Table Of Content

THIRD EDITION Robbins and Cotran Atlas of Pathology Edward C. Klatt, MD Professor of Pathology Biomedical Education Program Director Department of Biomedical Sciences Mercer University School of Medicine Savannah, Georgia 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 ROBBINS AND COTRAN ATLAS OF PATHOLOGY, THIRD EDITION ISBN: 978-1-4557-4876-1 International Edition ISBN 978-0-323-2-8080-8 Copyright © 2015, 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. 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Library of Congress Cataloging-in-Publication Data Klatt, Edward C., 1951- , author. Robbins and Cotran atlas of pathology / Edward C. Klatt. – Third edition. p. ; cm. Atlas of pathology Includes index. ISBN 978-1-4557-4876-1 (pbk. : alk. paper) – ISBN 978-0-323-28080-8 (E-ISBN) I. Title. II. Title: Atlas of pathology. [DNLM: 1. Pathology–Atlases. QZ 17] RB33 616.07022’2–dc23 2014031172 Executive Content Strategist: William Schmitt Content Development Specialist: Laura Schmidt Publishing Services Manager: Catherine Jackson Senior Project Manager: Mary Pohlman Design Direction: Ashley Miner Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Preface This third edition of the atlas accompanying the Robbins series. In addition, there are examples of normal organs and series of texts has been updated with the addition of over 400 tissues for review and orientation. new images that increase the depth and breadth for coverage Each figure is accompanied by a brief description that pro- of subject areas in pathology, enhancing its usefulness to the vides the key points illustrated by the figure. For initial and entire series. This atlas remains organized into chapters that more complete study, the learner is directed to the Robbins texts. closely follow the section on Diseases of Organ Systems in the The labels and descriptions provided for the figures will guide ninth edition of the “big” Robbins and Cotran Pathologic Basis the learner in a discovery process while perusing these figures. of Disease. The atlas is designed to complement the Pathologic Though concise, the figure descriptions cumulatively yield a Basis of Disease, Basic Pathology, and Robbins’ Pocket Companion considerable volume of reading, but that reading is highly com- texts by providing even more examples of disease processes. partmentalized to aid review and reflection. Correlations with The atlas reflects the knowledge base of the Robbins series findings from clinical history, physical examination, and clini- primarily in a visual format, and because most students are cal laboratory testing are included in many of the descriptions. “visual learners” they will readily take advantage of this study The atlas author pursues an integrative approach to medical aid. The gross, microscopic, and radiologic images used for the education, combining elements of basic science, clinical, and figures as presented in this atlas are designed to reinforce one behavioral subjects into learning materials that promote a flow- another, as well as those present in other works in the Robbins ering of knowledge to benefit those in need of health care. v Acknowledgments The author is indebted to the stalwart figures who have funda- a migration, so too medical educators build on the work of mentally contributed to the development of the entire Robbins colleagues over many generations. series, starting with the founding author Dr. Stanley Robbins, Persons associated with the publisher, Elsevier, require continuing with Dr. Ramzi Cotran, and ongoing with Dr. Vinay special thanks including the Content Development Specialist, Kumar. These lead authors have set the standard of excellence Laura Schmidt, and Senior Project Manager, Mary Pohlman. that characterizes this series. In addition, there have been and Of course, none of this work would be possible without the continue to be numerous contributing authors who have made support and vision provided by Mr. William Schmitt, Execu- the Robbins series into the valuable tool it remains for medi- tive Content Strategist for Medical Textbooks. cal education. Just as no single monarch butterfly completes Edward C. Klatt, MD vii To all who strive for improving the health