Pathology Practical Book

292 Pages·2013·94.177 MB·English

by  Mohan Harsh.;

PATHOLOGY
PRACTICAL BOOK
The photographs on the cover of the book depict images of following diseases:
FNA in tuberculous lymphadenitis
Lepra bacilli in lepramatous leprosy
Monckeberg’s arteriosclerosis
Infarct kidney
Bone marrow in megaloblastic anaemia
PATHOLOGY
PRACTICAL BOOK
THIRD EDITION
Harsh Mohan MD, FAMS, FICPath, FUICC
Professor and Head
Department of Pathology
Government Medical College
Sector-32 A, Chandigarh-160 030
INDIA
e-mail: [email protected]
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© 2013, Harsh Mohan
All rights reserved. No part of this book and CD-ROM may be reproduced in any form or by any means without the
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This book has been published in good faith that the contents provided by the author contained herein are original,
and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the
publisher and the author secifically 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 author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the
drug or device.
Pathology Practical Book
First Edition : 2000
Second Edition : 2007
Third Edition : 2013
Assistant Editors : Praveen Mohan, Tanya Mohan, Sugandha Mohan
ISBN 978-93-5090-266-0
Printed at

 
Knowledge is greater than experience;
 
Meditation is superior to knowledge;
 
Sacrifice is higher than meditation; and
 
Blessed are those who sacrifice.
 
The Bhagwadgita (Chapter 12, verse 12)
 

