Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum

454 Pages·2008·17.9 MB·English

by  Paul.J Tadrous

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DiagnosticCriteriaHandbook
in
HISTOPATHOLOGY
Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum. Paul J. Tadrous
Copyright (cid:2)C 2007 by John Wiley & Sons, Ltd. ISBN: 978-0-470-51903-5
i
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Diagnostic Criteria Handbook
in
HISTOPATHOLOGY
A Surgical Pathology Vade Mecum
by
Paul J. Tadrous
MB BS MSc PhD MRCPath
HistopathologyUnit,CRUK,London,UK
iii
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Tadrous,PaulJoseph.
Diagnosticcriteriahandbookinhistopathology:asurgicalpathologyvademecum/byPaulJ.Tadrous.
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Includesbibliographicalreferencesandindex.
ISBN978-0-470-51903-5(alk.paper)
1.Histology,Pathological–Handbooks,manuals,etc. 2.Pathology,Surgical–Handbooks,manuals,etc.
3.Diagnosis,Surgical–Handbooks,manuals,etc. 4.Histology,Pathological–Examinations,questions,etc.
5.Pathology,Surgical–Examinations,questions,etc. 6.Diagnosis,Surgical–Examinations,questionss,etc.
I.Title.[DNLM:1.Diagnosis,Differential–Handbooks.2.Pathology,Surgical–methods–Handbooks.
3.HistologicalTechniques–methods–Handbooks.WO39T122d2007]
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iv
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Disclaimer
Whileeveryefforthasbeenmadetoensuretheinformationinthisbookisaccurateandtimely,thereis
alwaysthepossibilitythaterrorshavebeenmadeorthatmedicalopinionhaschangedsincethetimeof
writing.Theauthorcannotacceptanyliabilityfordamagesofanykindresultingfromtheuseofinformation
receivedfromthisbook.
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Dedication
Idedicatethisbooktothememoryofmyfather,MrJosephZakiTadrous,whosadlypassedawayatthe
ageof84inMarch2007.
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Contents
PREFACE ix
ACKNOWLEDGEMENTS xi
ABBREVIATIONSANDSYMBOLS xiii
GENERALBIBLIOGRAPHYANDSUGGESTEDREADING xxiv
INDEXTOGRADINGANDCLASSIFICATIONSYSTEMS xxv
FROZENSECTIONINDEX xxvi
READER’SINDEX xxvi
1. ADVICEFOREXAMCANDIDATES 1
2. HISTOLOGICALTECHNIQUES 6
3. LABORATORYMANAGEMENT 22
4. CUT-UPANDREPORTINGGUIDELINES 36
5. PAEDIATRICANDPLACENTAL 56
6. VASCULAR 68
7. HEART 75
8. RESPIRATORYANDMEDIASTINUM 81
9. BONEMARROW 99
10. LYMPHORETICULAR 107
11. ALIMENTARYTRACT 126
12. LIVER,BILIARYTRACTANDPANCREAS 156
13. CENTRALNERVOUSSYSTEMANDSKELETALMUSCLE 181
14. EYEANDEAR 193
15. RENALMEDICINE 201
16. UROLOGICAL 211
17. GYNAECOLOGICAL 232
18. BREAST 258
19. ENDOCRINE 267
20. SKIN 281
21. SOFTTISSUES 309
22. OSTEOARTICULAR 329
23. INFECTIONANDIMMUNITY 343
24. CYTOPATHOLOGY 353
25. AUTOPSY 377
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contents viii
INDEXOFGENERALTERMS 395
INDEXOFMOLECULES 416
INDEXOFEPONYMS 420
Pleasenotethatfull-colourversionsofallfigureswithinChapter4,andalsofigures5.3,8.1,11.3,14.1,
16.1,17.1and23.1canbefoundinthecolourplatesectionofthisbook
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Preface
Thisbookpresentscriteriaforhistopathologicaldiagnosisinlistformforrapidaccess.Itcoversdiagnostic
surgicalpathology,cytology,autopsypractice,histologicaltechnique,labmanagement,RCPathguidance
andUKLawrelevanttohistopathology.Traineesandconsultantsindiagnosticpracticeandthoseneeding
a quick refresher in preparation for professional exams (such as the MRCPath) should find this book a
usefulcompanion.
Whileatthemicroscope,thepathologistwilloftenbeabletosuggestalimitedlistofconditions
inthedifferentialandmayneedareminderofthediagnosticcriteriaofthoseconditionsinordertodecide
on the preferred option. One may go to a standard diagnostic text for this purpose but there is almost
invariablyalengthyfewparagraphsofprosetoreadinordertogleantherequiredmorphologicalpoints.
Thesewordsarenotwastefulwhenlearningaboutaconditionforthefirsttimeasoneneedsasubstantial
backgroundofinformationtoappreciatetheconditioninitscontext.
However,mostpathologistswillhavealreadyreadafullaccountofmostconditionsandjustneed
toberemindedofthemajorpointsfordiagnosis.Thesepointsarewhatthisbookaimstoprovideasanaid
torapidacquisitionofdiagnosticcriteriaandsalientinformationonmanagement,Lawandtechnique.Itis
notintendedasaninitialsourcetextandisnotasubstituteforreadingafullaccountinspecialistreference
