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(BQ) Part 1 book Atlas of histopathology presents the following contents: The cardiovascular system, the respiratory system, hematopoietic and lymphoid system, digestive system, hepatobiliary system, pancreas, the urinary system.
Atlas of HISTOPATHOLOGY Atlas of HISTOPATHOLOGY Ivan Damjanov MD, PhD Professor of Pathology Department of Pathology and Laboratory Medicine The University of Kansas School of Medicine Kansas City, Kansas, USA ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Panama City London đ Jaypee Brothers Medical Publishers (P) Ltd Headquarter Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd., 83 Victoria Street London SW1H 0HW (UK) Phone: +44-2031708910 Fax: +02-03-0086180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: 507-317-0160 Fax: +50-73-010499 Email: cservice@jphmedical.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2012 Jaypee Brothers Medical Publishers All rights reserved No part of this book may be reproduced in any form or by any means without the prior permission of the publisher Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com This book has been published in good faith that the contents provided by the author(s) contained herein are original, and is intended for educational purposes only While every effort is made to ensure a accuracy of information, the publisher and the author(s) specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work If not specifically stated, all figures and tables are courtesy of the authors(s) Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device Publisher: Jitendar P Vij Publishing Director: Tarun Duneja Editor: Syed Amir Haider Cover Design: Seema Dogra, Sumit Kumar Atlas of Histopathology First Edition: 2012 ISBN-13: 978-93-5025-188-1 Printed in India This Atlas is dedicated to our students and residents The Authors from The University of Kansas School of Medicine (left to right): Da Zhang, Fang Fan, Paul St Romain, Ivan Damjanov, Garth Fraga, Maura O’Neil, and Rashna Madan Contributors Ivan Damjanov MD, PhD Professor of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Katie L Dennis MD Assistant Professor of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Fang Fan MD, PhD Associate Professor of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Garth Fraga MD Assistant Professor of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Rashna Madan MD Assistant Professor of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Maura O’Neil MD Assistant Professor of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Paul St Romain BA Post-Sophomore Fellow in Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Da Zhang MD Associate Professor of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA Preface Pathology as a medical discipline has been one of the cornerstones of medical education since the beginnings of the modern era of scientific medicine in the 19th century The teaching of pathology has nevertheless changed considerably during that time and the emphasis has recently shifted from descriptive anatomic pathology to more dynamic aspects of this science such as pathophysiology New vistas have been opened, like those made possible by molecular biology These new trends have irrevocably altered our perspective not only of pathology but of medicine in general The need to keep pace with the newest developments on the research front has also changed our approach to teaching of new generations of doctors as well Due to the constraints of time imposed by a hectic schedule of lectures, seminars, laboratory sessions and interim examinations, modern medical students spend less time at the autopsy table and medical museum and more time at the computer and interactive teaching sessions designed for the most efficient didactic impact Histopathology, traditionally taught during the preclinical years with the use of optical microscopes, has been one of the “casualties” of modern medical school restructured curricula The teaching of histopathology has been dramatically reduced in most US medical schools and consequently in many other parts of the world Ironically, this de-emphasis imposed on histopathology happened just as clinical microscopy remerged as one of the most widely used and most critical diagnostic approaches The number of microscopic examinations is constantly rising worldwide reflecting the wider use of biopsies and innovative techniques for obtaining tissue samples for