1. Lecture on pathomorphology for the 3-rd year students
Endocrine diseases.
Genital tract diseases.
Lecture on pathomorphology for the 3-rd year students
By T.G.Filonenko

2. Diabetes mellitus
Diabetes mellitus is a metabolic disorder characterized by hyperglycemia

3. Classification of Diabetes mellitus
I. Primary
Type I, also known as insulin-dependent diabetes melli­tus (IDDM)
Type II, or non-insulin-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

4. Type I (IDDM)
Type II (NIDDM)

5. nodular glomerulosclerosis Glaucoma with excavation of the optic cup
Complications of DM
nodular glomerulosclerosis
Glaucoma with excavation of the optic cup
budding cells with Candida albicans on PAS stain in the renal pelvis

6. Islet cell adenoma
Insulinoma

7. 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 The thyroid follicles have been replaced by fibrous tissue.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

8. 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.

9. Hashimoto thyroiditis
lymphoid follicle
The pink Hürthle cells
atrophy

10. De Quervain (subacute) thyroiditis
also known as giant cell or granulomatous thyroiditis
the foreign body giant cells with destruction of thyroid follicles

11. Follicular adenoma

12. Papillary carcinoma
psammoma body

13. Medullary carcinoma
of the thyroid
amyloid

14. Goiter
The follicles are irregularly enlarged, with flattened epithelium

16. THE NORMAL MENSTRUAL CYCLE
normal proliferative endometrium
early secretory endometrium
normal secretory phase endometrium

17. 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

18. 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

19. endometrial glands and stroma in the myometrium
ADENOMYOSIS ("endometriosis interna")
endometrial glands and stroma in the myometrium

20. ENDOMETRIOSIS ("endometriosis externa“)

21. 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")

22. To make the diagnosis, the pathologist must find two of three:
endometrial glands
endometrial stroma
hemosiderin (from the bleeding)
small cluster of endometrial glands and stroma with hemorrhage in the surface of the fallopian tube
Hemosiderin in the wall of "chocolate cysts"
Endometrial glands and stroma are seen at high magnification in the wall of the colon.

23. submucosal, intramural, and subserosal leiomyomata of the uterus
Endometrial polyp

24. metrorrhagia (uterine bleeding at irregular intervals),
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.

25. Simple hyperplasia ("cystic
hyperplasia", "mild hyperplasias")
features:
glands of very uneven sizes
cystically dilated glands
no anaplasia
no extra cancer risk

26. Complex hyperplasia
("complex / adenomatous
hyperplasia without atypia")
crowded glands
irregularly-shaped glands
no anaplasia
about 5% risk of turning
into adenocarcinoma

27. ("higher grade hyperplasia") crowded, irregular glands, "budding",
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

29. The placenta comes off the wall of the tube, causing heavy bleeding.
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 baby calcifies (a "lithopedion", or stone child).
Location: the oviduct, though ovary, peritoneum, uterine cornua and intraperitoneal pregnancy
Best-known cause is old pelvic inflammatory disease, scarring from endometriosis, previous laparotomy

30. tubal epithelium
Rupture site and chorionic villi
Blood clot and chorionic villi recovered outside of the tube following rupture of an ectopic pregnancy.

31. 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.

32. Partial mole that occurs when two sperms fertilize a single ovum
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.