Pathology First, second and third edition authors: Bethan Goodman Jones Daniel J O’Connor Atul Anand Commissioning Editor: Jeremy Bowes Development Editor: Ewan Halley Project Manager: Andrew Riley Designer/Design Direction: Stewart Larking Illustration Manager: Jennifer Rose Icon Illustrations: Geo Parkin 4 th Edition CRASH COURSE SERIES EDITOR Dan Horton-Szar BSc(Hons), MBBS(Hons), MRCGP Northgate Medical Practice Canterbury Kent, UK FACULTY ADVISOR Sebastian Lucas BA, BM BCh (Oxon), FRCP, FRCPath Department of Histopathology King’s College London School of Medicine London, UK Pathology Philip Xiu BA (Cantab) Hons Medical Student University of Cambridge Cambridge, UK Edinburgh London New York Oxford Philadel p hia St Louis Sydney Toronto 2012 © 2012 Elsevier Ltd. All rights reserved. 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First edition 1999 Second edition 2002 Third edition 2007 Fourth edition 2012 ISBN 978 0 7234 3619 5 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. 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The Publisher's policy is to use paper manufactured from sustainable forests Printed in China Series editor foreword The Crash Course series was first published in 1997 and now, 15 years on, we are still going strong. Medicine never stands still, and the work of keeping this series relevant for today’s students is an ongoing process. These fourth editions build on the success of the previous titles and incorporate new and revised material, to keep the series up-to-date with current guidelines for best practice, and recent developments in medical research and pharmacology. We always listen to feedback from our readers, through focus groups and student reviews of the Crash Course titles. For the fourth editions we have completely re-written our self-assessment material to keep up with today’s ‘single-best answer’ and ‘extended matching question’ formats. The artwork and layout of the titles has also been largely re-worked to make it easier on the eye during long sessions of revision. Despite fully revising the books with each edition, we hold fast to the principles on which we first developed the series. Crash Course will always bring you all the information you need to revise in compact, manageable volumes that integrate basic medical science and clinical practice. The books still maintain the balance between clarity and conciseness, and provide sufficient depth for those aiming at distinction. The authors are medical students and junior doctors who have recent experience of the exams you are now facing, and the accuracy of the material is checked by a team of faculty advisors from across the UK. I wish you all the best for your future careers! Dr Dan Horton-Szar v Prefaces Author My predecessor, Prof Rosemary Walker did an excellent job in steering this incredibly comprehensive short text through several editions, providing a very good background to all aspects of pathology and their relevance to clinical medicine. Reflecting this Advisor’s special interest, the text has been further revised and updated in several areas where there is progress, confusion and complexity: pregnancy-associated diseases, sickle cell disease, HIV and AIDS, leprosy, systemic sepsis, and infectious diseases in general. The classical areas of cancer and circulatory diseases have also been discretely amended to reflect current thinking where it matters. If all medical students knew most of what is in this text, with its appropriate organisation of knowledge, teachers could sleep more easily and the quality of diagnostic problem-solving among young doctors would be significantly improved. It will certainly help you in all aspects of your medical course. Special thanks and acknowledgement should also go to Philip Xiu for his work on the new edition. Philip Xiu Faculty advisor My predecessor, Prof Rosemary Walker did an excellent job in steering this incredibly comprehensive short text through several editions, providing a very good background to all aspects of pathology and their relevance to clinical medicine. Reflecting this Advisor’s special interest, the text has been further revised and updated in several areas where there is progress, confusion and complexity: pregnancy-associated diseases, sickle cell disease, HIV and AIDS, leprosy, systemic sepsis, and infectious diseases in general. The classical areas of cancer and circulatory diseases have also been discretely amended to reflect current thinking where it matters. If all medical students knew most of what is in this text, with its appropriate organisation of knowledge, teachers could sleep more easily and the quality of diagnostic problem-solving among young doctors would be significantly improved. It will certainly help you in all aspects of your medical course. Special thanks and acknowledgement should also go to Philip Xiu for his work on the new edition. Sebastian