Surgical pathology of the GI tract, liver, biliary tract, and pancreas

1350 Pages·2009·517.82 MB·English

by  Robert D Odze

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SURGICAL PATHOLOGY OF THE GI TRACT, LIVER, ISBN: 978-14160-4059-0
BILIARY TRACT, AND PANCREAS
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Library of Congress Cataloging-in-Publication Data
Surgical pathology of the GI tract, liver, biliary tract, and pancreas / [edited by] Robert D. Odze,
John R. Goldblum.—2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4160-4059-0
1. Gastrointestinal system—Surgery. 2. Liver—Surgery. 3. Biliary tract—Surgery. 4. Pancreas—
Surgery. I. Odze, Robert D. II. Goldblum, John R.
[DNLM: 1. Digestive System Surgical Procedures. 2. Pathology, Surgical—methods. 3. Digestive
System—physiopathology. WI 900 S9608 2009]
RD540.O396 2009
617.4′3—dc22
2008001963
Acquisitions Editor: William Schmitt
Developmental Editor: Liliana Kim
Publishing Services Manager: Tina Rebane
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Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my family and particularly my late mother, Natasha,
who is my hero in life.
ROBERT D. ODZE, MD, FRCP(C)
To those whom I hold most dear: my wife, Asmita; my children,
Andrew, Ryan, Janavi, and Raedan; my dear mother, Bette; my late
father, Raymond; and the rest of the Goldblum and Shirali families,
whom I also cherish.
JOHN R. GOLDBLUM, MD
Contributors
N. Volkan Adsay, MD Kenneth P. Batts, MD
Professor, Department of Pathology and Laboratory Medicine, Clinical Associate Professor, Department of Pathology,
Emory University School of Medicine; Vice-Chair and Director, University of Minnesota Medical School; Staff Pathologist,
Department of Anatomic Pathology, Emory University Hospital, Department of Laboratory Medicine and Pathology, Abbott
Atlanta, Georgia Northwestern Hospital, Minneapolis; Laboratory Director,
Benign and Malignant Tumors of the Gallbladder and Extrahepatic Minnesota Gastroenterology, Maplewood; Director of
Biliary Tract; Tumors of the Pancreas and Ampulla of Vater Gastrointestinal Pathology, Hospital Pathology Associates,
St. Paul, Minnesota
Lilian B. Antonio, MPH Autoimmune and Chronic Cholestatic Disorders of the Liver
Laboratory Supervisor, Department of Pathology, Mount Sinai
Ana E. Bennett, MD
Medical Center, New York, New York
Liver Tissue Processing and Normal Histology Staff Gastrointestinal and Liver Pathologist, Department of
Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
Donald A. Antonioli, MD Infl ammatory Disorders of the Esophagus
Professor of Pathology, Department of Pathology, Harvard Paulette Bioulac-Sage, MD
Medical School; Consultant and Senior Pathologist, Beth Israel
Professor of Medicine, Groupe de Recherche pour l’Etude du
Deaconess Medical Center; Emeritus Consultant in
Foie (GREF), University of Bordeaux 2 Faculty of Medicine;
Gastrointestinal Pathology, Children’s Hospital, Boston,
Staff Pathologist, Pellegrin Hospital and University Hospital,
Boston, Massachusetts
Bordeaux, France
Polyps of the Small Intestine
Toxic and Drug-Induced Disorders of the Liver
May R. Arroyo, MD, PhD
Elizabeth M. Brunt, MD
Assistant Professor, Department of Pathology, Immunology, and
Professor, Department of Pathology and Immunology,
Laboratory Medicine, University of Florida College of Medicine,
Washington University in St. Louis School of Medicine;
Gainesville, Florida
Staff Pathologist, Barnes-Jewish Hospital, St. Louis,
Pediatric Liver Disease and Inherited, Metabolic, and
Missouri
Developmental Disorders of the Pediatric and Adult Liver
Fatty Liver Disease
Kamran Badizadegan, MD Norman J. Carr, MBBS, FRCPath, FRCPA
Assistant Professor of Pathology and Health Sciences and Professor of Anatomical Pathology, University of Wollongong
Technology, Harvard Medical School; Assistant Pathologist in Graduate School of Medicine, Wollongong, New South Wales,
Gastrointestinal Pathology, Massachusetts General Hospital, Australia
Boston, Massachusetts Epithelial Neoplasms of the Appendix
Liver Pathology in Pregnancy
Barbara A. Centeno, MD
Charles Balabaud, MD
Professor of Pathology, Department of Oncologic Sciences,