diagnostic evaluation The numbers of tissue samples removed for diagnostic purposes by surgical biopsy, endoscopy or fine needle aspiration biopsy has reached multiple millions per year in the US alone The need for physicians who are qualified to interpret these samples has been greater than ever, and many countries report a shortage of diagnostic pathologists This exigency combined with the fact that pathologists still teach histopathology to medical students and many junior physicians in training highlights the need for additional investment into the didactic aspects of histopathology It is also one of the reasons that we undertook the writing of this Atlas; the other reason being our firm belief that histopathology remains one of the key medical disciplines essential for the understanding of basic concepts, mechanisms of diseases, their causes and complications For us ,it remains inconceivable that any medical doctor could graduate from his or her medical school without a strong foundation in basic microscopy of normal and pathologically altered human tissues As it logically follows from the above paragraph, histopathology can be perceived as a didactic discipline on one hand side and a diagnostic discipline on the other A comprehensive Histopathology Atlas should cover both aspects of histopathology With this notion in mind, we have prepared this Atlas with two goals in mind The first one was to provide additional illustrations of basic pathologic processes and thus expand the horizons of medical students studying pathology during their preclinical years The second goal was to provide a pictorial guide to advanced students and clinical trainees revisiting the arena of histopathology while preparing for specialty examinations in the clinical specialty of their choice Many residents in internal medicine and its subspecialties, such as gastroenterology, nephrology, pulmonology, oncology and hematology are required to spend a month or two in pathology during their years of clinical training Likewise, many residents in surgery and surgical subspecialties spend time in pathology, and are expected to become proficient in interpreting basic histopathologic findings The same holds true for residents in many other clinical specialties such as neurology, dermatology or gynecology We felt that all these residents might appreciate this Atlas of Histopathology, which was designed to enrich their clinical training and prepare them for a lifelong interaction with diagnostic pathologists Last but not least, we hope that our own pathology residents will use this Atlas to master the basics of diagnostic microscopy We wish them all a lot of luck and hope that this book will help them become better physicians Ivan Damjanov ATLAS OF HISTOPATHOLOGY 184 A B CHAPTER Figs 7.5A and B: Crescentic glomerulonephritis A The urinary space between the collapsed capillary loops and the Bowman’s capsules contains inflammatory cells admixed to proliferating epithelial cells and strands of fibrin B The disease leads to rapid destruction of glomeruli which become replaced by fibrous connective tissue (shown here as blue with the trichrome stain) 185 A THE URINARY SYSTEM B Figs 7.6A and B: IgA nephropathy A The glomerulus shows widening of mesangial areas which contain an increased number of mesangial cells B Immunofluorescence microscopy shows deposits of IgA in the mesangial areas (arrows) CHAPTER 186 ATLAS OF HISTOPATHOLOGY A B Figs 7.7A and B: Lupus nephritis A The glomerulus is hypercellular and also segmentally shows thickening of the glomerular basement membranes in the form of so-called “wire loops” (arrows) B Immunofluorescence microscopy shows widespread deposits of immune complexes along the glomerular basement membranes and in the mesangial areas CHAPTER 187 B C D THE URINARY SYSTEM A Figs 7.8A to D: Membranous nephropathy A Light microscopy shows diffuse thickening of the glomerular basement membranes without increased cellularity of the glomerulus B Deposits of immune complexes along the glomerular basement membrane are accompanied by projections of the basement membrane which is best demonstrated by silver impregnation C Immunofluorescence microscopy shows granular (lumpy-bumpy) deposits along the glomerular basement membranes D Electron microscopy shows evenly spaced deposits of dense immune complexes on the epithelial side of the basement membrane CHAPTER 188 ATLAS OF HISTOPATHOLOGY A B Figs 7.9A and B: Minimal change disease A By light microscopy