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Endocrine Sequence - LAB 2


Slide 159 [WebScope] [ImageScope]

Adrenal: Addison’s disease

The common denominator of Addison's disease is a chronic destructive process of the adrenal cortex. Clinical manifestations occur when about 90% of the cortex has been destroyed.

This slide shows an adrenal gland that is replaced by caseous material. Some residual cortical tissue may be present just underneath the capsule of the gland.

  1. What is the most common causes of Addison's disease in the U.S. today?...decades ago?

  2. What are some uncommon causes?

  3. What might be the process in this case?



Slide 160 [WebScope] [ImageScope]

Adrenal: Cortical hyperplasia

Begin by examining the slide with the naked eye (this is a good habit to develop). Note that the adrenal gland appears larger than normal with vague nodularity. The section shows cortical hyperplasia consisting of lipid-rich fasciculata-type cells (cells with clear cytoplasm with many lipid droplets). Occasional lipid-poor reticularis-type cells are also present. Notice that no medullary tissue is identified.

  1. What are the three morphologic types of hyperplasia associated with Cushing’s syndrome?

  2. How does nodular hyperplasia differ morphologically from an adenoma?

  3. What are the three major anatomic causes of Cushing's syndrome?

  4. Bonus: Who was Conn?



Slide 161 [WebScope] [ImageScope]

Adrenal: Pheochromocytoma

This section contains a cellular neoplasm and may contain normal adrenal cortex at the periphery. The neoplasm consists of cells that resemble the normal adrenal medulla growing in nests separated by prominent blood vessels. See Figure 26-57 in Robbins for an example of this pattern if you cannot appreciate it on the slide.

  1. What is the typical clinical picture associated with pheochromocytoma?

  2. Are pheochromocytomas benign or malignant? How can you tell?

  3. Pheochromocytoma occurs sporadically and as part of five familial syndromes. What are the syndromes?



Slide 44 [WebScope] [ImageScope]

Pancreas: Pancreatic endocrine neoplasm (islet cell tumor)

This section of pancreas contains an epithelial neoplasm. Compare the appearance of the neoplastic cells with those of the adjacent normal islets, if present. This is a classic pancreatic endocrine neoplasm in which the cells grow in islands and trabeculae. Notice the prominent vessels. The cells contain round nuclei with small nucleoli and abundant granular cytoplasm.

  1. How can patients with these neoplasms present clinically?

  2. Is it possible to predict the biologic behavior of these neoplasms based on their histologic appearance? If so, how? If not, why not?



Slide 102 [WebScope] [ImageScope]

Pancreas: Diabetes

This slide contains two separate sections of pancreas, one from a patient with insulin-dependent diabetes mellitus (type I) and the other from a patient with non-insulin dependent diabetes mellitus (type II). Carefully examine the islets from the two sections looking for lymphocytic infiltrates (insulitis) and amyloid deposition.

  1. Although these changes are not entirely specific, what type of diabetes is associated with lymphocytic infiltration of islets? ...amyloid deposition of islets?


The answers to the path lab questions will be posted approximately 48-72 hours after the lab sessions. These are abbreviated answers, not a full discussion of the topics. You can find them in the M2 CTools site resources. In the folder for each sequence the will be a folder called 'Path Lab Resources'


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