Progress in Surgical Pathology: Volume X

267 Pages·1989·12.101 MB·English

by  John J. Brooks, Cliff Miller (auth.), M. Cecilia Fenoglio-Preiser M.D., Marianne Wolff M.D., Franco Rilke M.D. (eds.)

Progress in
Surgical Pathology
o
VOLUMEX
Progress in
Surgical Pathology
D
VOLUME X
Edited by
Cecilia M. Fenoglio-Preiser,
M. D.
Professor of Pathology
University of New Mexico, and
Director of Laboratory Services
Albuquerque Veterans Administration Medical Center
Albuquerque, New Mexico
Marianne Wolff,
M.D.
Professor of Clinical Surgical Pathology
Columbia University College of Physicians and Surgeons, and
Department of Pathology
Memorial Hospital
Morristown, New Jersey
Franco Rilke,
M. D.
Deputy Director, National Cancer Institute
Milan, Italy, and
Director, Division of Pathology
Professor, Postgraduate School of Anatomic Pathology
University of Pavia, Italy
Copyright © 1989, Springer-Verlag Berlin Heidelberg .
Originally published by Field and Wood, Medical Publisher, Inc in 1989.
Softcover reprint of the hardcover 1s t edition 1989
All rights reserved. No part of this book may be reproduced or
transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any other information storage
and retrieval system, without permission in writing from the
Publisher.
Heidelberg Platz 3
1000 Berlin 33
Federal Republic of Germany
ISSN 0271-2350
ISBN 978-3-662-12825-1 ISBN 978-3-662-12823-7 (eBook)
DOI 10.1007/978-3-662-12823-7
Contents
Contributors vii
1 Handedness, Happiness, and Other Characteristics of Practicing Pathologists 1
John 1. Brooks, M.D., Cliff Miller, M.S.
2 The Histologic Diagnosis of Extrinsic Allergic Alveolitis and Its Differential
Diagnosis 11
Thomas V. Colby, M.D., Anne Coleman, M.D.
3 Pulmonary Vascular Neoplasia 27
Samuel A. Yousem, M.D.
4 Telangiectatic or Hemorrhagic Osteosarcoma of Bone: A Clinicopathologic
Study of 41 Patients at the Rizzoli Institute 63
F. Bertoni, M.D., G. Pignatti, M.D., P. Bacchini, M.D., P. Pieci, M.D., G. Bacci, M.D.,
M. Campanacci, M.D.
5 Sarcomatoid Carcinomas of the Breast: An Immunocytochemical Study
of 14 Cases 83
Vincenzo Eusebi, M.D., Maria G. Cattani, M.D., Claudio Ceccarelli, B.Sc.,
Janez Lamovec, M.D.
6 Micro-Papillary Hyperplasia with Atypical Features in Female Breasts,
Resembling Gynecomastia 101
Kyi-Toe Tham, M.D., Williarn D. Dupont, M.D., David L. Page, M.D., George F.
Gray, Jr., M.D., Lowell W. Rogers, M.D.
7 Cutaneous Histiocytoses in Children: Histopathologic, Ultrastructural, and
Immunohistochemical Findings 111
R. Caputo, M.D., E. Alessi, M.D., E. Berti, M.D.
8 The Clinical and Prognostic Relevance of Histopathologic Classification
in Hodgkin's Disease 127
Michael H. Bennett, MB.BChir., FRCPath., Kenneth A. MacLennan, MB.BS., MRCPath.,
Bryan Vaughan Hudson, Ph.D., MB.BS., Gillian Vaughan Hudson, MB.BS.
9 Analysis of Chromogranin A and B Proteins and Messenger Ribonucleic
Acids in Neuroendocrine Tissues 153
Ricardo V. Lloyd, M.D., Ph.D.
10 New Approaches to the Diagnosis of Thymic Epithelial Tumors 167
Thomas Kirchner, M.D., Hans Konrad Miiller-Hermelink, M.D.
v
vi Contents
11 The Role of Campylobacter pylori in Gastro-Duodenal Disease 191
Pelayo Correa, M.D., Nubia Muiioz, M.D., Carlos Cuello, M.D., James Fox, D.V.M.,
Diego Zavala, M.D., Bemardo Ruiz, M.D.
12 The Mucosal Prolapse Syndrome: Clinical and Pathologic Study of 154 Cases
and Review of the Literature 211
Matthias Kraemer, M.D., Wolfgang Remmele, M.D., Heinrich Miiller-Lobeck, M.D.
13 Surgical Pathology of the Anal Canal: A Review of Recent Literature on
Anatomy and Pathology 237
Claus Fenger, M.D.
