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1. ENDO 6224 – ENDOCRINE SYSTEM
PATHOLOGY PRACTICAL
DISEASES OF THE ENDOCRINE SYSTEM

2. Learning outcomes
At the end of this session the student would be able to
Identify and describe gross specimens and histopathological
appearance showing features of:
•Thyroid diseases: Multinodular Goiter, Graves Disease,
Thyroiditis, Adenomas & Carcinoma Thyroid
•Pituitary Tumor: Adenoma
•Adrenal diseases: Pheochromocytoma
Resources : Gross specimen, slides, microscope and photomicrograph

3. MULTINODULAR GOITER
An enlarged thyroid gland
Nodular in appearance on both capsular surface & cut section.
C.S. shows multiple brownish colloid filled nodules of various sizes,
separated by thin fibrous bands
Areas of haemorrhage are also seen. (Yellow arrows)

4. MULTINODULAR GOITER
(Museum Specimen QIU)
An enlarged thyroid gland, nodular in appearance on both capsular surface & C.S.
C.S. shows multiple brownish colloid filled nodules of various sizes, separated by thin
fibrous bands
Cystic degenerative changes (Blue arrow)
Intracystic haemorrhage are observed (Yellow arrow)

5. Normal thyroid: consists of follicles lined by a cuboidal epithelium 
and filled with
pink, homogenous
 
colloid.
NORMAL THYROID
MULTINODULAR GOITER
The follicles are irregularly enlarged;
filled with pinkish colloid.
Follicles lined by single regular layer
of cuboidal to flattened epithelium.
Irregular fibrous scarring
Focal haemorrhage & calcification

6. GRAVES’ DISEASE (DIFFUSE HYPERPLASIA) THYROID
A.Gross: Diffuse enlargement of gland; red brown meaty parenchyma
B.Micro:
The follicles are lined by tall, columnar epithelium.
Epithelial cells project into the lumens of the follicles as hyperplastic
infoldings (papillary structures).
Active resorption of colloid resulting in the scalloped margins of the colloid.

7. GRAVES DISEASE

8. Thyroid parenchyma is infiltrated by lymphocytes and plasma cells;
some areas forming lymphoid follicles with germinal centres. (blue
arrow)
Follicles are atrophic with less colloid. (red arrow)
Thyroid follicles are lined by epithelial cells with abundant eosinophilic,
granular cytoplasm, termed Hurthle cells
HASHIMOTO’S THYROIDITIS

9. A well confined thyroid lesion; surrounded by a thin white
 
capsule.
It is grey-white to red-brown in colour
The adenoma bulges from the cut surface and compress adjacent
tissue
Areas of haemorrhage, calcification are seen
FOLLICULAR ADENOMA THYROID

10. Normal thyroid follicles at the lower right. Follicular adenoma is at the
upper left.
There are small colloid filled compact follicles of variable sizes.
Follicles are lined by regular cuboidal epithelium
A well demarcation from the normal thyroid tissue by a thin compressed
capsule.
Capsular and vascular invasion are not seen.
FOLLICULAR ADENOMA THYROID

11. GROSS:
Solitary lesion,
Cystic structure contains
 
papillary
excrescences.
Area of haemorrhage and necrosis
Area of calcification
PAPILLARY CARCINOMA OF THE THYROID
MICROSCOPIC:
The papillary structures with thin fibro-
vascular cores.
A small
 
psammoma body 
is seen.
Tumor cells have characteristic ground-
glass nuclei, overlapping nuclei (Orphan
Annie eyes)

12. PAPILLARY CARCINOMA OF THE THYROID

13. A
 well circumscribed tumor mass
at
the base of the brain
It distorts the overlying brain
It is covered by a capsule
Focal area of haemorrhage are seen
PITUITARY ADENOMA
Well encapsulated tumour mass
Uniform, polygonal cells arranged in
solid sheets
Nuclei of tumor cells are uniform and
less pleomorphic
Mitotic activity is usually sparse
No area of H’ge & necrosis

14. DB CA E
Normal adrenal glands (Micro)
A.Capsule
B.Zona Glomerulosa
C.Zona Fasiculata
D.Zona Reticularis
E.Medulla
Normal adrenal glands (Gross)
Cut section reveals a golden yellow outer cortex and an inner red to grey
medulla.

15. Gross: The adrenals are black-red due to
extensive haemorrhage in a patient with
meningococcemia.
Waterhouse-Friderichsen syndrome in a patient
with meningococcemia
has sepsis with DIC and marked purpura
Adrenal Haemorrhage in Waterhouse-Friderichsen
syndrome
Histology: marked hemorrhagic necrosis
leading to acute adrenal insufficiency.

16. Adreno cortical adenoma
Gross:
A well defined yellowish lesion
Solitary lesion
Presence of capsule
No area of haemorrhage &
necrosis
Micro:
A capsulated adrenal lesion
Tumour cells resemble normal
adrenal cells.
minimal cellular pleomorphism

17. Pheochromocytoma
Gross:
Cut section of a large well circumscribed
adrenal neoplasm
A tumuor arising from the adrenal medulla:
Grey-tan colour
Area of haemorrhage
compressed normal adrenal tissue at the
periphery
Micro:
A.residual adrenal cortical tissue,
B.darker cells of
the
 
pheochromocytoma
zellballen pattern with nuclei

having salt and pepper
chromatin
A B

18. REFERENCES
Kumar, V., Abbas, A.K., Aster, J.C. (2015) Robbins and Cotran Pathologic
Basis of Diseases 9
th
edition. Elsevier Saunders.
Kumar, V., Abbas, A.K., A.K., Aster, J.C. (2013) Robbins Basic Pathology.
9th edition. (or latest edition) Elsevier Saunders.* (With Student Consult
Online Access / Edition 8).
Cross, S. (2013) Underwood’s Pathology: a Clinical Approach. 6
th
Edition.
Elsevier (With Student Consult Online Access).
http://library.med.utah.edu/WebPath/webpath.html
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