the glomeruli appear essentially normal, and the glomerular basement membranes are of normal thickness (PAS staining) B By electron microscopy the only visible change is the fusion of the foot processes of the epithelial cells (arrows) CHAPTER 189 A THE URINARY SYSTEM B Figs 7.10A and B: Focal segmental glomerulosclerosis A The middle of the three glomeruli shows sclerosis of the capillary loops at o’clock, whereas the other two glomeruli are essentially normal (PAS stain) B A portion of the glomerular capillaries is hyalinized (arrow) CHAPTER ATLAS OF HISTOPATHOLOGY 190 Fig 7.11: Diabetic nodular glomerulosclerosis Mesangial areas show nodular widening (arrows) CHAPTER 191 A THE URINARY SYSTEM B Figs 7.12A and B: Amyloidosis A Eosinophilic deposits of amyloid have obliterated the normal capillary structure of the glomerulus B Electron microscopy shows that amyloid has a fibrillar beaded structure CHAPTER ATLAS OF HISTOPATHOLOGY 192 CHAPTER Fig 7.13: Chronic glomerulonephritis Only one of the five glomeruli depicted here is still preserved whereas the other four are almost completely hyalinized (arrows) Fibrous tissue is replacing most of the tubules and the remaining tubules are atrophic Fig 7.14: Nephroangiosclerosis Hypertension causes vascular changes such as thickening of the arterial walls and narrowing their lumina and atrophy of the tubules 193 A THE URINARY SYSTEM Fig 7.15: Acute tubular necrosis Necrotic proximal tubules have lost their nuclei and have finely granular amorphous eosinophilic cytoplasm (asterisk) The remaining distal tubules and glomeruli have preserved nuclei B Figs 7.16A and B: Acute pyelonephritis A In early stages of the ascending infection the tubules contain neutrophils in their lumen B In advance stages of the infection the intratubular pus has caused dilatation of tubules and atrophy of the tubular cells Inflammatory cells are also found in the interstitial spaces CHAPTER 194 ATLAS OF HISTOPATHOLOGY A B Figs 7.17A and B: Chronic pyelonephritis A Chronic inflammation has caused destruction of the tubules in the midozone In the upper part of the figure one may see atrophic tubules filled with proteinaceous casts (thyroidization of the kidney) In the lower part of the figure one may see the preserved glomerulus and tubules which have been spared of destruction B At higher magnification one may see that the inflammatory infiltrate consists predominantly of lymphocytes and plasma cells On the left side one may see the epithelium lining the pyelon Figs 7.18A and B: Cystitis A Acute cystitis is evidence by the infiltrates of neutrophils transmigrating through the urothelium B Chronic cystitis is characterized by infiltrates of lymphocytes, plasma cells and macrophages in the lamina propria of the urinary bladder CHAPTER 195 THE URINARY SYSTEM Fig 7.19: Renal oncocytoma The tumor is composed of oncocytes, i.e cells that have abundant eosinophilic cytoplasm, and relatively uniform nuclei CHAPTER 196 ATLAS OF HISTOPATHOLOGY A B Figs 7.20A and B: Renal cell carcinoma A Clear cell carcinoma is composed of sheets of clear cells that have hyperchromatic nuclei B Papillary renal cell carcinoma is composed papillae lined by cuboidal cells which have eosinophilic cytoplasm CHAPTER 197 THE URINARY SYSTEM Fig 7.21: Wilms’ tumor The tumor is composed of immature cells forming tubules and called epithelial cell (E), forming dense aggregates of hyperchromatic cells, called blastema cell (B), and loosely arranged cells called stromal cells (S) CHAPTER 198 ATLAS OF HISTOPATHOLOGY A B C Figs 7.22A to C: Urothelial carcinoma of the bladder A Papillary carcinoma of low grade malignancy forms papillae by relatively uniform cells B Papillary carcinoma of high grade malignancy forms papillae lined by cells that show much more pleomorphism and mitotic activity C Invasive urothelial carcinoma is formed of cells that invade the muscle layer of the bladder CHAPTER ... Delhi 11 0 002, India Phone: + 91- 11- 43574357 Fax: + 91- 11- 43574 314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd., 83 Victoria Street London SW1H 0HW (UK) Phone: +44-20 317 08 910 ... 13 7 Maura O’ Neil Liver 13 7 Inflammatory Diseases 13 7 Metabolic Disorders 13 9 Cirrhosis 13 9 Neoplasms 13 9 Gallbladder 14 0 Inflammation 14 0 Neoplasms 14 1 Pancreas 15 9 Rashna... Inherited Conditions 15 9 Inflammatory Diseases 15 9 Neoplasms 16 0 Tumors of the Exocrine Pancreas 16 0 Tumors of the Endocrine Pancreas 16 1 The Urinary System 17 7 Da Zhang, Ivan Damjanov