Professor of Medicine, Groupe de Recherche pour l’Etude du University of South Florida College of Medicine; Full Member
Foie (GREF), University of Bordeaux 2 Faculty of Medicine; and Director of Cytopathology Laboratory, Department of
Staff Hepatologist, Hôpital Saint André CHU Bordeaux, Anatomic Pathology, H. Lee Moffi tt Cancer Center and
Bordeaux, France Research Institute, Tampa, Florida
Toxic and Drug-Induced Disorders of the Liver Diagnostic Cytology of the Biliary Tract and Pancreas
vii
viii CONTRIBUTORS
James M. Crawford, MD, PhD Robert M. Genta, MD, FACG, DTM&H
ASSOCIATE EDITOR Chief for Academic Aff airs, Caris Diagnostics, Inc., Irving; Staff
Professor and Chair, Department of Pathology, Immunology, Pathologist, Dallas VA Medical Center; Clinical Professor of
and Laboratory Medicine, University of Florida College of Pathology and Medicine (Gastroenterology), University of Texas
Medicine, Gainesville, Florida Southwestern Medical School, Dallas; Clinical Professor of
GI Tract Endoscopic and Tissue Processing Techniques and Normal Pathology and Medicine (Gastroenterology), Baylor College of
Histology; Gallbladder, Extrahepatic Biliary Tract, and Pancreas Medicine, Houston, Texas
Tissue Processing Techniques, and Normal Histology; Cirrhosis; Infl ammatory Disorders of the Stomach
Transplantation Pathology of the Liver; Pediatric Liver Disease and
Inherited, Metabolic, and Developmental Disorders of the Jonathan N. Glickman, MD, PhD
Pediatric and Adult Liver
Assistant Professor, Department of Pathology, Harvard Medical
School; Staff Pathologist, Brigham and Women’s Hospital;
Jason A. Daniels, MD Consultant Pathologist, Children’s Hospital Boston,
Boston, Massachusetts
Department of Pathology, Johns Hopkins University School of
Epithelial Neoplasms of the Esophagus
Medicine; Pathologist, Johns Hopkins Hospital, Baltimore,
Maryland
John R. Goldblum, MD
Infl ammatory Disorders of the Appendix
Professor of Pathology, Cleveland Clinic Lerner College of
Medicine; Chairman, Department of Anatomic Pathology,
Anthony J. Demetris, MD
Cleveland Clinic, Cleveland, Ohio
Starzl Professor of Transplant Pathology, Department of Infl ammatory Disorders of the Esophagus; Mesenchymal Tumors of
Pathology, University of Pittsburgh School of Medicine; the GI Tract
Director, Division of Transplantation Pathology, Department of
Pathology, University of Pittsburgh Medical Center, Pittsburgh, Fiona Graeme-Cook, MB, BCh
Pennsylvania
Assistant Professor, Department of Pathology, Harvard Medical
Transplantation Pathology of the liver
School; Assistant Pathologist, Massachusetts General Hospital,
Boston, Massachusetts
Theresa S. Emory, MD Neuroendocrine Tumors of the GI Tract and Appendix
Clinical Associate Professor of Pathology, East Tennessee State
University James H. Quillen College of Medicine, Johnson City, Joel K. Greenson, MD
Tennessee Professor of Pathology, University of Michigan Medical School;
Epithelial Neoplasms of the Appendix Pathologist, University of Michigan Health System, Ann Arbor,
Michigan
Infl ammatory Disorders of the Large Intestine
Francis A. Farraye, MD, MSc
Professor of Medicine, Division of Gastroenterology, Boston Elizabeth I. Harris, MD
University School of Medicine; Clinical Director, Section of
Clinical Instructor in Anatomic Pathology, Department of
Gastroenterology, Boston Medical Center, Boston,
Pathology, Vanderbilt University School of Medicine, Nashville,
Massachusetts
Tennessee
GI Tract Endoscopic and Tissue Processing Techniques and Normal
Manifestations of Immunodefi ciency in the GI Tract; Acute and
Histology; Screening and Surveillance Guidelines in
Chronic Infectious Hepatitis
Gastroenterology
Clara S. Heffess, MD
Linda D. Ferrell, MD
Chief, Endocrine Division, Department of Endocrine and
Professor and Vice Chair, Department of Pathology, University
Otorhinolaryngologic–Head & Neck Pathology, Armed Forces
of California, San Francisco, School of Medicine; Director of
Institute of Pathology, Washington, DC
Surgical Pathology, Department of Pathology, UCSF Medical
Infl ammatory, Infectious, and Other Non-neoplastic Disorders of
Center, San Francisco, California
the Pancreas
Benign and Malignant Tumors of the Liver
Jason L. Hornick, MD, PhD
