Pgs' 257260 Endocrine

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Pgs. 257-260Endocrine Reproductive Pathology

• Vanessa Faris

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I may not know much, but I know the difference
between chicken s??t and chicken salad. --
Lyndon B. Johnson
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Endocrine Pathology
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SIADH
ADH ? water permeability in collecting duct by
insertion of aquaporins into the luminal membrane

• Symptoms
• Excessive water retention (HTN)
• Hyponatremia
• Urine osmolarity gt serum osmolarity

• Causes
• Ectopic ADH
• CNS disorders
• Pulmonary disease
• Drugs

• Small cell lung cancer, (I), Air disease, Drugs,
  Head trauma

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Hypercalcemia

• C Calcium ingestion (milk-alkali syndrome)
• H Hyperparathyroid, Hyperthyroid
• I Iatrogenic (thiazides)
• M Multiple Myeloma
• P Pagets disease
• A Addisons disease
• N Neoplasms
• Z Zollinger-Ellison syndrome
• E Excess vitamin D
• E Excess vitamin A
• S Sarcoidosis

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Hyperparathyroidism
PTH acts on bone, kidneys, intestine w/ an
overall effect of ? serum calcium and ? serum
phosphate
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Hypoparathyroidism

• Due to accidental excision during thyroid surgery
  or DiGeorge syndrome
• Hypocalcemia, tetany
• Chvosteks sign tap facial nerve and see
  contraction of facial muscles
• Trousseaus sign occlude brachial a. w/ BP cuff
  and see carpal spasm

• Pseudohypoparathyroidism
• autosomal-recessive kidney unresponsiveness to
  PTH
• hypocalcemia, shortened 4th/5th digits, short
  stature

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Da George Syndrome
Chvosteks Sign
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Carcinoid Syndrome

• Rare, caused by carcinoid tumors that secrete
  high levels of serotonin (5-HT)
• Metastatic small bowel tumors (rarely 1 to
  lung), but not if tumor is limited to GI tract
• 5-HT undergoes first-pass liver metabolism
• most common tumor of appendix
• treat w/ octreotide

• Symptoms
• recurrent diarrhea
• cutaneous flushing
• asthmatic wheezing
• right-sided valvular disease

• Rule of ?s
• ? metastasize
• ? present w/ 2nd malignancy
• ? multiple

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Dont Ask for Chocolate, get Vanilla
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Zollinger-Ellison Syndrome

• Gastrin-secreting tumor of pancreas or duodenum
• Causes recurrent ulcers (distal duodenum)
• May be associated w/ MEN I

Zesty Enchilada Supreme
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Osteoporosis
- reduction of bone mass in spite of normal bone
mineralization - affects whites gt blacks gt Asians
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Reproductive Pathology
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Benign Prostatic Hypertrophy (BPH)

• Common in men gt 50 yoa
• may be due to age-related ? estradiol maybe
  sensitization of prostate to growth-promoting
  effects of DHT
• Testosterone DHT
• 5a-reductase (inhibited by
  Finisteride)
• Nodular enlargement of periurethral (lateral
  middle) lobes/transitional zone ? compresses
  urethra
• Urinary Sxs ? frequency, nocturia, difficulty
  starting stopping stream, dysuria
• Other UT Sxs distention hypertrophy of
  bladder, hydronephrosis, UTIs
• NOT a premalignant lesion

Big Prostates Have Doubly High Testosterone
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Prostatic Adenocarcinoma

• Common in men gt 50 yoa
• Arises most often in posterior lobe/peripheral
  zone
• Dxd w/ digital rectal exam prostate biopsy
• Tumor markers prostatic acid phosphatase
  prostate-specific antigen (PSA)
• PSA cut-off 4 ng/ml 4-10 is gray zone
• Free PSA gt 25 is reassuring
• PSA velocity gt 0.8 ng/ml/yr is suspicious
• Osteoblastic metastases in bone in late stages
  (indicated by ? serum alkaline phosphatase PSA)

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Osteoblastic Bone Lesion
Area of greater density
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Hydatidiform Mole

• Pathologic ovum (empty egg ovum w/ no DNA)
  resulting in cystic swelling of chorionic villi
  proliferation of chorionic epithelium
  (trophoblast)
• Most common precursor of choriocarcinoma
• ? ß-hCG
• Honeycombed uterus, cluster of grapes
  appearance
• Complete mole 46XX (diploid) completely
  paternal in origin no associated fetus
• Partial mole made up of 3 or more parts
  (triploid, tetraploid) may contain fetal parts

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Hydatidiform Mole
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Pregnancy-Induced HTN (PIH) (Preeclampsia
eclampsia)

• PREEclampsia Triad PRoteinuria, Edema, Elevated
  blood pressure
• eclampsia addition of seizures to triad
• Affects 7 of women from 20 wks gestation to 6
  wks postpartum
• ? incidence w/ preexisting HTN, DM, chronic renal
  disease, autoimmune disorders
• Etiology involves placental ischemia
• Can be associated w/ HELLP syndrome
• Hemolysis, Elevated LFTs, Low Platelets

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Clinical Features of PIH

• headache
• blurred vision
• abdominal pain
• lab findings
• thrombocytopenia
• hyperuricemia
• altered mentation
• hyperreflexia
• edema of face extremities

He Banged A Lover, And Hypertensive
Embryogenesis Followed
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Treatment of PIH

• Bed rest, salt restriction, and monitoring
  treatment of HTN
• Delivery of fetus as soon as viable
• For eclampsia medical emergency IV magnesium
  sulfate diazepam