Index 261
Contributors
E. Alessi, M.D., 1st Clinic of Dermatology, University of Milan, Milan, Italy
P. Bacchini, M.D., Rizzoli Orthopaedic Institute, Bologna, Italy
G. Bacci, M.D., Rizzoli Orthopaedic Institute, Bologna, Italy
Michael H. Bennett, MB.Bchir., FRcpath., British National Lymphoma Investigation (BNLI),
Department of Oncology, Middlesex Hospital Medical School, London, UK
E. Berti, M.D., 1st Clinic of Dermatology, University of Milan, Milan, Italy
F. Bertoni, M.D., Rizzoli Orthopaedic Institute, Bologna, Italy
John J. Brooks, M.D., Department of Pathology & Laboratory Medicine, Hospital of the University
of Pennsylvania, Philadelphia, Pennsylvania
M. Campanacci, M.D., Rizzoli Orthopaedic Institute, Bologna, Italy
R. Caputo, M.D., 1st Clinical of Dermatology, University of Milan, Milan, Italy
Maria G. Cattani, M.D., Institute of Anatomical Pathology, University of Bologna, Bologna, Italy
Claudio Ceccarelli, B.SC., Department of Oncology, University of Bologna, Bologna, Italy
Thomas V. Colby, M.D., Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester,
Minnesota
Anne Coleman, M.D., Department of Pathology, LDS Hospital, Salt Lake City, Utah
Pelayo Correa, M.D., Department of Pathology, Louisiana State University Medical Center, New
Orleans, Louisiana
Carlos Cuello, M.D., Department of Pathology, School of Medicine, Universidad del Valle, Cali,
Colombia
William D. Dupont, M.D., Department of Preventive Medicine, Vanderbilt University School of
Medicine, Nashville, Tennessee
Vincenzo Eusebi, M.D., Institute of Anatomical Pathology, University of Bologna, Bologna, Italy
Claus Fenger, M.D., The Department of Pathology, Odense University Hospital, Odense, Denmark
James Fox, D.V.M., Massachusetts Institute of Technology, Cambridge, Massachusetts
George F. Gray, Jr., M.D., Department of Pathology, Vanderbilt University School of Medicine,
Nashville, Tennessee
Thomas Kirchner, M. D., Institute of Pathology, University of Wurzburg, Federal Republic of Germany
Matthias Kraemer, M.D., Institut fUr Pathologie, Dr. Horst-Schmidt-Kliniken, Klinikum der
Landeshauptstadt Wiesbaden, Wiesbaden, Federal Republic of Germany
Janez Lamovec, M.D., Department of Pathology, Institute of Oncology, Ljubljana, Yugoslavia
Ricardo V. L1oyd, M.D., PH.D., Department of Pathology, University of Michigan Medical Center,
Ann Arbor, Michigan
Kenneth A. MacLennan, MB.BS., MRcpath., British National Lymphoma Investigation (BNLI),
Department of Oncology, Middlesex Hospital Medical School, London, UK
ClitTMiller, M.S., University of Pennsylvania Cancer Center, University of Pennsylvania, Philadelphia,
Pennsylvania
Hans Konrad Mfiller-Hermelink, M.D., Institute of Pathology, University of Wurzburg, Federal
Republic of Germany
Heinrich Mfiller-Lobeck, M.D., Deutsche Klinik fiir Diagnostik, Sektion Proktologie, Wiesbaden,
Federal Republic of Germany
Nubia Muiioz, M.D., International Agency for Research on Cancer, Lyon, France
vii
viii Contributors
David L. Page, M.D., Department of Pathology, Vanderbilt University School of Medicine, Nashville,
Tennessee
P. Pieci, M.D., Rizzoli Orthopaedic Institute, Bologna, Italy
G. Pignatti, M.D., Rizzoli Orthopaedic Institute, Bologna, Italy
Wolfgang Remmele, M.D., Institut fUr Pathologie, Dr. Horst-Schmidt-Kliniken, Klinikum der
Landeshauptstadt Wiesbaden, Wiesbaden, Federal Republic of Germany
Lowell W. Rogers, M.D., Carraway Methodist Medical Center, Birmingham, Alabama
Bernardo Ruiz, M.D., Department of Pathology, Louisiana State University Medical Center, New
Orleans, Louisiana
Kyi-Toe Tham, M.D., Department of Pathology, Vanderbilt University School of Medicine & Veterans
Administration Medical Center, Nashville, Tennessee
Bryan Vaughan Hudson, PH.D., MB .BS., British National Lymphoma Investigation (BNLI), Department
of Oncology, Middlesex Hospital Medical School, London, UK
Gillian Vaughan Hudson, MB.BS., British National Lymphoma Investigation (BNLI), Department
of Oncology, Middlesex Hospital Medical School, London, UK
Samuel A. Yousem, M.D., Assistant Professor of Pathology, Presbyterian University Hospital of
Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Diego Zavala, M.D., Department of Pathology, Louisiana State University Medical Center, New
Orleans, Louisiana
1
Handedness, Happiness, and Other
Characteristics of Practicing Pathologists
John J. Brooks
Cliff Miller
The reader might well ask why investigate handed individuals so selected chores (such
handedness and happiness in pathologists? Is as cut with scissors or deal cards) with the
there some reason to believe that this particu left hand. Likewise, left-handers (defined ini
lar group of physicians is unusually sad, tially as people who write with that hand)
manic, or clumsy? Not at all, let me assure are a diverse group with some doing most
you. The impetus for this pilot study came other chores with the right hand, some split
from a discussion among the authors and col ting chores in a roughly equal manner (ambi
leagues at a time when three of the four surgi dexterity), and some being complete left
cal pathologists in the office were left-handed. handers. To confront this situation, a rather
When the late Friday afternoon conversation complex form but one that most properly clas
eventually turned to talk about the obvious sifies handedness was developed (see meth
natural superiority of the left-handed and their ods). After researching the topic further, it
impact upon the course of human history, was also realized that other personal traits
lively debates ensued about things like pattern might be involved and it was decided to add
recognition and its .significance to a career such queries to the questionnaire. Before the
in pathology, about why anyone chooses pa form was mailed, a series of other questions
thology as a specialty, and about what quali relating to personal preferences and happiness
ties make for a good surgical pathologist. in general were added.