Judith A. Ferry, MD
Assistant Professor, Department of Pathology, Harvard
Associate Professor, Department of Pathology, Harvard Medical Medical School; Staff Pathologist, Brigham and Women’s
School; Associate Pathologist, James Homer Wright Hospital; Consultant Pathologist, Dana-Farber Cancer
Department of Pathology, Massachusetts General Hospital, Institute; Consultant in Gastrointestinal Pathology,
Boston, Massachusetts Department of Pathology, Children’s Hospital Boston,
Lymphoid Tumors of the GI Tract, Hepatobiliary Tract, and Boston, Massachusetts
Pancreas Polyps of the Large Intestine
CONTRIBUTORS ix
Dale S. Huff, MD Gregory Y. Lauwers, MD
Associate Professor, Department of Pathology and Laboratory Associate Professor, Department of Pathology, Harvard Medical
Medicine, University of Pennsylvania School of Medicine; School; Director, Surgical Pathology and Gastrointestinal
Senior Pathologist, Th e Children’s Hospital of Philadelphia, Pathology Service, Massachusetts General Hospital, Boston,
Philadelphia, Pennsylvania Massachusetts
Congenital and Developmental Disorders of the GI Tract Infl ammatory Disorders of the Stomach; Epithelial Neoplasms of
the Stomach
Christine A. Iacobuzio-Donahue, MD, PhD
Audrey Lazenby, MD
Associate Professor of Pathology and Oncology, Department of
Professor and Interim Chair, Department of Pathology,
Pathology, Gastrointestinal/Liver Division, Johns Hopkins
University of Nebraska College of Medicine, Omaha, Nebraska
University School of Medicine; Pathologist, Johns Hopkins
Polyps of the Esophagus
Hospital, Baltimore, Maryland
Infl ammatory and Neoplastic Disorders of the Anal Canal
David N. B. Lewin, MD
Professor of Pathology, Department of Pathology, Medical
Brian C. Jacobson, MD, MPH
University of South Carolina College of Medicine, Charleston,
Assistant Professor of Medicine, Department of South Carolina
Gastroenterology, Boston University School of Medicine; Systemic Illnesses Involving the GI Tract
Associate Director of Endoscopy, Boston Medical Center,
Boston, Massachusetts
Marta Ida Minervini, MD
GI Tract Endoscopic and Tissue Processing Techniques and
Normal Histology Clinical Assistant Professor of Pathology, Department of
Pathology, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania; Chief Pathologist, Istituto
Dhanpat Jain, MD Mediterraneo per Trapianti e Terapie Ad Alta Specializzazione,
Associate Professor, Departments of Pathology and Internal Palermo, Italy
Medicine (Digestive Diseases), Yale University School of Transplantation Pathology of the Liver
Medicine; Attending Physician, Department of Pathology,
Yale–New Haven Hospital, New Haven, Connecticut Kisha A. Mitchell, MD
Neuromuscular Disorders of the GI Tract
Assistant Professor, Department of Pathology, Yale University
School of Medicine; Attending Pathologist, Yale–New Haven
Jose Jessurun, MD Hospital, New Haven, Connecticut
Vascular Disorders of the GI Tract
Professor of Pathology, Department of Laboratory Medicine
and Pathology, University of Minnesota Medical School,
Minneapolis, Minnesota Elizabeth Montgomery, MD
Infectious and Infl ammatory Disorders of the Gallbladder and Department of Pathology, Johns Hopkins University School of
Extrahepatic Biliary Tract Medicine; Director of Clinical Gastrointestinal Pathology,
Department of Pathology, Johns Hopkins Hospital, Baltimore,
Maryland
David S. Klimstra, MD
Infl ammatory Disorders of the Appendix
Professor of Pathology and Laboratory Medicine, Department
of Pathology and Laboratory Medicine, Weill Medical College
Michael A. Nalesnik, MD
of Cornell University; Attending Pathologist and Chief of
Surgical Pathology, Department of Pathology, Memorial Professor of Pathology, University of Pittsburgh School of
Sloan-Kettering Cancer Center, New York, New York Medicine; Staff Pathologist, University of Pittsburgh Medical
Benign and Malignant Tumors of the Gallbladder and Extrahepatic Center, Pittsburgh. Pennsylvania
Biliary Tract, Tumors of the Pancreas and Ampulla of Vater Transplantation Pathology of the Liver
Amy E. Noffsinger, MD
Laura W. Lamps, MD
Associate Professor, Department of Pathology, Th e University of
Professor of Pathology, University of Arkansas for Medical
