Virtual Microscopy	Choose another topic Cardiovascular Respiratory Renal and Urinary Tract Musculoskeletal Neuro(CNS and PNS) Gastrointestinal Reproductive Endocrine Hematopoiesis and Lymphoid Skin

Case 1

A 35 year old woman presented to her gynecologist with bilateral nipple discharge. She also reported irregular menses with amenorrhea for the past two months. A home pregnancy test was negative. She and her husband have been trying to become pregnant over the past year and are considering undergoing evaluation for infertility. Physical examination was significant for bilateral milky nipple discharge. There were no other abnormal physical findings. A serum -HCG was negative. Laboratory studies revealed marked elevation of serum prolactin (200ng/dl; normal <20 ng/dl). A CT scan of the head showed expansion of the sella turcica. She was diagnosed with a prolactin secreting pituitary adenoma and underwent transsphenoidal hypophysectomy.

Slides: [normal pituitary tissue] [normal pituitary tissue] [this patient's lesion]

Other images: [normal pituitary (PowerPoint Slides)]

1. Identify the following structures in the normal pituitary gland: pars nervosa, pars distalis, pars intermedia, basophil, acidophil, chromophobe, pituicytes, blood vessels.
2. What are the hormones secreted by each of the major parts of the gland (adenohypophysis and neurohypophysis)?
3. How does the microscopic architecture of the pituitary facilitate both response to hypothalamic hormones and release of pituitary hormones? Describe the basic structure of the hypothalamic-hypophysial portal system.
4. What are the differences in gland architecture between the normal pituitary and the gland containing the adenoma? What are the different cell types seen in the adenoma versus normal pituitary?

Case 2

A 46 year old woman presented to her primary care physician reporting excessive fatigue, weight gain and cold intolerance. She had tolerated these symptoms for over a year, but she recently began noticing what she terms a "mental slowness" and is concerned about a neurologic disorder. Her past medical history is non-contributory. Her mother had a thyroid goiter and took "thyroid medication" for many years.On physical examination, she has dry skin and a somewhat assymetrically but diffusely enlarged thyroid gland. The relaxation phase of her deep tendon reflexes is prolonged. Laoratory studies reveal increased TSH with decreased serum T4 and T3. High titers of antimicrosomal antibodies are noted. A fine needle aspiration was performed and confirms the diagnosis of Hashimoto's thyroiditis.

Slides: [normal thyroid] [this patient's thyroid tissue]

1. Identify the following structures in the normal thyroid gland: capsule, septa, follicles, colloid, C-cells, blood vessels.
2. Compare the histologic appearance of the normal thyroid follicle with a follicle in the Hashimoto's thyroid. How are the individual follicles different?
3. Compare the interstitium of the normal thyroid to that in the gland involved by Hashimoto's thyroiditis. How does the interstitium differ?

Case 3

A 45 year old man was referred to a urologist for evaluation of recurrent renal stones over the past 2 years. He is otherwise healthy and asymptomatic. Past medical history, family history and physical examination were unremarkable. Renal imaging revealed structurally normal kidneys with a large right renal pelvic stone. Laboratory studies were remarkable for an elevated serum calcium (3.0 mmol/L; normal 2.2-2.6 mmol/L) and a decreased serum phosphate. Neck imaging revealed an enlarged ovoid structure along the right inferior posterior aspect of the thyroid gland, but separate from the thyroid gland. He was diagnosed with primary hyperparathyroidism and underwent surgical exploration of the neck with resection of a parathyroid adenoma. The remaining three parathyroid glands were identified and were normal.

Slides: [normal parathyroid] [patient's parathyroid tissue]

1. Identify the following structures in the normal parathyroid gland: capsule, chief cells, oxyphil cells, blood vessels.
2. Compare the architecture of the normal parathyroid gland to the gland containing the adenoma. How do they differ with regard to cell number and organization? How does the interstitium differ?