Endocrine diseases.
Genital tract diseases.
Lecture on pathomorphology for the 3-rd year students
By T.G.Filonenko
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Diabetes mellitus
Diabetes mellitus is a metabolic disorder
characterized by hyperglycemia
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Classification of Diabetes
mellitus
I. Primary




Type I, also known
as insulin-dependent
diabetes mellitus
(IDDM)
Type II, or noninsulin-dependent
diabetes mellitus
(NIDDM)
Impaired glucose
tolerance
Gestational diabetes
II. Secondary




Pancreatic diseases (Chronic
pancreatitis, Hemochromatosis,
Cystic fibrosis, Tumors of
pancreas)
Endocrine disorders (Cushing
disease, Acromagaly,
Pheochromocytoma)
Genetic disease (Glycogen storage
disease, Down syndrome)
Drug-induced (Diuretics,
Psychoactive drugs
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Type I (IDDM)
Type II (NIDDM)
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Complications of DM
nodular
glomerulosclerosis
Glaucoma with excavation of the
optic cup
budding cells with Candida
albicans on PAS stain in the renal
pelvis
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Islet cell adenoma
Insulinoma
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A. Graves disease is an autoimmune disorder caused by antibodies to the
TSH receptor on follicular cells. Follicles are lined by cells that show signs of
hyperfunction, and the stroma contains lymphoid follicles.
B. Hashimoto thyroiditis is an autoimmune disease of unknown etiology.
The thyroid is diffusely infiltrated with lymphocytes. A part of the thyroid is
destroyed, and many follicles are lined by Hurthle cells.
C. De Quervain (subacute) thyroiditis (or giant cell or granulomatous
thyroiditis) is characterized by a sudden painful enlargement of the thyroid.
It is presumed to be of viral origin. The rupture of follicles is associated with an
inflammatory response that includes macrophages and giant cells.
D. Riedel thyroiditis is a chronic fibrosing process in which dense fibrous
tissue replaces the damaged thyroid follicles. There are no antithyroid
antibodies in this disease. The thyroid follicles have been replaced by fibrous
tissue.
Thyroiditis
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Graves disease
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.
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Hashimoto thyroiditis
lymphoid follicle
The pink Hürthle cells
atrophy
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De Quervain (subacute) thyroiditis
also known as giant cell or granulomatous
thyroiditis
the foreign body
giant cells with
destruction of
thyroid follicles
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Follicular adenoma
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Papillary carcinoma
psammoma body
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Medullary carcinoma
of the thyroid
amyloid
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Goiter
The follicles are
irregularly enlarged,
with flattened
epithelium
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THE NORMAL MENSTRUAL CYCLE
normal proliferative endometrium
early secretory endometrium
normal secretory phase endometrium
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The causes uterine
bleeding
– complication of pregnancy (ectopic pregnancy,
miscarriage, trophoblastic disease)
– submucosal leiomyoma (interferes with the
development of the endometrium)
– endometrial polyp (abnormal benign patch of
endometrium)
– endometrial hyperplasia
– cancer
– "dysfunctional uterine bleeding", i.e., some problem
with the hormonal symphony; this is the most
common
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Causes of Dysfunctional uterine
bleeding
– Anovulatory cycles
– A granulosa and/or theca tumor in an ovary
producing estrogens and/or progesterone
– Endocrine disease elsewhere
– Massive obesity (too much estrogen being
converted)
– Too little body fat (too little estrogen being
converted)
– Severe chronic disease
– Inadequate luteal phase
– Persistent luteal phase
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ADENOMYOSIS ("endometriosis interna")
endometrial glands and
stroma in the myometrium
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ENDOMETRIOSIS ("endometriosis externa“)
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The gross appearance of endometriosis
Minor lesions look like powder
burns under the serosal surface
Repeated hemorrhage in a cystic space in the
ovary (so-called "chocolate cyst")
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small cluster of endometrial glands and
stroma with hemorrhage in the surface of
the fallopian tube
To make the diagnosis,
the pathologist must
find two of three:
•endometrial glands
•endometrial stroma
•hemosiderin (from
the bleeding)
Hemosiderin in the wall of
"chocolate cysts"
Endometrial glands and stroma are seen
at high magnification in the wall of the
colon.
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submucosal,
intramural, and
subserosal
leiomyomata of the
uterus
Endometrial polyp
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ENDOMETRIAL HYPERPLASIA
Endometrial hyperplasia
usually results with
conditions of prolonged
estrogen excess and can
lead to
metrorrhagia (uterine
bleeding at irregular
intervals),
menorrhagia (excessive
bleeding with menstrual
periods), or
menometrorrhagia.
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Simple hyperplasia ("cystic
hyperplasia", "mild hyperplasias")
features:
•glands of very uneven sizes
•cystically dilated glands
•no anaplasia
•no extra cancer risk
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Complex hyperplasia
("complex / adenomatous
hyperplasia without atypia")
•crowded glands
•irregularly-shaped glands
•no anaplasia
•about 5% risk of turning
into adenocarcinoma
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Atypical hyperplasia
("higher grade hyperplasia")
•crowded,
• irregular glands,
•"budding",
but there is still stroma between them
•anaplasia (bizarre cells,
some piling up or "tufting")
•about 25% risk of
turning into adenocarcinoma
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Location: the oviduct, though ovary,
peritoneum,
uterine
cornua
and
intraperitoneal pregnancy
Best-known cause is old pelvic
inflammatory disease, scarring from
endometriosis, previous laparotomy
•The placenta has
invaded far enough
through the wall of the
tube to make it rupture,
with massive internal
bleeding.
•The expanding mass
passes back out through
the fimbriated end of the
oviduct ("tubal abortion").
•The placenta comes off
the wall of the tube,
causing heavy bleeding.
•Or the baby can simply
die, and the whole
gestation gets
reabsorbed. Rarely the
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baby calcifies (a
tubal epithelium
Rupture site and chorionic villi
Blood clot and chorionic villi
recovered outside of the tube
following rupture of an ectopic
pregnancy.
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Hydatidiform mole
Molar pregnancies are uncommon and occur when there is
fertilization of an ovum by a sperm but loss of maternal
chromosomes, leaving a 46XX karyotype composed only of
paternal chromosomes, enough to form a placenta, but not a
fetus. The result is a mass of tissue with grape-like swollen villi.
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Partial mole that occurs when two sperms fertilize a single ovum. The
result is triploidy (69 XXY). Only some of the villi are grape- like, and a
fetus can be present, but rarely survives past 15 weeks.
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