Surgical Pathology Dissection: An Illustrated Guide PDF
Preview Surgical Pathology Dissection: An Illustrated Guide
Surgical Pathology Dissection Second Edition Surgical Pathology Dissection An Illustrated Guide Second Edition William H. Westra, M.D. Ralph H. Hruban, M.D. Department of Pathology Department of Pathology The Johns Hopkins University The Johns Hopkins University School of Medicine School of Medicine Baltimore, Maryland Baltimore, Maryland Timothy H. Phelps, M.S. Christina Isacson, M.D. Department of Art as Applied to Medicine Department of Pathology The Johns Hopkins University Virginia Mason Medical Center School of Medicine Seattle, Washington Baltimore, Maryland With Forewords by Frederic B. Askin, M.D. With 58 Illustrations WilliamH.Westra,M.D. RalphH.Hruban, M.D. DepartmentofPathology DepartmentofPathology TheJohnsHopkinsHospital TheJohnsHopkinsHospital TheWeinberg CancerBuilding,Room2242 TheWeinbergCancerBuilding, 401North Broadway Room 2242 Baltimore,MD21231-2410,USA 401NorthBroadway Baltimore,MD21231-2410,USA TimothyH.Phelps,M.S. ChristinaIsacson,M.D. DepartmentofArtasApplied DepartmentofPathology toMedicine VirginiaMasonMedicalCenter TheJohnsHopkinsUniversity 1100NinthAvenue,C6-Path SchoolofMedicine Seattle,WA98101, USA 1830EastMonumentStreet, Suite7000 Baltimore,MD21205-2100,USA Cover illustration: Extrahepatic biliary tract resection for carcinoma of the common bile duct. IllustrationbyTimothyH.Phelps. LibraryofCongressCataloging-in-PublicationData Surgicalpathologydissection:anillustratedguide/[editedby]WilliamH.Westra... [etal.].—2nded. p.; cm. Includesbibliographicalreferencesandindex. ISBN0-387-95559-3(s/c:alk.paper) 1. Pathology,Surgical—Laboratorymanuals. 2. Humandissection— Laboratorymanuals. I. Westra,WilliamH. [DNLM: 1. Pathology,Surgical—LaboratoryManuals. 2. Dissection—LaboratoryManuals. WO142S9615 2002] RD57. S87. 2002 617′.07—dc21 2002029448 ISBN0-387-95559-3 Printedonacid-freepaper. (cid:1)2003,1996Springer-VerlagNewYork,Inc. Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthe written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York,NY10010,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computersoftware,orbysimilarordissimilarmethodologynowknownorhereafterdeveloped isforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,evenif theyarenotidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetheror nottheyaresubjecttoproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedate of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibilityforanyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty, expressorimplied,withrespecttothematerialcontainedherein. PrintedintheUnitedStatesofAmerica. 9 8 7 6 5 4 3 2 SPIN10888565 www.springer-ny.com Springer-Verlag NewYork Berlin Heidelberg AmemberofBertelsmannSpringerScience+BusinessMediaGmbH To the Breakfast Club. Fond memories of hooping it up. To the team: Sharon, Caryn, Janine, and Willem. William H. Westra To my wonderful wife, Claire, and our three terrific children, Zoe, Emily, and Carolyn. Ralph H. Hruban To my wife, Lyn, for her ever-present love and support; my two children, Katie and Kevin, who bring me great and constant joy; my art instructors of the past for all they have shared with me; and, particularlyandmostimportantly,myFather;andinlovingmemory of my Mother. Timothy H. Phelps To my sisters, Charlotte and Patty. Christina Isacson Foreword to the Second Edition It isa pleasure,an honor,and a distinctprivilege towrite the forewordfor the secondeditionofSurgicalPathologyDissection:AnIllustratedGuide.Iam delightedtoseethatmypredictionswereaccurateinregardtothiseffective and useful book. It has become an extremely popular dissection manual withregardtobothitstextandillustrativematerial.Infact,themanualand its medical illustrator, Timothy H. Phelps, received the Illustrated Book Award from the Association of Medical Illustrators in 1996. Pathologist reviewers have uniformly characterized the text as valuable and inclusive while still leaving room for individual variation in specimen handling. Just as our other clinical colleagues continually endeavor to improve pa- tientcarebyaddingnewdiagnostictestsandtechniques,itisincumbenton anatomicpathologiststodothesame.Theauthors’goalinthedevelopment of the second edition of this manual was not to replace the first edition but, rather, to build on its strength. In this second edition, one finds the additionofnewcoauthorswithrecognizedexpertiseintheirrespectivefields of interest. These coauthors have provided chapters on contemporary topicsnotcoveredinthefirsteditionandnewillustrations(thespecificsare listed in the Preface). In addition, a number of the original illustrations, such as the breast specimen dissection, have been significantly revised and improved. In an attempt to provide more uniform description and tumor staging,theexistingchaptershavebeenupdatedtoconformwiththerecently publishedCollegeofAmericanPathologists(CAP)andAssociationofDirec- tors of Anatomic and Surgical Pathology (ADASP) guidelines. The basic goals for the first edition have been retained: to provide an accurate, concept-oriented, easy-to-use manual that provides a logical, conciseapproachtothemostcommonly encounteredspecimens. Although newauthorsandnewmaterialhavebeenadded,thebasicsolidframework of the manual persists. I am confident that the second edition provides significantimprovementsandthatthismanualwillcontinuetobeamainstay in the anatomic pathology armamentarium. Frederic B. Askin, M.D. Professor of Pathology The Johns Hopkins University School of Medicine and Director of Surgical Pathology The Johns Hopkins Hospital Baltimore, MD 21231-2410, USA vii Foreword to the First Edition The modern surgical pathology cutting room is replete with tools of the electronicage.Computers,automaticcassettelabelers,barcoding,andeven