Chicago Pritzker School of Medicine, Chicago, Illinois
Sciences College of Medicine, Little Rock, Arkansas
Epithelial Neoplasms of the Small Intestine
Infectious Disorders of the GI Tract; Acute and Chronic Infectious
Hepatitis
Erin Rubin Ochoa, MD, FCAP
Staff Pathologist, Division of Transplantation Pathology,
Richard H. Lash, MD
University of Pittsburgh Medical Center, Pittsburgh,
Chief Medical Offi cer, Caris Diagnostics, Inc., Irving, Texas Pennsylvania
Infl ammatory Disorders of the Stomach Transplantation Pathology of the Liver
x CONTRIBUTORS
Robert D. Odze, MD, FRCP(C) Leslie H. Sobin, MD
Associate Professor of Pathology, Harvard Medical School; Professor of Pathology, Department of Pathology, Uniformed
Chief, GI Pathology Service, Brigham and Women’s Hospital, Services University of the Health Sciences F. Edward Hébert
Boston, Massachusetts School of Medicine, Bethesda, Maryland; Chief, Division of
Infl ammatory Disorders of the Esophagus; Infl ammatory Disorders Gastrointestinal Pathology, Department of Hepatic and
of the Stomach; Infl ammatory Disorders of the Large Intestine; Gastrointestinal Pathology, Armed Forces Institute of Pathology,
Polyps of the Stomach; Polyps of the Large Intestine; Epithelial Washington, DC
Neoplasms of the Esophagus Epithelial Neoplasms of the Appendix
Stefan E. Pambuccian, MD Arief Suriawinata, MD
Associate Professor of Pathology, Department of Laboratory Assistant Professor of Pathology, Department of Pathology,
Medicine and Pathology, University of Minnesota Medical Dartmouth Medical School; Pathologist, Dartmouth-Hitchcock
School, Minneapolis, Minnesota Medical Center, Lebanon, New Hampshire
Infectious and Infl ammatory Disorders of the Gallbladder and Liver Tissue Processing and Normal Histology
Extrahepatic Biliary Tract
Swan N. Thung, MD
Martha B. Pitman, MD
Professor, Department of Pathology and Department of Gene
Associate Professor, Department of Pathology, Harvard Medical and Cell Medicine, Mount Sinai School of Medicine; Attending
School; Associate Pathologist, Massachusetts General Hospital, Pathologist, Mount Sinai Medical Center, New York, New York
Boston, Massachusetts Liver Tissue Processing and Normal Histology
Diagnostic Cytology of the Liver
Dina G. Tiniakos, MD, PhD
Arati Pratap, MD
Assistant Professor, Laboratory of Histology and Embryology,
Fellow, Section of Gastroenterology, Boston Medical Center/ Medical School, National and Kapodistrian University of
Boston University School of Medicine, Boston, Massachusetts Athens, Athens, Greece
Screening and Surveillance Guidelines in Gastroenterology Fatty Liver Disease
Parmjeet Randhawa, MD Jerrold R. Turner, MD, PhD
Professor of Pathology, University of Pittsburgh School of Professor of Pathology and Associate Chairman for Academic
Medicine; Staff Pathologist, University of Pittsburgh Medical Aff airs, Department of Pathology, Th e University of Chicago
Center, Pittsburgh, Pennsylvania Pritzker School of Medicine, Chicago, Illinois
Transplantation Pathology of the Liver Polyps of the Stomach
Mark Redston, MD Helen H. Wang, MD, DrPH
Director of GI and Molecular Diagnostics, AmeriPath Associate Professor, Department of Pathology, Harvard Medical
Northeast, Shelton, Connecticut School; Director of Cytopathology, Department of Pathology,
Epithelial Neoplasms of the Large Intestine Beth Israel Deaconess Medical Center, Boston, Massachusetts
Diagnostic Cytology of the GI Tract
Marie E. Robert,
MD
Ian R. Wanless, MD, CM, FRCPC
Associate Professor of Pathology and Internal Medicine,
Department of Pathology, Yale University School of Medicine; Professor of Pathology, Department of Pathology, Dalhousie
Director, Program in Gastrointestinal Pathology, Yale–New University Faculty of Medicine; Staff Pathologist, Department of
Haven Hospital, New Haven, Connecticut Pathology and Laboratory Medicine, Queen Elizabeth II Health
Infl ammatory Disorders of the Small Intestine Sciences Centre, Halifax, Nova Scotia, Canada
Cirrhosis; Vascular Disorders of the Liver
Pierre Russo, MD
Kay Washington, MD, PhD
Professor, Department of Pathology and Laboratory Medicine,
University of Pennsylvania School of Medicine; Director, Professor of Pathology, Vanderbilt University School of
