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Section I: GENERAL PATHOLOGY

Chapter 1: Introduction to Pathology 1 Study of Pathology, 1: Health and Disease, 1; Common Terms in Pathology, 1 Evolution of Pathology, 2: Prehistoric Times to Medieval Period, 2; Human Anatomy and Era of Gross Pathology, 3; Era of Technology Development and Cellular Pathology, 4; Modern Pathology, 6; Telepathology and Virtual Microscopy, 7

Subdivisions of Pathology, 7: Morphological Branches, 7; Non-Morphological Branches, 8

Chapter 2: Cell Injury, Cellular Adaptations and Cellular Ageing 9 Cell Injury, 9: Etiology of Cell Injury, 9; Pathogenesis of Cell Injury, 10; Morphology of Reversible Cell Injury, 17; Intracellular Accumulations, 19; Pigments, 22; Morphology of Irreversible Cell Injury (Cell Death), 26; Changes after Cell Death, 32

Adaptive Disorders, 37: Atrophy, 37; Hypertrophy, 38; Hyperplasia, 39; Metaplasia, 39; Dysplasia, 41 Ageing, 42: Theories of Ageing, 42; Organ Changes in Ageing, 43

Chapter 3: Immunopathology Including Amyloidosis 44 The Immune System, 44: Organs and Cells of Immune System, 44; Cytokines, 48; HLA System and Major Histocompatibility Complex, 48; Transplant Rejection, 49

Diseases of Immunity, 50: Acquired Immunodeficiency Syndrome (AIDS), 51; Hypersensitivity Reactions (Immunologic Tissue Injury), 57; Autoimmune Diseases, 61

Amyloidosis, 66: Physical and Chemical Nature of Amyloid, 67; Pathogenesis of Amyloidosis, 69; Classification of Amyloidosis, 70; Staining Characteristics of Amyloid, 72; Diagnosis of Amyloidosis, 73; Morphologic Features of Amyloidosis of Organs, 73; Prognosis of Amyloidosis, 75

Chapter 4: Derangements of Homeostasis and Haemodynamics 78 Homeostasis, 78: Normal Water and Electrolyte Balance (Gibbs-Donnan Equilibrium), 79; Acid-Base Balance, 79; Pressure Gradients and Fluid Exchanges, 79

Disturbances of Body Water, 80: Oedema, 80; Dehydration, 87; Overhydration, 87 Disturbances of Electrolytes and pH of Blood, 88: Acid Base Imbalance, 89 Haemodynamic Derangements, 89: Disturbances in the Volume of Circulating Blood, 90; Circulatory Disturbances of Obstructive Nature, 99

Chapter 5: Inflammation and Healing 116 Acute Inflammation, 116: Acute Inflammatory Response, 116; Mediators of Inflammation, 122; Regulation of Inflammation, 127; The Inflammatory Cells, 128; Acute Inflammation—Factors, Morphology, Effects, Fate, 131

Chronic Inflammation, 134: Granulomatous Inflammation, 135; Examples of Granulomatous Inflammation, 137

Healing, 155: Regeneration and Repair, 155; Healing of Skin Wounds, 158; Healing in Specialised Tissues, 161; Stem Cell Concept of Healing—Regenerative Medicine, 163

Chapter 6: Infectious and Parasitic Diseases 165 Diseases Caused by Bacteria, Spirochaetes and Mycobacteria, 167: Plague, 167; Anthrax, 168; Whooping Cough (Pertussis), 169; Donovanosis, 170; Lymphogranuloma  Venereum, 170; Cat-Scratch Disease, 170; Staphylococcal Infections, 170; Streptococcal Infections, 171; Clostridial Diseases, 172

Diseases Caused by Fungi, 173: Mycetoma, 173; Candidiasis, 173; Cutaneous Superficial Mycosis, 174 Diseases Caused by Viruses, 174: Viral Haemorrhagic Fevers, 175; Influenza Virus Infections, 176; Varicella Zoster Virus Infection, 177; Herpes Simplex Virus Infection, 177; Rabies, 178

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xii Diseases Caused by Parasites, 178: Amoebiasis, 178; Malaria, 179; Filariasis, 180; Cysticercosis, 181 Torch Complex, 182:

Chapter 7: Neoplasia 184 Nomenclature and Classification, 184 Characteristics of Tumours, 186 I.  Rate of Growth, 186; II.  Cancer Phenotype and Stem Cells, 188; III.  Clinical and Gross Features, 188; IV.  Microscopic Features, 188; V. Spread of Tumours, 192; Grading and Staging of Cancer, 197