These discussions were conducted in a
friendly manner but without resolution. How
ever, the fundamental question inquiring RESEARCH ON HANDEDNESS
whether there was an increased percentage
of left-handers in morphologic pathology con In the general population, the frequency
tinued to intrigue me. of non-right-handedness is estimated to be
It was decided to approach this very answer approximately 5-10 percent in a number of
able question in as scientifically a manner references on the topic. \-3 In the literature
as possible with the resources available. A there is a vast and confusing body of informa
questionnaire was agreed upon as the only tion on handedness and its relationship to a
way to begin, and so began the task of design number of characteristics and conditions. For
ing one. It soon became clear that the process some reason yet unknown, disproportionate
of developing a good questionnaire was not right-handedness is a property exclusive to
as easy surmized. People are not easily classi humans.4 From prehistoric times until about
fied as right- or left-handers. Some right- 1950, left-handedness had been associated
2 Brooks and Miller
with evil, weakness, disease, and of course, on handedness, but also on sex and reasoning
anything gauche or sinister. 4,5 It is now appar ability. Indeed, many authors have noted the
ent that, while there is an increased incidence importance of sex in handedness stud
of sinstrality (left-handedness) among epilep ies.4,14,16-18 More males than females are non
tics,6 dyslexics,7 autistics,6 stutterers,2,8 and right handers, 2 a fact that points to the possible
the mentally retarded;8 it is also true that there influence of hormones in determining handed
is a higher frequency of left handedness (or ness. After a number of careful investigations
non-right-handedness) among gifted students on handedness in gifted students, Geschwind
(20 percent in Mensa8) and certain occupa has proposed that left-handedness, as well
tions like mathematics,1,9 music,1,9 architec as language difficulties result from the devel
ture,8 art,8 science,4 and certain defensive opment of anomalous dominance in the brain
sports. 10 Thus, there is a fairly clear relation promoted by early increased testosterone
ship between left-handedness (and therefore levels.7 His hypothesis may explain why most
right-brainedness) and visual-spacial func gifted mathematicians are male and, through
tions. Left-handers also often achieve higher the effects of the hormone on the immune
scores on creativity tests.ll It has also been system, why sixty percent ofleft-handers have
found that left-handers are not a neatly classi immune disorders.7,9 Thus, the entire topic
fied nor homogeneous groUp.8 For example, of left-handedness and its possible causes and
there apparently are three distinct groups of associations has always aroused curiosity, and
left-handers (natural, learned, and patho recently, it has gained renewed interest. In
logic), with the above list of speech and men fact, the increased recognition of the special
tal disorders present only in the last two.8 characteristics and importance of the right
Natural left-handers are normal in every way brain has lately been carried to the extreme
(unless forced to use the right hand, a process in the so-called right brain movement, which
which may account for about 50 percent of attempts to teach businessmen how to be more
all stutterers8). Otherwise, contrary to previ intuitive and creative. 19
ous beliefs, there is no detectable difference Here, it was thought that our profession
in intelligence3 or personality12 between right offered the unique opportunity to study hand
and left-handers. edness in an occupation in which visual-spa
In right-handers, the more verbal, logical, cial recognition plays such an important role
and analytic left brain dominates; in left and in which medical individuals possessing
handers, the more spatial and intuitive right a very visual or photographic memory might
brain functions seem enhanced, although cere cluster. The results did document a large pro
bral dominance is not clear-cut.5 Left-handers' portion of non-right-handers and underscored
show more variation in the localization of the importance of visual memory in our field.
cerebral functions (and less cerebral asymme
try) than right-handers.1 This explains why
cerebral lesions such as stroke result in less IMPORTANCE OF STUDIES
severe functional disorders and more rapid ON CHARACTERISTICS
recovery in left-handed individuals.2,13 Hand OF PATHOLOGISTS
edness also affects visual acuity, but there
are sex differences. 14 The association between If you stop to think, there is precious little
left-handedness and the visual-spacial (as op gathered information available concerning a
posed to the verbal) fields, while generally medical student's choice of a career in pathol
true, is not uniformly detected,15 and is actu ogy. It is even more difficult to predict who
ally quite complicated. Thus, in a study that will go on to become superb diagnosticians.
demonstrated that left-handed males have su Presently, there is no clue as to which qualities
perior spatial ability, Harsbman et al. deter predict future strength in anatomic pathology.
mined that spatial scores depended not only Are there ways to gauge accurately a candi-