Pathology Practicals 3 (Part 3)

Endocrine, Breast, Urinary System By: Jeffrey James Co :D

** Remember! Graves Disease, Papillary Carcinoma (Thyroid), Hashimotos (Chronic Lymphocytic) Thyroiditis

Pituitary Adenoma
Olfactory Bulb

Pituitary Adenoma Basilar Artery

Hx: 54 yo male complained of severe frontal headache and blurring of vision of 2 weeks duration.

normal

vs pituitary adenoma

Diffuse pattern, cells arranged in sheets, closely packed, supported by scant fibrovascular stroma and absence of reticulin.

Adenoma

Residual Tissue

Normal Thyroid

Colloid

Follicular cells Parafollicular cells

HASHIMOTOs THYROIDITIS (CHRONIC LYMPHOCYTIC)

Remaining thyroid follicles

Lymphoid follicle

Germinal Centers

Hurthle or Askanazy Cells

Hx: 50 yo women, enlarged mass on neck Clinical Features: Goiter, Hypothyroidism, Increased TSH, Low T3 and T4 levels

 Hashimoto (Auto-Immune)
(Lymphoid follicles with germinal centers Subacute Lymphocytic (just like Hashimotos but NO fibrosis and no germinal centers), often post-partum

Diffuse Non-toxic (Simple) Goiter

Hx: 59 yo female, non-tender, large anterior neck mass

Gross: Enlarged, doughy, purplish to reddish-brown Microscopy: Enlarged irregular Thyroid Follicles with excessive colloid

Graves disease (diffuse toxic goiter)

Hx: 29 yo female non-tender, large anterior neck mass SCALLOPING APPEARANCE! (Yung mga butas butas sa sides)

Low TSH, Hyperthyroidism,

Follicular adenoma
Hx: 24 yo female mass solitary

Follicular Adenoma

Normal

Papillary Carcinoma

Hx: 54 yo male, pricking pain and dyspnea

ORPHAN ANNIE CELLS (Clear Ground Glass)

PSAMMOMA BODIES

PAPILLARY CARCINOMA

external surface in the left photo shows a yellow-tan color. The cut surface in the right photo is hemorrhagic, of a yellow-pink-tan color, and shows minor cystic change.

Tumors: Adrenal cortex

Adrenocortical carcinoma

Adrenocortical carcinoma

Hindi ko na lahatin, lalagay ko nalang yun pinakasure lalabas.. :D

Fibroadenoma
Hx: 20 yo female, tender mass o the right breast

Hx: 53 yo female, 4 yrs past her menopause w/ tumor of increaseing size in the breast

Microscopy: Spindly and stellate, myxomatous stromal cells w/ areas of necrosis and hemorrhages

MAY DELINEATIONS PA FROM NORMAL AND ABNORMAL CELLS

DISTORTED CAPSULE

INDIAN FILING

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

MUST KNOW!!! :D

Pathogenesis: Secondary to congenital obstruction of the ureteropelvic junction.

Wilms tumor resembles the developing fetal nephrogenic zone of the kidney. The tumor shows attempts to form primitive glomerular and tubular structures. Pediatric neoplasms are often composed of cells that resemble primitive embryonic counterparts: -blasts. In this case the cells are reminiscent of developing nephroblasts.

Composition of Urine 1. Chemical Constituent: NaCl, Urea (Most impt) 2. Microscopic Constituent: RBC, WBC, Epith cells, Casts, Crystals Normal Volume of urine: 1200-1500ml/day Normal Spec.Gravity: 1.016-1.022 Normal pH: 4.6-8 Normal Protein: 150mg/24hrs or 10mg/dl Renal Glucose Threshold: 160-180mg/dl RBC : 0-2/HPF WBC: 0-5/HPF Epithelial Cells: >3 is ischemic necrosis

Casts
Factors affecting cast formation: 1. pH: acidic 2. Concentrated urine 3. Proteinuria 4. Stasis or obstruction Types of Casts: 1. Matrix Casts: Hyaline- glomeruloneph, pyeloneph, Chronic renal dse, CHF Waxy- Stasis or urine flow 2. Cellular Casts: RBC glomeruloneph, strenuous exercise WBC pyeloneph, acute interstitial neph Epithelial cells Renal Tubular Damage Mixed cells 3. Inclusion Casts: Granular Casts, Fatty casts, Hemosiderin Casts

RBC CASTS!

WBC Casts

Hyaline Casts

Epithelial Cell Casts

Waxy Casts

Granular Cast Fatty Casts Hemosiderin Casts

OFB = Oval Fat Body

Crystals
Normal Acid Urine:

Crystalline urates Amorphous Urates

Calcium Oxalate Crystalline Uric Acid

Normal Alkaline Urine

Amorphous Phosphate

Crystalline phosphates

Calcium carbonate

Ammonium biurate

Abnormal Crystals

Cystine

Tyrosine

Leucine Sulfonamide

YOU HAVE NOW FINISHED THE LAST PART!!!! PASADO KANA! LOL :P
GOOD LUCK! :D