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Pregnancy Complications

• Abruptio placentae - premature separation of
  placenta
• painful uterine bleeding (usually 3rd trimester)
• fetal death
• may be associated w/ DIC
• Placenta accreta - defective decidual layer
  allows placenta to attach directly to myometrium
• predisposed by prior C-section or inflammation
• may have massive hemorrhage after delivery

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Pregnancy Complications (contd)

• Placenta previa - attachment of placenta to lower
  uterine segment
• painless bleeding in any trimester
• may occlude cervical os
• Ectopic pregnancy - most often in fallopian tubes
• predisposed by salpingitis (PID)

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Cervical Pathology

• Dysplasia Carcinoma in situ - disordered
  epithelial growth
• begins at basal layer and extends outward
• classified CIN 1, 2, or 3 depending on extent of
  dysplasia (koilocytes)
• associated w/ HPV (16 18)
• may progress to invasive carcinoma
• Invasive Carcinoma - often squamous cell
  carcinoma
• Pap smear can catch koilocytes before progression
  to invasive CA

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Dysplasia
Carcinoma in situ
Invasive Carcinoma
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Uterine Pathology

• Endometriosis
• Adenomyosis
• Endometrial hyperplasia
• Endometrial carcinoma
• Leiomyoma
• Leiomyosarcoma

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Endometriosis

• Non-neoplastic endometrial glands/stroma in
  abnormal locations (ovary, peritoneum) outside
  the uterus
• cyclic bleeding (menstrual type) from ectopic
  endometrial tissue ? blood-filled chocolate
  cysts
• manifests as severe menstrual-related pain
• often results in infertility
• Adenomyosis endometriosis w/in myometrium

Ovarian Endometriosis
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• Endometrial Hyperplasia
• abnormal endometrial gland proliferation
• caused by excess estrogen stimulation
• ? risk of endometrial carcinoma
• manifests as vaginal bleeding

• Endometrial Carcinoma
• most common gynecologic malignancy
• peak age 55-65 yoa
• manifests as vaginal bleeding
• typically preceded by endometrial hyperplasia
• risk factors prolonged estrogen, obesity, DM,
  HTN

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• Leiomyoma
• most common of all female tumors
• presents w/ multiple tumors
• ? incidence in blacks
• malignant transformation rare
• estrogen sensitive -- tumor size ? w/ pregnancy,
  ? w/ menopause
• does not progress to leiomyosarcoma

• Leiomyosarcoma
• bulky tumor w/ areas of necrosis hemorrhage
• typically arise de novo (not from leiomyoma)
• ? incidence in blacks
• highly aggressive tumor w/ tendency to recur
• may protrude from cervix and bleed

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Polycystic Ovarian Syndrome (Stein-Leventhal
Syndrome)

• ? LH production leads to anovulation
• hyperandrogenism due to deranged steroid
  synthesis
• manifests by amenorrhea, infertility, obesity,
  hirsutism
• treat w/ weight loss, OCPs, gonadotropin analogs,
  or surgery

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Ovarian Cysts

• Follicular Cyst - distention of unruptured
  Graafian follicle
• may be associated w/ hyperestrinism endometrial
  hyperplasia
• Corpus Luteum Cyst - hemorrhage into persistent
  corpus luteum
• menstrual irregularity
• Theca-lutein Cyst - due to gonadotropin (LH)
  stimulation
• often bilateral/multiple
• associated w/ choriocarcinoma and moles
• Chocolate Cyst - blood-containing cyst from
  ovarian endometriosis
• varies w/ menstrual cycle

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Follicular Cyst
Corpus Luteum Cyst
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Theca-lutein Cyst
Chocolate Cyst
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Ovarian Germ Cell Tumors

• Dysgerminoma - analogous to male seminoma
• Yolk sac tumor - similar to testicular form
  produces a-fetoprotein
• Choriocarcinoma - like testicular version ? hCG
• associated w/ hydatidiform moles theca-lutein
  cysts
• Teratoma - constitutes 90 of germ cell tumors of
  ovary
• all 3 germ layers (think Teratomas have Triple
  layers)
• mature teratoma (dermoid cyst) is benign
• immature teratoma is aggressive malignant
• Struma ovarii - contains fxnal thyroid tissue

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Dysgerminoma
Yolk Sac Tumor
Teratoma
Choriocarcinoma
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Ovarian Non-Germ Cell Tumors

• Serous cystadenoma - 20 of ovarian tumors
• frequently bilateral
• lined w/ fallopian (serous) tube-like epithelium
• benign
• Serous cystadenocarcinoma - 50 ovarian tumors
• frequently bilateral
• malignant

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• Mucinous Cystadenoma - multilocular cyst lined by
  mucus-secreting epithelium
• benign
• Mucinous Cystadenocarcinoma
• malignant
• Pseudomyxoma peritonei - intraperitoneal
  accumulation of mucinous material from ovarian or
  appendiceal tumor

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• Brenner Tumor - benign tumor that resembles
  Bladder epithelium
• Ovarian Fibroma - bundles of spindle-shaped
  fibroblasts
• Meigs syndrome - triad of ovarian fibroma,
  ascites, hydrothorax (i.e. fluid in both body
  cavities)
• Granulosa Cell Tumor - secretes estrogen
• precocious puberty (kids)
• endometrial hyperplasia or carcinoma (adults)
• Call-Exner bodies - small follicles filled w/
  eosinophilic secretions

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THANK YOU!