Endocrine Pancreas Pathology Part 2

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Endocrine Pancreas Pathology Part 2
2012-01-20 14:49:07
Block IV Russell

Endocrine Pancreas Pathology Block IV Russell
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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.
    • Acute pyleonephritis with renal papilla necrosis which appear yellow
    • Massive inflammatory infiltrates in cortex and medulla
    • Necrosis
    • 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
  1. 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.
    • OPTIC DISC: Blue circle
    • MACULA: Square
    • EDEMATOUS AREA: Large oval
    • One ugly retina.
    • Also: intraretinal hemorrhage in the outer plexiform layer
    • 1. Neovascular membrane
    • 2. Fragile new vessel not invested within connective tisssue
    • 3. Nerve fiber layer (missing)
    • 4. Ganglion cell layer (missing)
    • Ophthalmoscopic view of retinal neovascularization
    • Neovascular membrane is clinically known as neovascularization “elsewhere” in contrast with neovascularization of the optic disc
  2. Diabetic neuropathy with marked loss of myelinated fibers, a thinly myelinated fiber (arrowheads), and thickening of endoneurial vessel wall (arrow)
  3. Polyglucosan bodies in the brain of a 45 yo IV drug user with DM
    • 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
  4. Pancreatic islet cell tumor
    • Diagnosis: Insulinoma.
    • Description: Monomorphic tumor cells with small, round “salt and pepper” nuclei and granular cytoplasm form cords and nests. The stroma appears hyalinized.
    • Diagnosis: Insulinoma with amyloid stroma.
    • Description: Abundant amorphic material between tumor cells contains amyloid.
    • Left: Tumor cells invade into capsule.
    • Right: CD31 decorates endothelial cells. No tumor invasion into vascular spaces is present.
    • 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.