Epidemiology and Molecular Pathogenesis of Cancer, 197: Epidemiologic Factors, 198; Molecular Basis of Cancer, 201

Carcinogens and Carcinogenesis, 209: A. Chemical Carcinogenesis, 210; B. Physical Carcinogenesis, 214; C. Biologic Carcinogenesis, 216

Clinical Aspects of Neoplasia, 222: Host Response against Tumour (Tumour Immunology), 222; Effect of Tumour on Host, 224; Pathologic Diagnosis of Cancer, 226

Chapter 8: Environmental and Nutritional Diseases 231 Environmental Diseases, 231: Environmental Pollution, 231; Chemical and Drug Injury, 233; Injury by Physical Agents, 237

Nutritional Diseases, 238: Obesity, 238; Starvation, 240; Protein-Energy Malnutrition, 240; Metals and Trace Elements, 240; Disorders of Vitamins, 241; Diet and Cancer, 249

Chapter 9: Genetic and Paediatric Diseases 251 Genetic Diseases, 251: Developmental Defects, 251; Cytogenetic (Karyotypic) Abnormalities, 252; Single-Gene Defects (Mendelian Disorders), 254; Multifactorial Inheritance, 256; Storage Diseases (Inborn Errors of Metabolism), 256

Other Paediatric Diseases, 258: Tumours of Infancy and Childhood, 259

Section II: HAEMATOLOGY AND LYMPHORETICULAR TISSUES

Chapter 10: Introduction to Haematopoietic System and Disorders of Erythroid Series 261

Bone Marrow and Haematopoiesis, 261: Haematopoietic Organs, 261; Haematopoietic Stem Cells, 262; Bone Marrow Examination, 262

Erythropoiesis, 264: Erythropoietin, 264; Erythroid Series, 265; The Red Cell, 265; Nutritional Requirements for Erythro poiesis, 266

Anaemia—General Considerations, 268: General Clinical Features, 268; General Scheme of Investigations of Anaemia, 269; Classification of Anaemias, 271

Hypochromic Anaemias, 272: Iron Deficiency Anaemia, 272; Sideroblastic Anaemia, 277; Anaemia of Chronic Disorders, 278

Megaloblastic Anaemias—Vitamin B12 and Folate Deficiency, 280: Megaloblastic Anaemia, 280; Pernicious Anaemia, 285

Haemolytic Anaemias and Anaemia due to Blood Loss, 286: General Aspects, 287; I. Acquired Haemolytic Anaemias, 288; II. Hereditary Haemolytic Anaemias, 291; Anaemia of Blood Loss, 301

Aplastic Anaemia and Other Primary Bone Marrow Disorders, 301: Aplastic Anaemia, 301; Myelophthisic Anaemia, 303; Pure Red Cell Aplasia, 303

Chapter 11: Disorders of Platelets, Bleeding Disorders and Basic Transfusion Medicine 305

Disorders of Platelets, 305: Investigations of Haemostatic Function, 306 Bleeding Disorders (Haemorrhagic Diathesis), 309: Haemorrhagic Diatheses due to Vascular Disorders, 309; Haemorrhagic Diatheses due to Platelet Disorders, 310; Coagulation Disorders, 313; Other Bleeding and Coagulation Disorders, 315

Blood Groups and Blood Transfusion, 317: Blood Transfusion, 318; Haemolytic Disease of Newborn, 319

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xiiiChapter 12: Disorders of Leucocytes and Lymphoreticular Tissues 321 Lymph Nodes: Normal and Reactive, 321: Reactive Lymphadenitis, 322 White Blood Cells: Normal and Reactive, 324: Granulopoiesis, 324; Lymphopoiesis, 326; Mature Leucocytes in Health and Reactive Proliferation in Disease, 326; Infectious Mononucleosis, 329; Leukaemoid Reactions, 331

Lymphohaematopoietic Malignancies (Leukaemias-Lymphomas): General, 333: Etiology of Lymphohaematopoietic Malignancies, 334; Pathogenesis, 334

Myeloid Neoplasms, 335: Myeloproliferative Diseases, 335; Acute Myeloid Leukaemia, 340; Myelodysplastic Syndromes, 343