of everyone. viii Contributors Arthur J. Belanger, MHS, PA(ASCP) Walter H. Henricks, MD Autopsy Service Manager Staff Pathologist and Yale University School of Medicine Director of Laboratory Information Services New Haven, Connecticut The Cleveland Clinic Foundation Cleveland, Ohio John Blackmon, MD Associate Professor of Pathology Lauren C. Hughey, MD Florida State University College of Medicine Associate Professor of Dermatology Tallahassee, Florida University of Alabama at Birmingham Birmingham, Alabama Professor David Y. Cohen Director of Pathology Carl R. Kjeldsberg, MD Herzliyah Medical Center Professor of Pathology and Medicine Herzliyah-on-Sea, Israel University of Utah School of Medicine Chief Executive Officer and Chairman Richard M. Conran, MD, PhD, JD ARUP Laboratories Professor of Pathology Salt Lake City, Utah Uniformed Services University of the Health Sciences Bethesda, Maryland Nick Mamalis, MD Professor of Ophthalmology and Visual Sciences Todd Cameron Grey, MD John A. Moran Eye Center Chief Medical Examiner, State of Utah University of Utah Associate Professor of Pathology Salt Lake City, Utah University of Utah Salt Lake City, Utah Professor John Nicholls Clinical Professor Ilan Hammel, DSc Department of Pathology Professor and Chairman The University of Hong Kong Department of Pathology Pok Fu Lam, Hong Kong, SAR Sackler Faculty of Medicine Tel Aviv University Sherrie L. Perkins, MD, PhD Tel Aviv, Israel Professor of Pathology University of Utah School of Medicine M. Elizabeth H. Hammond, MD Director of Hematopathology Laboratory Professor of Pathology and ARUP Laboratories Adjunct Professor of Internal Medicine Salt Lake City, Utah University of Utah School of Medicine Salt Lake City, Utah Mary Ann Sens, MD, PhD Professor and Chair of Pathology Sate Hamza, MD University of North Dakota School of Medicine Assistant Professor and Health Sciences University of Manitoba Grand Forks, North Dakota Winnipeg, Manitoba, Canada ix x Contributors Shane Silver, MD, FRCPC Amy Theos, MD Dermatologist Associate Professor of Dermatology 203 Edmonton Street University of Alabama Medical Center Winnipeg, Manitoba Birmingham, Alabama Hiroyuki Takahashi, MD, PhD Omid Zargari, MD Associate Professor Consultant Dermatologist Department of Pathology Pars Clinic The Jikei University School of Medicine Rasht, Iran Tokyo, Japan C H A P T E R 1 Blood Vessels 1 2 CHAPTER 1 Blood Vessels Figure 1-1 Normal artery, microscopic This is a muscular artery in longitudinal section showing a thin intima ( ) on top of the internal elastic lamina. Below this is the thick media ( ), with layers of circular smooth muscle and interspersed elastic fibers to withstand the arterial pressure load and dampen the pressure wave from left ventricular contraction. The media is bounded by the external elastic lamina ( ). Out- side the media is the adventitia ( ), which merges with surrounding supporting connective tissue. Figure 1-2 Normal artery and vein, microscopic Seen here in cross-section is a normal artery ( ) with a thick, smooth muscle wall alongside a normal vein ( ) with a thin, smooth muscle wall, running in connective tissue in a fascial plane between muscle bundles of the lower leg. The larger arteries and veins are often grouped, along with a nerve, into a neurovascular bundle to sup- ply a body region. More distal areas of regional blood flow and the blood pressure are regulated by alternating vasoconstriction and dilation of small muscular arteries and arterioles. Figure 1-3 Normal arteriole and venule, microscopic A normal arteriole ( ) is alongside a normal venule ( ) and a small peripheral nerve ( ), all in cross- section, grouped into a loose neurovascular bundle. The major point of blood pressure regula- tion is at the arteriolar level. Exchange of solutes and gases with diffusion into tissues occurs at the capillary level. The diminished vascular pressure of the venules, along with the intravascular oncotic pressure exerted by plasma proteins, brings interstitial fluids back into the venules. Not seen here are the normally inconspicuous lym- phatic channels that scavenge what little residual fluid is exuded from capillaries and not recovered into the venous system, preventing edema.