Lucas vi Acknowledgements I would like to thank everyone who has helped during the writing of this book. I am grateful to the numerous friends who provided moral support and accepted having ideas thrown at them. Particular mentions must go to Kent Yip, Adam Young, Kevin McCarthy, Kari Schaitel, Oscar Bennett, Tom Clare, Saurabh Singh, Ben Pierce and Sarah Mason. Finally I wish to thank the very helpful people involved in the production of this book, both in Edinburgh and Oxford. Figure Acknowledgements Figs 3.3, 3.4, 3.6, 3.7, 6.21, 7.18, 11.2 and 13.23 and Fig. 5.15 are adapted with permission from General and Systematic Pathology, 5 th Edition, edited by JCE Underwood. Churchill Livingstone, Edinburgh, 2009. Figs 5.6 and 5.8 are adapted with permission from Anderson’s Pathology, 10th edition, edited by I Damjanov and J Linder. Mosby, St.Louis, 1996. Fig. 10.2 and Figs 5.11 and 7.8 are adapted with permission from medicshandbook. com, 2011. Fig. 6.16 is adapted with permission from Robbins and Cotran, Pathologic Basis of Disease, 7th edition, edited by V Kumar, A Abbas, and N Fausto. Elsevier Saunders, Philadelphia, 2005. Fig. 8.20 is adapted with permission from Clinical Medicine, 7th edition, edited by P Kumar and M Clark., Elsevier, London, 2009. Fig. 8.37 is adapted with permission from Principles and Practice of Surgery, 3rd edition, edited by APM Forrest, DC Carter and IB Macleod. Churchill Livingstone, Edinburgh, 1995. Fig. 8.40 is adapted with permission from Lecture Notes in General Surgery, 12th edn, by H Ellis, Wiley-Blackwell, 2010. Fig. 11.14 is adapted with permission from Lecture Notes on Urology, 5th edition, by J Blandy. Blackwell Scientific, Oxford, 1998. Fig. 13.4 is adapted with permission from Lecture Notes in Paediatrics, 8th Edition, by S Newell. Wiley-Blackwell, 2010. Fig. 13.14 is adapted with permission from Essential Haematology, 5th edition, by AV Hoffbrand and JE Pettit. Wiley-Blackwell, Oxford, 2006. Figs 13.30 and 13.31 are adapted with permission from Pathology Illustrated, 6th edition, by R Reid and F Roberts. Churchill Livingstone, Edinburgh, 2005. vii Dedication To Mum, Dad and Jane viii Contents Series editor foreword . . . . . . . . . . . . . . . v Prefaces . . . . . . . . . . . . . . . . . . . . . . vi Acknowledgements . . . . . . . . . . . . . . . . . vii Dedication . . . . . . . . . . . . . . . . . . . . viii Part I: Principles of pathology 1. Introduction to pathology . . . . . . . . . 1 Diseases . . . . . . . . . . . . . . . . . . 1 Pathology . . . . . . . . . . . . . . . . . 1 How pathology is covered in this book . . . 2 2. Inflammation, repair and cell death . . . . . 3 Inflammation . . . . . . . . . . . . . . . 3 Acute inflammation . . . . . . . . . . . . 3 Chemical mediators of inflammation. . . . . 5 Chronic inflammation . . . . . . . . . . . 8 Cell death . . . . . . . . . . . . . . . . 10 3. Cancer . . . . . . . . . . . . . . . . . 15 Definitions and nomenclature . . . . . . . 15 Molecular basis of cancer . . . . . . . . . 18 Tumour growth and spread . . . . . . . . 19 Carcinogenic agents . . . . . . . . . . . 22 Host defences against cancer . . . . . . . 24 Clinical cancer pathology . . . . . . . . . 25 4. Infectious disease . . . . . . . . . . . . 27 General principles of infection. . . . . . . 27 Categories of infectious agent. . . . . . . 28 Mechanisms of pathogenicity . . . . . . . 32 Sepsis . . . . . . . . . . . . . . . . . . 35 Inflammatory responses to infection . . . . 36 Part II: Systemic pathology 5. Pathology of the nervous system . . . . . 37 Disorders of the central nervous system . . 37 Disorders of the peripheral nervous system. 50 Disorders of the autonomic nervous system 53 6. Pathology of the cardiovascular system . . 55 Congenital abnormalities of the heart . . . 55 Atherosclerosis, hypertension and thrombosis . . . . . . . . . . . . . . . 60 Ischaemic heart disease and heart failure. . 68 Disorders of the heart valves . . . . . . . 72 Diseases of the myocardium . . . . . . . 76 Diseases of the pericardium . . . . . . . . 77 Aneurysms . . . . . . . . . . . . . . . 79 Inflammatory and neoplastic vascular disease . . . . . . . . . . . . . . . . . 81 Diseases of the veins and lymphatics . . . 84 7. Pathology of the respiratory system. . . . 87 Disorders of the upper respiratory tract . . 87 Disorders of the lungs . . . . . . . . . . 89 Infections of the lungs . . . . . . . . . . 98 Neoplastic diseases of the lungs . . . . . . 104 Diseases of vascular origin . . . . . . . . 108 Diseases of iatrogenic origin . . . . . . . 111 Disorders of the pleura . . . . . . . . . . 111 8. Pathology of the gastrointestinal system 115 Disorders of the upper gastrointestinal tract . . . . . . . . . . . . . . . . . . 115 Disorders of the stomach . . . . . . . . . 119 General aspects of hepatic damage . . . . 124 Disorders of the liver and biliary tract . . . 