Division of Anatomic Pathology, Department of Pathology and Medicine, Nashville, Tennessee
Laboratory Medicine, Th e Children’s Hospital of Philadelphia, Manifestations of Immunodefi ciency in the GI Tract; Acute and
Philadelphia, Pennsylvania Chronic Infectious Hepatitis
Congenital and Developmental Disorders of the GI Tract; GI Tract
Enteropathies of Infancy and Childhood Bruce M. Wenig, MD
Professor of Pathology, Albert Einstein College of Medicine,
Eizaburo Sasatomi, MD, PhD
Bronx; Chairman, Department of Pathology and Laboratory
Assistant Professor, Department of Pathology, Division of Liver Medicine, Beth Israel Medical Center, St. Luke’s-Roosevelt
and Transplantation Pathology, University of Pittsburgh School Hospitals, New York, New York
of Medicine, Pittsburgh, Pennsylvania Infl ammatory, Infectious, and Other Non-neoplastic Disorders of
Transplantation Pathology of the Liver the Pancreas
CONTRIBUTORS xi
A. Brian West, MD, FRCPath Tong Wu, MD, PhD
Professor of Pathology and Vice-Chair, Department of Associate Professor of Pathology, University of Pittsburgh
Pathology, Yale University School of Medicine; Director of School of Medicine; Staff Pathologist, University of Pittsburgh
Anatomic Pathology, Department of Pathology, Yale–New Medical Center, Pittsburgh, Pennsylvania
Haven Hospital, New Haven, Connecticut Transplantation Pathology of the Liver
Vascular Disorders of the GI Tract
Rhonda K. Yantiss, MD
Joseph Willis, MD Associate Professor of Pathology, Department of Pathology and
Associate Professor of Pathology, Case Western Reserve Laboratory Medicine, Weill Medical College of Cornell
University School of Medicine; Vice Chair of Pathology for University; Attending Physician, Department of Pathology and
Clinical Aff airs, University Hospitals Case Medical Center, Laboratory Medicine, New York–Presbyterian Hospital, New
Cleveland, Ohio York, New York
Developmental Disorders of the Gallbladder, Extrahepatic Biliary Polyps of the Small Intestine
Tract, and Pancreas
Jacqueline L. Wolf, MD
Associate Professor, Department of Medicine, Harvard Medical
School; Division of Gastroenterology, Beth Israel Deaconess
Medical Center, Boston, Massachusetts
Liver Pathology in Pregnancy
Preface
Surgical Pathology of the GI Tract, Liver, Biliary Tract, In the second edition, we have, once again, paid special
and Pancreas was originally conceived on the basis of attention to providing only the most relevant, up-to-date
our perceived need in academic surgical pathology for clinical, etiologic, and management information necessary
a textbook that includes diseases of all organs tradition- for surgical pathologists to make clinically relevant diagno-
ally considered part of the fi eld of “gastrointestinal ses. Th is continues to be a morphology-based textbook with
pathology”—the tubular gut, liver, gallbladder, biliary particular emphasis on histologic methods that can help
tract, and pancreas—all under one cover. Th e second diff erentiate diseases based on evaluation of biopsy and
edition represents a signifi cant improvement over the resection specimens. However, gastroenterologists, surgeons,
fi rst edition in many ways, outlined in the following few and residents/fellows in training may also fi nd this textbook
paragraphs: of interest because of the accent on clinical-pathologic asso-
ciations. Th e second edition is even more user friendly than
1 Overall, the book is 40% larger. For instance, fi ve new the fi rst edition, and it is organized in a method that helps
chapters have been added, and these are titled pathologists gain access to diagnostic information quickly
“Screening and Surveillance Guidelines in Gastroen- without having to waste time leafi ng through the index and
terology,” “Congenital and Developmental Disorders turning pages. Th e overall organization of the textbook
of the GI Tract,” “GI Tract Enteropathies of Infancy remains the same as in the fi rst edition: part 1 represents
and Childhood,” “Vascular Disorders of the GI Tract,” disorders of the gastrointestinal tract; part 2, the gallbladder,
and “Fatty Liver Disease.” extrahepatic biliary tract, and pancreas; and part 3, the liver.
