optic chiasm, just
like a pituitary
adenoma.
Craniopharyngioma
s are uncommon and
tend to occur in
young persons.