Pathology Review Carousel

Pathology Review Carousel
Endocrine

Image

Slide #

Tissue

Mag

Feature

1

Adrenal gl.

Gross

Early pheochromocytoma. Note the small gray-tan nodule within the adrenal medulla.

2

Adrenal gl.

Gross

Pheochromocytoma. Pale gray to light brown mass with focal hemorrhage. Note very thin rim of adrenal cortex at the periphery of some of the tumor.

3

Adrenal gl.

LP

Pheochromocytoma. Nests of blue tumor cells separated into the lobular pattern by delicate fibrovascular septa (pink strands).

4

Adrenal gl.

HP

Pheochromocytoma. One nest of tumor cells with abundant granular eosinophilic cytoplasm with rim of delicate fibrovascular septa. (Often the cells will be even larger and more pleomorphic with prominent nucleoli).

5

Adrenal gl.

LP

Pheochromocytoma. Note lobular pattern with nests of cells separated by fibrovascular septa, some with dilated vascular spaces (eosinophilic).

6

Adrenal gl.

MP

Pheochromocytoma. Lobular pattern less distinct, but abundance of granular eosinophilic cytoplasm evident.

7

Adrenal gl.

HP

Pheochromocytoma. One nest of tumor cells showing abundant granular eosinophilic cytoplasm and nuclei with prominent nucleoli. Mitoses are rare.

9

Sympathetic ganglion

LP

Ganglioneuroma. Mature ganglion on cell (large peripheral neurons) scattered in background of spindle cells with loose pink stroma.

10

Sympathetic ganglion

HP

Same

12

Parathyroid glands (4)

Gross

Parathyroid hyperplasia. Note that all four glands are enlarged, but not to the same degree.

13

Parathyroid gland

Gross

Parthyroid adenoma. From one gland it would be impossible to determine whether this is hyperplasia or an adenoma. In the history the other glands were normal; therefore, this gland would be an adenoma (or if malignant, a carcinoma).

14

Parathyroid

LP

Parathyroid adenoma. Note the increase of parthyroid chief cells and loss of adipose tissue. From this photmic, it would not be possible to differentiate hyperplasia from an adenoma. The normal appearance of the other glands make this an adenoma. (Reminder: Adenomas should have a capsule and may have a thin rim of normal parthyroid gland with fat outside the adenoma).

16

Adrenal gl.

Gross

Adrenal cortical hyperplasia. Note there is some diffuse thickening and nodular thickening of the adrenal cortex.

17

Adrenal gl.

Gross

Adrenal cortical tumor. Note bright yellow nodule within the thin or normal residual cortex.

18

Adrenal gl.

Gross

Adrenal cortical carcinoma. Bulky, soft, encapsulated tumor with hemorrhage and necrosis sitting abouve and medially to the kidney. (Note size of tumor, > 10 cm).

19

Adrenal gl.

LP

Adrenal cortical adenoma. Encapsulated tumor nodule (pink and clear) compressing the nonneoplastic hemorrhagic adrenal gland.

20

Adrenal gl.

MP

Adrenal cortical adenoma. Sheets of clear, lipid-laden (fasciculata type) cells interspersed with cells with eosinophilic cytoplasm (lipid depleted, reticularis type cells).

22

Thyroid

LP

Hashimoto's thyroiditis. Thyroid follicles extensively replaced by lympho-plasmacytic infiltrate with germinal centers.

23

Thryoid

LP

Hashimoto's thyroiditis. Extensive destruction of thyroid follicles by mononuclear inflammatory infiltrate with fibrosis.

24

Thyroid

HP

Hashimoto's thyroiditis. Same as 23. Also oncocytic (Hurthle cell) change of the thyroid follicular epithelium is more evident (follicular cells gain abundant, eosinophilic granular cytoplasm).

26

Thyroid

Gross

Papillary Carcinoma. Infiltrative borders and whitish areas indicating fibrosis. Often multifocal.

27

Thyroid

LP

Papillary carcinoma. Thyroid follicles are being replaced by a papillary neoplasm (epithelium covers fibrous stalk that branches). Note the fibrosis (pink) and the calcification (dark blue or black).

28

Thyroid

MP

Papillary carcinoma. Neoplasm forming glands and papillary structures destroying and replacing normal thyroid follicles.

29

Thyroid

HP

Papillary carcinoma. Papillary structure with neoplastic epithelium covering a poorly identified connective tissue stalk. Notice the nuclear clearing evident at this magnification.

30

Thyroid

HP

Papillary carcinoma. Psammoma bodies (spherical, concentrically laminated calcified mass).

31

Thyroid

HP

Papillary carcinoma. Papillary foci with central fibrovascular stalks. Follicular neoplasms with nuclear features of papillary carcinomas such as ground glass nuclei, intranuclear pseudoinclusions and longitudinal grooving would also be considered papillary carcinomas. Nuclear clearing can be seen in this photomic but other features are less obvious.

33

Thyroid

Gross

Normal.

34

Thyroid

Gross

Multinodular goiter. Striking gland enlargement with multiple nodules, some solid and some containing colloid.

35

Thyroid

Gross

Graves disease. Thyroid gland mildly and symmetrically enlarged. Note the change is diffuse without nodules.

37

Thyroid

Gross

Follicular adenoma. Sharply circumscribed, usually solitary, pale tan to gray nodule with soft fleshy consistency. Can not exclude carcinoma on gross appearance alone.

38

Thyroid

Gross

Follicular carcinoma. This emphasizes that often carcinomas such as this can mimic adenomas and must be distinguished by histologic evaluation looking for vascular or pseudocapsular invasion into surrounding thyroid or soft tissues. (You would not be able to distinguish this as a carcinoma from the gross only.)