2 Additional sections on normal histology of the GI In each part, an introductory chapter on pertinent tissue
tract, pancreatico-biliary tract, and liver have been processing techniques and normal histology, and a well-
added to chapters 1, 29, and 36, respectively. illustrated chapter on diagnostic cytology of each of the
3 Tables to outline specifi c diff erential diagnostic points major organ systems, are included. Subsequent chapters in
helpful for surgical pathologists at the level of the each section are separated into general disease categories,
microscope have been increased in number and such as systemic disorders, infl ammatory disorders, polyps,
expanded. epithelial neoplasms, and other types of neoplasms, similar
4 Th e number (and quality) of color photographs have to the method used by pathologists to evaluate tissue speci-
been increased by at least 30%. mens. In addition, the liver section is divided into chapters
5 A succinct and clinically relevant discussion of the based on major patterns of injury, recapitulating the approach
key molecular aspects of tumor progression and risk to liver biopsy assessment. Of course, all chapters were
assessment have been added to all chapters that cover written by pathologists with a special interest or expertise in
neoplastic disorders. a particular fi eld. Finally, the editors have paid careful atten-
6 An outline has been added to the beginning of all tion to providing a consistent style of writing, structure, and
chapters in order to expedite searching for specifi c content from chapter to chapter.
topics of interest. We are confi dent that the second edition represents a
7 All chapters have been updated to include the most bigger, better, and, ultimately, state-of-the-art textbook on
current references, concepts, data, and controversies. the pathology of the gastrointestinal system, liver, biliary
8 Diagnostic algorithms have been added to many tract, and pancreas that can be enjoyed by pathologists and
chapters in order to simplify the evaluation of diag- clinicians worldwide.
nostically challenging entities.
ROBERT D. ODZE, MD, FRCP(C)
9 Th e new edition includes an online version that readers
JOHN R. GOLDBLUM, MD
can access from any laptop computer, world-wide.
Acknowledgments
As in the fi rst edition, many individuals contributed greatly that, I am grateful. Similarly, Dr. Goldblum would like to
to the conception, editing, and production of this textbook. acknowledge his mentor in gastrointestinal pathology, Dr.
Th e editors are appreciative of all the technical, administra- Henry Appelman.
tive, and support staff involved in the production of this On a personal level, I would like to thank all members
textbook and, particularly, Kendra Glueck-Abramson and of my family, Pilar, and my extended family in Boston, for
Kathleen Ranney at the Brigham and Women’s Hospital their love, friendship, advice, and support in my personal
and Cleveland Clinic, respectively. We would also like to and professional endeavors. In addition, I am eternally
thank William Schmitt, Liliana Kim, and Linda Grigg for grateful and fortunate to have had the opportunity to
their patience, support, and endless dedication to helping benefi t from the inspiration and love of my late dear
us produce an excellent quality textbook, and John Alpert mother, Natasha Odze, whose courage, wisdom, and
for his book cover layout. outlook on life has always served as the basis for my own
From a professional point of view, I am greatly indebted personal and academic endeavors. My heart goes out to all
to my longtime friends and mentors Dr. Donald Antonioli, other individuals who have close family members or friends
who, unfortunately, has recently retired from academic suff ering from Alzheimer’s disease or senile dementia.
pathology and Dr. Harvey Goldman, who continues to rep- Finally, we would like to thank all of the authors of the
resent a pillar of knowledge in GI pathology. Th eir contin- second edition for their excellent contributions and for the
ued support and helpful advice during the long and patience required to labor through the editorial process.
sometimes tedious process of creating a textbook was very We are particularly grateful to Dr. James Crawford for his
much appreciated. As all academic pathologists realize, role as Associate Editor of this textbook.
creating a textbook of this magnitude requires a great deal
ROBERT D. ODZE, MD, FRCP(C)
of time and support, which was provided to me initially by
JOHN R. GOLDBLUM, MD
Dr. Ramsy Cotran and later by Dr. Michael Gimbrone. For