Lymphoid Neoplasms: General, 344: Common to ALL Lymphoid Malignancies, 347 Hodgkin’s Disease, 348 Non-Hodgkin’s Lymphomas-Leukaemias, 352: Precursor (Immature) B- and T-Cell Leukaemia/Lymphoma, 353; Peripheral (Mature) B-Cell Malignancies, 355; Peripheral (Mature) T-Cell Malignancies, 359; Staging of NHL, 360; Lymph Node Metastatic Tumours, 360

Plasma Cell Disorders, 360 Histiocytic Neoplasms: Langerhans Cell Histiocytosis, 365 Spleen, 366: Splenic Enlargement and Effects on Function, 367 Thymus, 368: Structural and Functional Changes in Thymus, 369

Section III: SYSTEMIC PATHOLOGY

Chapter 13: The Blood Vessels and Lymphatics 370 Normal Structure, 370 Arteriosclerosis, 371: Senile Arteriosclerosis, 371; Hypertensive Arteriolosclerosis, 371; Mönckeberg’s Arteriosclerosis (Medial Calcific Sclerosis), 372; Atherosclerosis, 373

Vasculitis, 381: I. Infectious Arteritis, 381; II. Non-Infectious Arteritis, 382 Aneurysms, 386 Common Diseases of Veins, 389 Diseases of Lymphatics, 390 Tumours and Tumour-like Lesions, 391: A. Benign Tumours and Hamartomas, 391; B. Intermediate Grade Tumours, 394; C. Malignant  Tumours, 394

Chapter 14: The Heart 397 Normal Structure and Classification, 397 Heart Failure, 399: Etiology, 399; Types of Heart Failure, 399; Compensatory Mechanisms: Cardiac Hypertrophy and Dilatation, 400

Congenital Heart Disease, 402: I.  Malpositions of the Heart, 403; II. Shunts (Cyanotic Congenital Heart Disease), 403; III. Obstructions (Obstructive Congenital Heart Disease), 406

Ischaemic Heart Disease, 407: Etiopathogenesis, 407; Effects of Myocardial Ischaemia, 408 Hypertensive Heart Disease, 417 Cor Pulmonale, 418 Rheumatic Fever and Rheumatic Heart Disease, 418 Non-Rheumatic Endocarditis, 424: Atypical Verrucous (Libman-Sacks) Endocarditis, 424; Non-Bacterial Thrombotic (Cachectic, Marantic) Endocarditis, 425; Infective (Bacterial) Endocarditis, 425

Valvular Diseases and Deformities, 429 Myocardial Diseases, 432: Myocarditis, 432; Cardiomyopathy, 434 Pericardial Diseases, 437: Pericardial Fluid Accumulations, 437; Pericarditis, 437 Tumours of the Heart, 439 Pathology of Cardiovascular Interventions, 440

Chapter 15: The Respiratory System 442 Normal Structure of Lungs, 442 Paediatric Lung Disease, 443 Pulmonary Vascular Disease, 446 Pulmonary Infections, 448: Pneumonias, 448; Lung Abscess, 457; Pulmonary Tuberculosis, 457 Chronic Obstructive Pulmonary Disease, 458: Chronic Bronchitis, 458; Emphysema, 459; Bronchial Asthma, 463; Bronchiectasis, 465; Small Airways Disease, 466

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xiv Chronic Restrictive Pulmonary Disease, 467: Pneumoconioses, 467; ILDs Associated with Immunologic Lung Diseases, 474; ILDs Associated with Connective Tissue Diseases, 475; Idiopathic Pulmonary Fibrosis, 476; ILDs Associated with Smoking, 476

Tumours of Lungs, 477: Bronchogenic Carcinoma, 477; Bronchial Carcinoid and Other Neuroendocrine Tumours, 483; Hamartoma, 484; Metastatic Lung Tumours, 484

Diseases of Pleura, 485: Inflammations, 485; Non-Inflammatory Pleural Effusions, 485; Pneumothorax, 485; Tumours of Pleura, 486; Secondary Pleural Tumours, 487

Chapter 16: The Eye, ENT and Neck 488 Eye, 488: Congenital Lesions, 488; Inflammatory Conditions, 489; Vascular Lesions, 489; Miscellaneous Conditions, 491; Tumours and Tumour-like Lesions, 492