129 Disorders of the exocrine pancreas . . . . 140 Disorders of the intestine . . . . . . . . . 142 Disorders of the peritoneum . . . . . . . 156 9. Pathology of the kidney and urinary tract . . . . . . . . . . . . . . . . . . 159 Abnormalities of kidney structure . . . . . 159 Diseases of the glomerulus . . . . . . . . 161 Glomerular lesions in systemic disease . . . 168 Diseases of the tubules and interstitium . . 169 Diseases of the renal blood vessels . . . . 171 Neoplastic disease of the kidney. . . . . . 174 Disorders of the urinary tract . . . . . . . 175 ix [...]... 329 PART I PRINCIPLES OF PATHOLOGY 1 Introduction to pathology 1 3 2 Inflammation, repair and cell death 3 Cancer 15 27 4 Infectious disease Intentionally left as blank Introduction to pathology 1 Objectives In this chapter, you will learn to: • Define ‘disease’ • Define pathology • Understand the divisions of pathology • Understand the... environment PATHOLOGY Pathology is the scientific study of disease It is concerned with the causes and effects of disease, and the functional and structural changes that occur Changes at the molecular and cellular level correlate with the clinical manifestations of the disease Understanding the processes of disease assists in the accurate recognition, diagnosis and treatment of diseases Divisions of pathology. .. diagnosis and treatment of diseases Divisions of pathology Pathology is traditionally subdivided into five main clinical disciplines: 1 Histopathology—the study of histological abnormalities of diseased cells and tissues 2 Haematology—the study of primary diseases of the blood and the secondary effects of other diseases on the blood 3 Chemical pathology the study of biochemical abnormalities associated... natural history of the disease HOW PATHOLOGY IS COVERED IN THIS BOOK Part I: Principles of pathology A limited number of tissue responses underlie all diseases These responses are known as basic pathological responses The first part of this book describes the 2 principles of these in relation to our advancing knowledge of the molecular sciences Part II: Systematic pathology As well as an understanding... of the prostate 201 204 208 210 214 217 217 220 12 Pathology of the musculoskeletal system 223 Disorders of bone structure Infections and trauma Tumours of the bones Disorders of the neuromuscular Myopathies Arthropathies x junction 223 226 228 230 231 233 13 Pathology of the blood and immune systems 243 Autoimmune... of white blood cells Disorders of the spleen and thymus Disorders of red blood cells Disorders of haemostasis 243 250 251 261 263 273 14 Pathology of the skin 279 Terminology of skin pathology Inflammation and skin eruptions Infections and infestations Disorders of specific skin structures Disorders of pigmentation Blistering disorders ...Contents 10 Pathology of the endocrine system 179 Disorders of the pituitary Thyroid disorders Parathyroid disorders Disorders of the adrenal gland Disorders of the endocrine pancreas Multiple endocrine neoplasia syndromes 179 183 189 191 195 199 11 Pathology of the reproductive system 201 Disorders... responses, it is also necessary to understand how they affect individual tissues and organs The second part of this book describes the common pathology of the specific diseases as they affect individual organs or organ systems This approach is termed systematic pathology, and it is illustrated by clinical examples of disease Inflammation, repair and cell death 2 Objectives In this chapter, you will... other diseases on the blood 3 Chemical pathology the study of biochemical abnormalities associated with disease 4 Microbiology—the study of infectious diseases and the organisms that cause them 5 Immunopathology—the study of diseases through the analysis of immune function © 2012 Elsevier Ltd Congenital Congenital causes can be either genetic (e.g cystic fibrosis) or non-genetic (e.g thalidomide anomalies)... However, many, if not most, diseases are due to a combination of causes, and they are, therefore, said to have a multifactorial aetiology Figure 1.1 illustrates the features of disease 1 Introduction to pathology Fig 1.1 Characteristics of disease Characteristic Explanation Definition A clear, concise and accurate description Incidence Number of new cases of disease occurring in a population of a defined . I: Principles of pathology 1. Introduction to pathology . . . . . . . . . 1 Diseases . . . . . . . . . . . . . . . . . . 1 Pathology . . . . . . . . . . . . . . . . . 1 How pathology is covered. I PRINCIPLES OF PATHOLOGY 1. Introduction to pathology 1 2. Inflammation, repair and cell death 3 3. Cancer 15 4. Infectious disease 27 Intentionally left as blank Introduction to pathology 1 Objectives In. diagnosis and treatment of diseases. Divisions of pathology Pathology is traditionally subdivided into five main clinical disciplines: 1. Histopathology—the study of histological abnor- malities