Pathology Review Carousel
Endocrine

Image	Slide #	Tissue	Mag	Feature
	1	Adrenal gl.	Gross	Early pheochromocytoma. Note the small gray-tan nodule within the adrenal medulla.
	2	Adrenal gl.	Gross	Pheochromocytoma. Pale gray to light brown mass with focal hemorrhage. Note very thin rim of adrenal cortex at the periphery of some of the tumor.
	3	Adrenal gl.	LP	Pheochromocytoma. Nests of blue tumor cells separated into the lobular pattern by delicate fibrovascular septa (pink strands).
	4	Adrenal gl.	HP	Pheochromocytoma. One nest of tumor cells with abundant granular eosinophilic cytoplasm with rim of delicate fibrovascular septa. (Often the cells will be even larger and more pleomorphic with prominent nucleoli).
	5	Adrenal gl.	LP	Pheochromocytoma. Note lobular pattern with nests of cells separated by fibrovascular septa, some with dilated vascular spaces (eosinophilic).
	6	Adrenal gl.	MP	Pheochromocytoma. Lobular pattern less distinct, but abundance of granular eosinophilic cytoplasm evident.
	7	Adrenal gl.	HP	Pheochromocytoma. One nest of tumor cells showing abundant granular eosinophilic cytoplasm and nuclei with prominent nucleoli. Mitoses are rare.
	9	Sympathetic ganglion	LP	Ganglioneuroma. Mature ganglion on cell (large peripheral neurons) scattered in background of spindle cells with loose pink stroma.
	10	Sympathetic ganglion	HP	Same
	12	Parathyroid glands (4)	Gross	Parathyroid hyperplasia. Note that all four glands are enlarged, but not to the same degree.
	13	Parathyroid gland	Gross	Parthyroid adenoma. From one gland it would be impossible to determine whether this is hyperplasia or an adenoma. In the history the other glands were normal; therefore, this gland would be an adenoma (or if malignant, a carcinoma).
	14	Parathyroid	LP	Parathyroid adenoma. Note the increase of parthyroid chief cells and loss of adipose tissue. From this photmic, it would not be possible to differentiate hyperplasia from an adenoma. The normal appearance of the other glands make this an adenoma. (Reminder: Adenomas should have a capsule and may have a thin rim of normal parthyroid gland with fat outside the adenoma).
	16	Adrenal gl.	Gross	Adrenal cortical hyperplasia. Note there is some diffuse thickening and nodular thickening of the adrenal cortex.
	17	Adrenal gl.	Gross	Adrenal cortical tumor. Note bright yellow nodule within the thin or normal residual cortex.
	18	Adrenal gl.	Gross	Adrenal cortical carcinoma. Bulky, soft, encapsulated tumor with hemorrhage and necrosis sitting abouve and medially to the kidney. (Note size of tumor, > 10 cm).
	19	Adrenal gl.	LP	Adrenal cortical adenoma. Encapsulated tumor nodule (pink and clear) compressing the nonneoplastic hemorrhagic adrenal gland.
	20	Adrenal gl.	MP	Adrenal cortical adenoma. Sheets of clear, lipid-laden (fasciculata type) cells interspersed with cells with eosinophilic cytoplasm (lipid depleted, reticularis type cells).
	22	Thyroid	LP	Hashimoto's thyroiditis. Thyroid follicles extensively replaced by lympho-plasmacytic infiltrate with germinal centers.
	23	Thryoid	LP	Hashimoto's thyroiditis. Extensive destruction of thyroid follicles by mononuclear inflammatory infiltrate with fibrosis.
	24	Thyroid	HP	Hashimoto's thyroiditis. Same as 23. Also oncocytic (Hurthle cell) change of the thyroid follicular epithelium is more evident (follicular cells gain abundant, eosinophilic granular cytoplasm).
	26	Thyroid	Gross	Papillary Carcinoma. Infiltrative borders and whitish areas indicating fibrosis. Often multifocal.
	27	Thyroid	LP	Papillary carcinoma. Thyroid follicles are being replaced by a papillary neoplasm (epithelium covers fibrous stalk that branches). Note the fibrosis (pink) and the calcification (dark blue or black).
	28	Thyroid	MP	Papillary carcinoma. Neoplasm forming glands and papillary structures destroying and replacing normal thyroid follicles.
	29	Thyroid	HP	Papillary carcinoma. Papillary structure with neoplastic epithelium covering a poorly identified connective tissue stalk. Notice the nuclear clearing evident at this magnification.
	30	Thyroid	HP	Papillary carcinoma. Psammoma bodies (spherical, concentrically laminated calcified mass).
	31	Thyroid	HP	Papillary carcinoma. Papillary foci with central fibrovascular stalks. Follicular neoplasms with nuclear features of papillary carcinomas such as ground glass nuclei, intranuclear pseudoinclusions and longitudinal grooving would also be considered papillary carcinomas. Nuclear clearing can be seen in this photomic but other features are less obvious.
	33	Thyroid	Gross	Normal.
	34	Thyroid	Gross	Multinodular goiter. Striking gland enlargement with multiple nodules, some solid and some containing colloid.
	35	Thyroid	Gross	Graves disease. Thyroid gland mildly and symmetrically enlarged. Note the change is diffuse without nodules.
	37	Thyroid	Gross	Follicular adenoma. Sharply circumscribed, usually solitary, pale tan to gray nodule with soft fleshy consistency. Can not exclude carcinoma on gross appearance alone.
	38	Thyroid	Gross	Follicular carcinoma. This emphasizes that often carcinomas such as this can mimic adenomas and must be distinguished by histologic evaluation looking for vascular or pseudocapsular invasion into surrounding thyroid or soft tissues. (You would not be able to distinguish this as a carcinoma from the gross only.)