Ear, 495: Inflammatory and Miscellaneous Lesions, 495; Tumours and Tumour-Like Lesions, 495 Nose and Paranasal Sinuses, 496: Inflammatory Conditions, 496; Tumours, 498 Pharynx, 499: Inflammatory Conditions, 499; Tumours, 499 Larynx, 500: Inflammatory Conditions, 500; Tumours, 500 Neck, 501: Cysts of Neck, 502; Tumours, 502

Chapter 17: The Oral Cavity and Salivary Glands 504 Oral Soft Tissues, 504: Developmental Anomalies, 504; Mucocutaneous Lesions, 504; Inflammatory and Pigmentary Diseases, 504; Tumours and Tumour-like Lesions, 505

Teeth and Periodontal Tissues, 509: Inflammatory Diseases, 510; Epithelial Cysts of the Jaw, 511; Odontogenic Tumours, 513

Salivary Glands, 515: Inflammatory and Salivary Flow Diseases, 515; Tumours of Salivary Glands, 516

Chapter 18: The Gastrointestinal Tract 521 Oesophagus, 521: Congenital Anomalies, 521; Muscular Dysfunctions, 521; Haematemesis of Oesophageal Origin, 522; Inflammatory Lesions, 523; Tumours of Oesophagus, 524

Stomach, 526: Gastric Analysis, 527; Congenital and Miscellaneous Acquired Conditions, 529; Inflammatory Conditions, 529; Haematemesis and Melaena of Gastric Origin, 537; Tumours and Tumour-like Lesions, 537

Small Intestine, 544: Congenital Anomalies and Intestinal Obstruction, 544; Ischaemic Bowel Disease (Ischaemic Enterocolitis), 546; Inflammatory Bowel Disease (Crohn’s Disease and Ulcerative Colitis), 548; Infective and Other Enterocolitis, 552; Malabsorption Syndrome, 556; Small Intestinal Tumours, 559

Appendix, 561: Appendicitis, 561; Tumours of Appendix, 562 Large Bowel, 563: Congenital and Other Miscellaneous Conditions, 563; Polyps and Tumours of Large Bowel, 566; Causes of Gastrointestinal Bleeding, 573

Peritoneum, 574: Peritonitis, 574; Tumour-like Lesions and Tumours, 575

Chapter 19: The Liver, Biliary Tract and Exocrine Pancreas 577 Liver, 577: Liver Function Tests, 578; Jaundice—General, 581; Neonatal Jaundice, 585; Hepatic Failure, 587; Circulatory Disturbances, 589; Viral Hepatitis, 590; Other Infections and Infestations, 599; Chemical and Drug Injury, 601; Cirrhosis, 603; Portal Hypertension, 615; Hepatic Tumours and Tumour-like Lesions, 617

Biliary Tract, 623: Congenital Anomalies, 623; Cholelithiasis (Gallstones), 623; Cholecystitis, 626; Tumours of Biliary Tract, 628

Exocrine Pancreas, 630: Developmental Anomalies, 631; Pancreatitis, 631; Tumours and Tumour-like Lesions, 633

Chapter 20: The Kidney and Lower Urinary Tract 636 Kidney, 636: Renal Function Tests, 639; Pathophysiology of Renal Disease: Renal Failure, 640; Congenital Malformations, 643; Glomerular Diseases, 647; Pathogenesis of Glomerular Injury, 649; Specific Types of Glomerular Diseases, 652; Tubular and Tubulointerstitial Diseases, 666; Obstructive Uropathy, 672; Renal Vascular Diseases, 675; Tumours of Kidney, 680

Lower Urinary Tract, 685: Congenital Anomalies, 685; Inflammations, 685; Tumours, 686

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xvChapter 21: The Male Reproductive System and Prostate 691 Testis and Epididymis, 691: Developmental Disorders, 691; Inflammations, 692; Miscellaneous Lesions, 694; Testicular Tumours, 694

Penis, 702: Developmental and Inflammatory Disorders, 702; Tumours, 702 Prostate, 703: Prostatitis, 704; Nodular Hyperplasia, 705; Carcinoma of Prostate, 706

Chapter 22: The Female Genital Tract 710 Vulva, 710: Miscellaneous Conditions, 710; Vulval Tumours, 711 Vagina, 712: Vaginitis and Vulvovaginitis, 712; Tumours and Tumour-like Conditions, 713 Cervix, 713: Cervicitis, 713; Tumours, 714 Myometrium and Endometrium, 719: Effects of Hormones, 720; Endometritis and Myometritis, 721; Adenomyosis, 721; Endometriosis, 722; Endometrial Hyperplasias, 723; Tumours of Endometrium and Myometrium, 723

