Endocrine Pancreas Pathology Part 2

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    • Diagnosis: Nodular glomerulosclerosis (diabetic nephropathy).
    • Description: Several capsular drops (red arrow) in the Bowman' capsule (exudative lesion). Peripheral glomerular capillaries (green arrows) with thickened basal membranes
    • including cellular debris. Some glomerular loops with relatively thin but layered basal membranes.( yellow arrow). Increase of mesangial matrix.
    • Clinical findings: Diabetes mellitus type 1.
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    • Acute pyleonephritis with renal papilla necrosis which appear yellow
    • Massive inflammatory infiltrates in cortex and medulla
    • Necrosis
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    • Diagnosis: Cataract.
    • Comment: Increased intracellular glucose is converted by aldose reductase to sorbitol (a polyol) and then to fructose. Accumulation of sorbitol and fructose leads to increased
    • intracellular osmolarity, water influx, and to osmotic cell injury. A “sugar” cataract can develop in three days.

    Accumulation of sorbitol and fructose leads to increased intracellular osmolarity, water influx and to osmotic cell injury
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    This is the ciliary body in chronic diabetes mellitus. Note the massive thickening of the basement membrane reminiscent of changes in the mesangium of the renal glomerulus.
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    • OPTIC DISC: Blue circle
    • MACULA: Square
    • EDEMATOUS AREA: Large oval
    • NEOVASCULARIZATION: Small ovals
    • FOCAL HEMORRHAGES: Arrows
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    • One ugly retina.
    • Also: intraretinal hemorrhage in the outer plexiform layer
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    • 1. Neovascular membrane
    • 2. Fragile new vessel not invested within connective tisssue
    • 3. Nerve fiber layer (missing)
    • 4. Ganglion cell layer (missing)
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    • Ophthalmoscopic view of retinal neovascularization
    • Neovascular membrane is clinically known as neovascularization “elsewhere” in contrast with neovascularization of the optic disc
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    Diabetic neuropathy with marked loss of myelinated fibers, a thinly myelinated fiber (arrowheads), and thickening of endoneurial vessel wall (arrow)
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    Polyglucosan bodies in the brain of a 45 yo IV drug user with DM
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    • Pancreas, islet cell tumor - Gross, cut surface. This cross section of pancreas shows a circumscribed, firm, pale mass
    • that is homogeneous except for a central yellow focus of necrosis.
    • < 2cm in diameter and non-angioinvasive: close to 100% benign
    • >2cm in diameter and/or angioinvasive: uncertain behavior and uncertain malignant potential
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    Pancreatic islet cell tumor
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    • Diagnosis: Insulinoma.
    • Description: Monomorphic tumor cells with small, round “salt and pepper” nuclei and granular cytoplasm form cords and nests. The stroma appears hyalinized.
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    • Diagnosis: Insulinoma with amyloid stroma.
    • Description: Abundant amorphic material between tumor cells contains amyloid.
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    • Left: Tumor cells invade into capsule.
    • Right: CD31 decorates endothelial cells. No tumor invasion into vascular spaces is present.
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    • Diagnosis: Islet cell tumor - insulinoma.
    • Description: Solid tumor of monomorphic cells grows in in a trabecular pattern and infiltrates normal pancreas. The tumor stroma is hyalinized.
    • Clinical findings: Recurring hypoglycemic episodes with jitteriness, sweating, and fainting.
    • Comment: About 70-90% of insulinomas behave in a benign fashion. Tumors are usually diagnosed before they have metastasized, because they cause significant clinical symptoms when still small.
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mycards2014
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Card Set:
Endocrine Pancreas Pathology Part 2
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Endocrine Pancreas Pathology Block IV Russell
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