texts.Thisisnotacomprehensiveaccountofpathology–noattemptismadetocoververybasicmaterial
andsomeoftherarerentitiesarepointedtoviareferences.Thisbookfocuseson:
(cid:2)
diagnosticcriteriaforeachcondition;
(cid:2)
immunoprofilesofnormalcells,tissuesandpathologicalentitieswherethisishelpful;
(cid:2)
criteriaformalignancyinotherwisebenignlesionse.g.whatmakesamalignantSFT?Whatarethe
criteriaformalignancyinapilomatricoma?Whenshouldyoubeworriedwithanameloblastomaand
whendoesMGUSbecomemyeloma?
(cid:2)
differentialdiagnoseswithnotesondistinguishingfeaturese.g.howdoyoudistinguishKaposi’ssar-
comafromKaposiformhaemangioendotheliomaormucoepidermoidcarcinomafromadenosquamous
carcinoma or epithelioid haemangioendothelioma from epithelioid angiosarcoma or an atypical ade-
nomatoushepatocellularnodulefromhepatocellularcarcinoma?
(cid:2)
definition of terms and quantities needed for diagnosis. For example, what are the size and mitotic
countcriteriaforplacingGISTsintomalignancyriskcategories?Whatisthedefinitionofverticaland
radial growth phases for melanoma? What constitutes an inadequate cervical smear? How big must
a focus of atypical adenomatous hyperplasia be before it is considered bronchioalveolar carcinoma?
Whatmakesalymphnodemetastasisamicrometastasisandhowdoesthisdifferfrom‘isolatedtumour
cellspresent’?Manyofthesehaveimportantmanagementimplications;
(cid:2)
grading, scoring, classification and staging criteria for tumours and non-neoplastic conditions (e.g.
transplantrejection,hepatitis,ERandPgRreceptorstatus,spermatogenesis,etc.).Noattempthasbeen
madetoreproducetheTNMstagingsystemastheUICCbookisanexcellenthandyreferencewhichall
pathologistsworkingwithtumoursshouldhave.SomeaspectsofTNMhave,howeverbeenincluded
in this book where it emphasises certain practical points (e.g. in Chapter 4: Cut-Up and Reporting
Guidelines).AseparateGradingIndexpageisprovidedforrapidaccesstothevariousschemes(see
pagexxv);
(cid:2)
datingcriteriaforendometria,myocardialinfarction,thrombiandvilli(followingintra-uterinedeath);
(cid:2)
normalvaluesandrangese.g.forPMweights,placentalweights,weightratios,mitoticcounts,etc;
(cid:2)
laboratorymethodsarecoveredfromapathologist’sperspective;
(cid:2)
laboratorymanagement(healthandsafety,UKlegislationandgovernmentinitiatives,budgetarycon-
trol, Clinical Governance, etc.) and summary guidance from the RCPath National Datasets for Re-
portingCancers,cut-up,autopsypracticeandreportingmajortypesofspecimentogetherwithhandy
anatomicaldiagrams;
(cid:2)
frozensectiondiagnosis–aseparate‘FrozenSectionIndex’(seepagexxvi)pointstoadviceforper-
operativediagnosisinallthechaptersforrapidaccesstothisinformation;
(cid:2)
mnemonicsandgeneraladviceinexamtechniqueareofferedforMRCPathexamcandidates.
This book bridges the gap between specialist diagnostic texts (with their reams of context) and study
books for trainees (with their reams of aetiology, pathogenesis and molecules) by presenting diagnostic
informationinpracticaldetail–butwithoutthepadding.
PJT,London,2007
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Acknowledgements
ThesupportofthePathologicalSocietyofGreatBritainandIrelandinhelpingtogetthisbooktopressis
gratefullyacknowledged.Iwouldliketothankallmycolleagues,bothjuniorandsenior,whocontributed
to this book by answering my queries and by giving me questions to answer. A special thanks to all the
pathologistswhoansweredmyspecificquestionsregardingtopicsintheirownfieldwhileIwasresearching
thisbook–thiswasofteninresponsetoqueriesIhadoverindividualpatient’scasesaswellasspecifically
for the book. They include (in alphabetical order – and apologies for anyone I may have missed): Dr
Emyr Wyn Benbow, Dr Ashish Chandra, Prof H. Terry Cook, Prof Amar P. Dhillon, Prof Cyril Fisher,
Prof Andrew M. Hanby, Prof Alec J. Howie, Prof Stefan G. Hu¨bscher, Prof Gu¨nter Klo¨ppel, Dr Jay H.
Lefkowitch, Dr Iain Lindsay, Dr Neil J. Sebire, Prof Neil A. Shepherd, Prof Sami Shousha, Prof Ian C.
Talbot,ProfRosemaryA.WalkerandProfCliveA.Wells.ThanksarealsoduetoDrCarolineBrodiewho
proofreadearlydraftsofsomeofthechaptersandgavehelpfulfeedback.Thanksalsotoallthosewhomade
theirlibrariesandcollectionsavailabletome,includingDrAnnSandison,DrJosephineWyatt-Ashmead,
DrNeilJ.Sebire,DrAlanW.Bates,DrMichaelT.Sheaff,DrMalcolmGallowayandDrJuanPiris.Finally,
IwouldliketothankallthestaffatJohnWiley&Sonsfortheirhelpfulnessandskillintakingthisbook
frommanuscripttopress.
xi