electronicvoice-recognitionsystemsareavailabletohelpthesurgicalpathol- ogistbeaneffective,efficient,andhighlyproductivecoginthemachineryof healthcaredelivery.Inspiteofthisautomatedarmamentarium,muchofour abilitytorenderdiagnosesrestswiththesurgicalpathology‘‘cutters.’’These personnelneedtobetrainedtohandlesurgicalspecimensconsistently and appropriately, with the goal of providing optimal diagnostic information and adequate pathologic correlation with clinical and radiologic findings. This dissection manual is an outgrowth of what Waldemar Schmidt hascalledthe‘‘oraltradition’’ofsurgicalpathology.Traditionally,thesenior pathologist passed down to the trainee an individual accumulation of ex- pertiseonthehandlingofspecimens.Thistransferofinformationwasoften random and based solely on the specific case at hand. Now, despite the importance of training personnel, the exigencies of modern practice limit theamountoftimeavailableforindividualtraining,andsomostlaboratories havedevelopedtheirownlocalmanual.Unfortunately,manyofthesemanu- als are incomplete or not user-friendly. Drs. Hruban, Westra, and Isacson have prepared this manual with the helpofadistinguishedandtalentedmedicalartist.TimothyH.Phelps’spen andinkdrawingsbringauniquevitalityandmultidimensionaleffecttothe reader throughout the manual as dissection techniques are explained and illustrated.Theeditorsandcontributorshaveeffectivelysharedtheirtalents and experience by providing general principles that can be employed to resolve even the most complex problems in dissection and effective tissue sampling.Themethodsarebroadlyapplicableandunusuallyeasytofollow. This text should be at hand in all surgical pathology laboratories, where it will be useful to a wide variety of personnel including staff pathologists, residents, pathologist’s assistants, histotechnologists, and other laboratory personnel. It is highly likely that many surgeons would also benefit from use of this manual, through which they can gain an understanding of how specimens are dissected and can become familiar with the way in which margin and tumor sampling are carried out. This is a very practical manual. The authors discuss the clinically im- portant features of various types of specimens and lesions in each organ system.Theyinstructtheprosectorineveryinstanceastowhatinformationis needed to provide the clearest clinical picture. I suspect that this work will ix x ForewordtotheFirstEdition be most valuable to the surgical pathology cutter late in the evening or on weekends,whentheredoubtableoralhistorianofsurgicalpathologyisnot available. This manual should serve as a cornerstone on which to build a stable but malleable standard of excellence in the surgical pathology cut- ting room. Frederic B. Askin, M.D. Professor of Pathology The Johns Hopkins University School of Medicine and Director of Surgical Pathology The Johns Hopkins Hospital Baltimore, MD 21231-2410, USA Preface Our goal in writing the first edition of Surgical Pathology Dissection: An Illustrated Guide was to create a user-friendly, hands-on guide for the dis- section of surgical pathology specimens. To do this, we brought a team of surgicalpathologistswithabroadrangeofexpertisetogetherwithTimothy H.Phelps,oneoftheleadingmedicalillustratorsintheUnitedStates.Inso doing, we believe we created a manual that provides a logical, concise approach to the most commonly encountered specimens. In the years since the first edition was published, Surgical Pathology Dissection: An Il- lustratedGuidehasemergedasthestandardinthefield,andin1996,Timothy H. Phelps was awarded the Illustrated Book Award from the Association of Medical Illustrators for his artwork in the book. Wehavemadeanumberofsignificantimprovementsinthesecondedition of Surgical Pathology Dissection: An Illustrated Guide. First, new coauthors were asked to join the existing team to add a fresh perspective to key chapters. For example, Elizabeth Montgomery, Robb E. Wilentz, Michael Torbenson, Susan Abraham, E. Rene Rodriguez, and Pedram Argani have helped update key chapters on the digestive system, heart, and breast. Second, new chapters, including chapters on transplantation and sentinel lymph nodes, have been added, reflecting emerging trends in surgical pa- thology practice. Importantly, these new chapters retain the user-friendly style characteristic of the first edition. Third, new illustrations, including those for dissection of an explanted heart, craniofacial bones, and sentinel lymphnodes,havebeenadded.Inaddition,anumberoftheoriginalillustra- tions,suchasforthedissectionofbreastspecimens,havebeensignificantly revised and improved. Fourth, updates to existing chapters, particularly wheretheywereneededtoconformtothemorerecentlypublishedCollege of American Pathologists (CAP) and Association of Directors of Anatomic and Surgical Pathology (ADASP) guidelines, have been made. These changes were made with the goal of keeping Surgical Pathology Dissection: An Illustrated Guide user-friendly and up to date. Each chapter therefore continuestoincludedescriptionsandillustrationsofthemechanicsinvolved whenhandlingeach specimenaswellasaconceptual frameworkforques- tionstokeepinmindduringthedissection.Attheendofeachchapter,the section entitled “Important Issues to Address in Your Pathology Report” helps guide the user to the key information needed to stage most tumors accurately. xi xii Preface Finally, to reflect the equal contributions of the two first authors, Drs. Westra and Hruban have switched places in authorship, and Dr. Westra is now the first author on the second edition. We believe the second edition is a significant improvement over the first edition, and we continue to hope that this illustrated guide will make the dissection of any specimen an important and enjoyable endeavor. William H. Westra, M.D. Ralph H. Hruban, M.D. Timothy H. Phelps, M.S. Christina Isacson, M.D.
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