Tadrous P.J. Diagnostic criteria handbook in histopathology: a surgical pathology vade mecum
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Diagnostic Criteria Handbook
in
HISTOPATHOLOGY
i
Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum. Paul J. Tadrous
Copyright
C
2007 by John Wiley & Sons, Ltd. ISBN: 978-0-470-51903-5
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Diagnostic Criteria Handbook
in
HISTOPATHOLOGY
A Surgical Pathology Vade Mecum
by
Paul J. Tadrous
MB BS MSc PhD MRCPath
Histopathology Unit, CRUK, London, UK
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Copyright
C
2007 John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester,
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Library of Congress Cataloging-in-Publication Data:
Tadrous, Paul Joseph.
Diagnostic criteria handbook in histopathology : a surgical pathology vade mecum / by Paul J. Tadrous.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-470-51903-5 (alk. paper)
1. Histology, Pathological–Handbooks, manuals, etc. 2. Pathology, Surgical–Handbooks, manuals, etc.
3. Diagnosis, Surgical–Handbooks, manuals, etc. 4. Histology, Pathological–Examinations, questions, etc.
5. Pathology, Surgical–Examinations, questions, etc. 6. Diagnosis, Surgical–Examinations, questionss, etc.
I. Title. [DNLM: 1. Diagnosis, Differential–Handbooks. 2. Pathology, Surgical–methods–Handbooks.
3. Histological Techniques–methods–Handbooks. WO 39 T122d 2007]
RB30.T33 2007
616.07
583–dc22 2007024036
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 978-0-470-51903-5 (HB)
ISBN 978-0-470-77096-2 (HB Custom)
Typeset in 10/12 in Times New Roman by Aptara Inc., New Delhi, India
Printed and bound in Great Britain by Antony Rowe Ltd, Chippenham, Wiltshire.
This book is printed on acid-free paper responsibly manufactured from sustainable forestry in which at least two
trees are planted for each one used for paper production.
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Disclaimer
While every effort has been made to ensure the information in this book is accurate and timely, there is
always the possibility that errors have been made or that medical opinion has changed since the time of
writing. The author cannot accept any liability for damages of any kind resulting from the use of information
received from this book.
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Dedication
I dedicate this book to the memory of my father, Mr Joseph Zaki Tadrous, who sadly passed away at the
age of 84 in March 2007.
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Contents
PREFACE ix
ACKNOWLEDGEMENTS xi
ABBREVIATIONS AND SYMBOLS xiii
GENERAL BIBLIOGRAPHY AND SUGGESTED READING xxiv
INDEX TO GRADING AND CLASSIFICATION SYSTEMS xxv
FROZEN SECTION INDEX xxvi
READER’S INDEX xxvi
1. ADVICE FOR EXAM CANDIDATES 1
2. HISTOLOGICAL TECHNIQUES 6
3. LABORATORY MANAGEMENT 22
4. CUT-UP AND REPORTING GUIDELINES 36
5. PAEDIATRIC AND PLACENTAL 56
6. VASCULAR 68
7. HEART 75
8. RESPIRATORY AND MEDIASTINUM 81
9. BONE MARROW 99
10. LYMPHORETICULAR 107
11. ALIMENTARY TRACT 126
12. LIVER, BILIARY TRACT AND PANCREAS 156
13. CENTRAL NERVOUS SYSTEM AND SKELETAL MUSCLE 181
14. EYE AND EAR 193
15. RENAL MEDICINE 201
16. UROLOGICAL 211
17. GYNAECOLOGICAL 232
18. BREAST 258
19. ENDOCRINE 267
20. SKIN 281
21. SOFT TISSUES 309
22. OSTEOARTICULAR 329
23. INFECTION AND IMMUNITY 343
24. CYTOPATHOLOGY 353
25. AUTOPSY 377
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contents viii
INDEX OF GENERAL TERMS 395
INDEX OF MOLECULES 416
INDEX OF EPONYMS 420
Please note that full-colour versions of all figures within Chapter 4, and also figures 5.3, 8.1, 11.3, 14.1,
16.1, 17.1 and 23.1 can be found in the colour plate section of this book
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Preface
This book presents criteria for histopathological diagnosis in list form for rapid access. It covers diagnostic
surgical pathology, cytology, autopsy practice, histological technique, lab management, RCPath guidance
and UK Law relevant to histopathology. Trainees and consultants in diagnostic practice and those needing
a quick refresher in preparation for professional exams (such as the MRCPath) should find this book a
useful companion.
While at the microscope, the pathologist will often be able to suggest a limited list of conditions
in the differential and may need a reminder of the diagnostic criteria of those conditions in order to decide
on the preferred option. One may go to a standard diagnostic text for this purpose but there is almost
invariably a lengthy few paragraphs of prose to read in order to glean the required morphological points.