Dedicated to
My wife Praveen,
for her profound love and devotion;
and our daughters: Tanya and Sugandha,
for their abiding faith.
Preface to the Third Edition
Since the last revision of the Pathology Practical Book in 2007, many technological advances have taken place in
diagnostic pathology; therefore the students have to keep pace with the rapid strides and hence revised edition
became necessary. While revising the book, however, well-accepted basic style of both the previous editions of the
book as exercise-based learning akin to teaching in a practical class of pathology has been retained. The emphasis
throughout the revised edition has been on effortless and focused learning by the students on practical points in
various sections of pathology and simultaneously preparing them for viva voce in diagnostic pathology such as on
slides, specimens, instruments, normal values, similes, etc. Thus, the revised edition in a small package encompasses
abundant practical knowledge of immense value.
Some of the highlights of the revise edition are as under:
Reorganised and updated contents: The revised edition is reorganised into 8 sections, each section having certain
number of practical exercises (in all 61 compared to 58 in the last edition) patterned on the format of practical class
of students. These are: Techniques in Pathology (Exercise 1-5), General Pathology (Exercise 6-20), Systemic
Pathology (Exercise 21-38), Cytopathology (Exercise 39-41), Clinical Pathology (Exercise 42-45), Haematology
(Exercise 46-59), Autopsy Pathology (Exercise 60-61) and Appendices (I-III compared to one in the last edition). All
these exercises have been updated in their textual content and newer images added at several places while redundant
information and older images have been deleted, taking care that the volume of the book does not grow much bigger.
Additional exercises: Besides rational reorganisation of the exercises in various sections, the revised edition has
three totally new exercises. These include exercises on topics of immunohistochemistry (Exercise 4), surgical
pathology request form (Exercise 5) and types of blood samples, anticoagulants and blood collection (Exercise 46).
Learning and practice of these contemporary topics by the students during their formative years in pathology were
considered essential.
Newer appendices: While the appendix on normal values of the previous edition has been retained and updated,
present edition has two new appendices: Common Instruments in Pathology (Appendix I) and Common Similes in
Pathology (Appendix II). Both these appendices are profusely illustrated with fairly catchy and helpful legends for
quick learning.
CD on CPCs and museum review: Ten CPCs (including organ images and their photomicrographs) on the self-
learning CD given in the previous edition were found quite useful and user-friendly and have been retained and
updated. Besides, the CD in the revised edition also contains a quick review of pathology museum with images
and legends of 108 museum specimens of common conditions considered must know for students.
Although the revised edition of the book is primarily prepared for undergraduate students of pathology, it is also
expected to be useful for practising clinicians and other students of medicine such as those pursuing course in
dentistry, physiotherapy, pharmacy, nursing, laboratory technology and alternate systems of medicine.
viii Pathology Practical Book
ACKNOWLEDGEMENTS
In preparing the revised edition, I have been helped and supported by various friends, colleagues and my family,
which is gratefully acknowledged. I owe a word of special thanks to Ms Agam Verma, MSc (MLT), Senior Laboratory
Technician, for liberal and skillful technical assistance and her valuable suggestions in chapters on laboratory
technology.
I thank profusely the entire staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, in general
for their constant support and cooperation, and Mrs Y Kapoor (Senior Desktop Operator) and Mr Manoj Pahuja
(Senior Graphic Designer) in particular, in layout of the text and organising the large number of figures as per my
requirements, ungrudgingly and smilingly. My special thanks are due to Shri Jitendar P Vij (Group Chairman) and
Mr Ankit Vij (Managing Director), M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their
constant co-operation and for being so supportive for getting the best final product for the users.
Finally, although sincere effort has been made to be as accurate as possible, an element of human error is still
likely. I shall humbly request users to continue giving their valuable suggestions and feedback as they have been
doing before for my all books; this helps me greatly to learn from the experience of users, improve further and carry
out correction, wherever required, at the earliest possible opportunity.
Government Medical College Harsh Mohan, MD, FAMS, FICPath, FUICC
Sector-32 A, Chandigarh-160030 Professor & Head
INDIA Department of Pathology
e-mail: [email protected]
Contents
SECTION 1: TECHNIQUES IN PATHOLOGY
Exercise 1: Microscopy........................................................................................................................................................................................3
Exercise 2: Routine Histopathology Techniques and Staining...........................................................................................................7
Exercise 3: Frozen Section and its Staining .............................................................................................................................................13
Exercise 4: Special Stains and Immunohistochemistry.......................................................................................................................15
Exercise 5: Surgical Pathology Request Form.........................................................................................................................................19
SECTION 2: GENERAL PATHOLOGY
Exercise 6: Degenerations..............................................................................................................................................................................23
Exercise 7: Intracellular Accumulations ....................................................................................................................................................26
Exercise 8: Amyloidosis ...................................................................................................................................................................................30
Exercise 9: Necrosis...........................................................................................................................................................................................34
Exercise 10: Gangrene and Pathologic Calcification..............................................................................................................................38
Exercise 11: Derangements of Body Fluids................................................................................................................................................41
Exercise 12: Obstructive Circulatory Disturbances.................................................................................................................................45
Exercise 13: Types of Inflammation...............................................................................................................................................................48
Exercise 14: Granulomatous Inflammation—Tuberculosis.................................................................................................................51
Exercise 15: Other Granulomatous Inflammations.................................................................................................................................55
Exercise 16: Fungal Infections.........................................................................................................................................................................58
Exercise 17: Actinomycosis and Parasitic Infections...............................................................................................................................61
Exercise 18: Adaptive Disorders of Growth................................................................................................................................................64
Exercise 19: Primary Epithelial Tumours.....................................................................................................................................................68
Exercise 20: Mesenchymal and Metastatic Tumours..............................................................................................................................73
SECTION 3: SYSTEMIC PATHOLOGY
Exercise 21: Atherosclerosis and Vascular Tumours...............................................................................................................................79
Exercise 22: Diseases of the Heart..................................................................................................................................................................83
Exercise 23: Pneumonias...................................................................................................................................................................................86
Exercise 24: Chronic Obstructive Pulmonary Diseases and Lung Cancer......................................................................................90
Exercise 25: Diseases of the Jaws, Salivary Glands and Stomach......................................................................................................94
Exercise 26: Diseases of Appendix and Large Intestine........................................................................................................................98
Exercise 27: Hepatitis—Viral, Alcoholic, Fulminant.............................................................................................................................103
Exercise 28: Cirrhosis, Hepatocellular Carcinoma, Gallbladder Diseases.................................................................................... 106
x Pathology Practical Book
Exercise 29: Primary Glomerulonephritis and Tubulointerstitial Disease................................................................................... 111
Exercise 30: Diabetic Nephropathy and Tumours of Renal System..............................................................................................116
Exercise 31: Testicular Tumours and Diseases of Prostate................................................................................................................121
Exercise 32: Diseases of Endometrium, Placenta, Cervix...................................................................................................................124
Exercise 33: Ovarian Tumours......................................................................................................................................................................127
Exercise 34: Diseases of Breast.....................................................................................................................................................................131
Exercise 35: Diseases of Thyroid..................................................................................................................................................................134
Exercise 36: Osteomyelitis and Benign Bone Tumours......................................................................................................................138
Exercise 37: Malignant Bone Tumours......................................................................................................................................................141
Exercise 38: Meningitis and CNS Tumours..............................................................................................................................................145
SECTION 4: CYTOPATHOLOGY
Exercise 39: Basic Cytopathologic Techniques and their Applications........................................................................................151
Exercise 40: Interpretation of Pap Smears and Fluid Cytology.......................................................................................................155
Exercise 41: Interpretation of FNA Smears..............................................................................................................................................158
SECTION 5: CLINICAL PATHOLOGY
Exercise 42: Urine Examination I: Physical and Chemical.................................................................................................................. 163
Exercise 43: Urine Examination II: Microscopy.......................................................................................................................................171
Exercise 44: Semen Analysis..........................................................................................................................................................................178
Exercise 45: Examination of CSF..................................................................................................................................................................181
SECTION 6: HAEMATOLOGY
Exercise 46: Types of Blood Samples, Anticoagulants and Blood Collection............................................................................ 187
Exercise 47: Haemoglobin Estimation......................................................................................................................................................190
Exercise 48: Counting of Blood Cells......................................................................................................................................................... 194
Exercise 49: Reticulocyte Count...................................................................................................................................................................199
Exercise 50: Preparation and Staining of Peripheral Blood Film ....................................................................................................201
Exercise 51: Differential Leucocyte Count...............................................................................................................................................204
Exercise 52: ESR, PCV (Haematocrit) and Absolute Values................................................................................................................209
Exercise 53: Screening Tests for Haemostasis........................................................................................................................................214
Exercise 54: Blood Grouping and Cross-matching...............................................................................................................................218
Exercise 55: Peripheral Smear Examination in Anaemias..................................................................................................................223
Exercise 56: Bone Marrow Examination...................................................................................................................................................230
Exercise 57: Haemoparasites........................................................................................................................................................................234
Exercise 58: Haematologic Malignancies: Leukaemias......................................................................................................................237
Exercise 59: Haematologic Malignancies: Lymphomas.....................................................................................................................243