These words are not wasteful when learning about a condition for the first time as one needs a substantial
background of information to appreciate the condition in its context.
However, most pathologists will have already read a full account of most conditions and just need
to be reminded of the major points for diagnosis. These points are what this book aims to provide as an aid
to rapid acquisition of diagnostic criteria and salient information on management, Law and technique. It is
not intended as an initial source text and is not a substitute for reading a full account in specialist reference
texts. This is not a comprehensive account of pathology – no attempt is made to cover very basic material
and some of the rarer entities are pointed to via references. This book focuses on:
r
diagnostic criteria for each condition;
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immuno profiles of normal cells, tissues and pathological entities where this is helpful;
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criteria for malignancy in otherwise benign lesions e.g. what makes a malignant SFT? What are the
criteria for malignancy in a pilomatricoma? When should you be worried with an ameloblastoma and
when does MGUS become myeloma?
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differential diagnoses with notes on distinguishing features e.g. how do you distinguish Kaposi’s sar-
coma from Kaposiform haemangioendothelioma or mucoepidermoid carcinoma from adenosquamous
carcinoma or epithelioid haemangioendothelioma from epithelioid angiosarcoma or an atypical ade-
nomatous hepatocellular nodule from hepatocellular carcinoma?
r
definition of terms and quantities needed for diagnosis. For example, what are the size and mitotic
count criteria for placing GISTs into malignancy risk categories? What is the definition of vertical and
radial growth phases for melanoma? What constitutes an inadequate cervical smear? How big must
a focus of atypical adenomatous hyperplasia be before it is considered bronchioalveolar carcinoma?
What makes a lymph node metastasis a micrometastasis and how does this differ from ‘isolated tumour
cells present’? Many of these have important management implications;
r
grading, scoring, classification and staging criteria for tumours and non-neoplastic conditions (e.g.
transplant rejection, hepatitis, ER and PgR receptor status, spermatogenesis, etc.). No attempt has been
made to reproduce the TNM staging system as the UICC book is an excellent handy reference which all
pathologists working with tumours should have. Some aspects of TNM have, however been included
in this book where it emphasises certain practical points (e.g. in Chapter 4: Cut-Up and Reporting
Guidelines). A separate Grading Index page is provided for rapid access to the various schemes (see
page xxv);
r
dating criteria for endometria, myocardial infarction, thrombi and villi (following intra-uterine death);
r
normal values and ranges e.g. for PM weights, placental weights, weight ratios, mitotic counts, etc;
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laboratory methods are covered from a pathologist’s perspective;
r
laboratory management (health and safety, UK legislation and government initiatives, budgetary con-
trol, Clinical Governance, etc.) and summary guidance from the RCPath National Datasets for Re-
porting Cancers, cut-up, autopsy practice and reporting major types of specimen together with handy
anatomical diagrams;
r
frozen section diagnosis –a separate ‘Frozen Section Index’ (see page xxvi) points to advice for per-
operative diagnosis in all the chapters for rapid access to this information;
r
mnemonics and general advice in exam technique are offered for MRCPath exam candidates.
This book bridges the gap between specialist diagnostic texts (with their reams of context) and study
books for trainees (with their reams of aetiology, pathogenesis and molecules) by presenting diagnostic
information in practical detail – but without the padding.
PJT, London, 2007
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Acknowledgements
The support of the Pathological Society of Great Britain and Ireland in helping to get this book to press is
gratefully acknowledged. I would like to thank all my colleagues, both junior and senior, who contributed
to this book by answering my queries and by giving me questions to answer. A special thanks to all the
pathologists who answered my specific questions regarding topics in their own field while I was researching
this book – this was often in response to queries I had over individual patient’s cases as well as specifically
for the book. They include (in alphabetical order – and apologies for anyone I may have missed): Dr
Emyr Wyn Benbow, Dr Ashish Chandra, Prof H. Terry Cook, Prof Amar P. Dhillon, Prof Cyril Fisher,
Prof Andrew M. Hanby, Prof Alec J. Howie, Prof Stefan G. H¨ubscher, Prof G¨unter Kl¨oppel, Dr Jay H.
Lefkowitch, Dr Iain Lindsay, Dr Neil J. Sebire, Prof Neil A. Shepherd, Prof Sami Shousha, Prof Ian C.
Talbot, Prof Rosemary A. Walker and Prof Clive A. Wells. Thanks are also due to Dr Caroline Brodie who
proofread early drafts of some of the chapters and gave helpful feedback. Thanks also to all those who made
their libraries and collections available to me, including Dr Ann Sandison, Dr Josephine Wyatt-Ashmead,
Dr Neil J. Sebire, Dr Alan W. Bates, Dr Michael T. Sheaff, Dr Malcolm Galloway and Dr Juan Piris. Finally,
I would like to thank all the staff at John Wiley & Sons for their helpfulness and skill in taking this book
from manuscript to press.
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