Fallopian Tubes, 728: Inflammations, 728; Ectopic Tubal Pregnancy, 729; Tumours and Tumour-like Lesions, 729

Ovaries, 729: Non-Neoplastic Cysts, 729; Ovarian Tumours, 730 Placenta, 741: Hydatidiform Mole, 741; Choriocarcinoma, 742

Chapter 23: The Breast 745 Non-Neoplastic Conditions, 746: Inflammations, 746; Fibrocystic Change, 746; Gynaecomastia (Hypertrophy of Male Breast), 748

Breast Tumours, 748: Fibroadenoma, 748; Phyllodes Tumour (Cystosarcoma Phyllodes), 749; Intraductal Papilloma, 749; Carcinoma of the Breast, 750

Chapter 24: The Skin 759 Dermatoses, 760: I. Genetic Dermatoses, 760; II. Non-Infectious Inflammatory Dermatoses, 761; III. Infectious Dermatoses, 762; IV. Granulomatous Diseases, 765; V. Connective Tissue Dermatoses, 765; VI. Non-Infectious Bullous Dermatoses, 766; VII. Scaling Dermatoses, 768; VIII. Metabolic Diseases of Skin, 769

Tumours and Tumour-like Lesions, 770: I. Tumours and Cysts of the Epidermis, 771; II. Adnexal (Appendageal) Tumours, 776; III.  Melanocytic Tumours, 777; IV. Tumours of the Dermis, 779; V. Cellular Migrant Tumours, 780

Chapter 25: The Endocrine System 782 Basic Concept of Endocrines, 782: Neuroendocrine System, 782; The Endocrine System, 782 Pituitary Gland, 784: Hyperpituitarism, 784; Hypopituitarism, 785; Pituitary Tumours, 786 Adrenal Gland, 787: Adrenocortical Hyperfunction (Hyperadrenalism), 788; Adrenocortical Insufficiency (Hypoadrenalism), 789; Tumours of Adrenal Glands, 790

Thyroid Gland, 792: Functional Disorders, 793; Thyroiditis, 794; Graves’ Disease (Diffuse Toxic Goitre), 796; Goitre, 797; Thyroid Tumours, 800

Parathyroid Glands, 806: Hyperparathyroidism, 806; Hypoparathyroidism, 807; Parathyroid Tumours, 808

Endocrine Pancreas, 808: Diabetes Mellitus, 808; Islet Cell Tumours, 818 Miscellaneous Endocrine Tumours, 819

Chapter 26: The Musculoskeletal System 821 Skeletal System, 821: Infection, Necrosis, Fracture Healing, 822; Disorders of Bone Growth and Development, 825; Metabolic and Endocrine Bone Diseases, 826; Paget’s Disease of Bone (Osteitis Deformans), 828; Tumour-like Lesions of Bone, 829; Tumours of Bone and Cartilage, 831

Joints, 841: Degenerative Joint Disease (Osteoarthritis), 842; Inflammatory Joint Diseases, 843 Skeletal Muscles, 848: Neurogenic Diseases, 848; Myopathic Diseases (Myopathies), 850

Chapter 27: Soft Tissue Tumours 851 General Features, 851 Soft Tissue Tumours, 853: Tumours and Tumour-like Lesions of Fibrous Tissue, 853; Fibrohistiocytic  Tumours, 855; Tumours of Adipose Tissue, 857; Skeletal Muscle Tumours, 859; Tumours of Uncertain Histogenesis, 861

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xvi Chapter 28: The Nervous System 863 Central Nervous System, 863: Developmental Anomalies and Hydrocephalus, 865; Infections of CNS, 866; Cerebrovascular Diseases, 871; Miscellaneous Diseases, 875; Tumours of the CNS, 878

Peripheral Nervous System, 884: Pathologic Reactions to Injury, 884; Peripheral Neuropathy, 884; Nerve Sheath Tumours, 885

APPENDICES

Appendix I: Basic Diagnostic Cytology 888 Exfoliative Cytology, 889: I. Gynaecologic Exfoliative Cytology, 889; II. Non-Gynaecologic Exfoliative Cytology, 894; Techniques in Exfoliative Cytology, 897

Interventional Cytology, 899: I. Fine Needle Aspiration Cytology, 899; II. Imprint Cytology, 905; III. Crush Smear Cytology, 905; IV. Biopsy Sediment Cytology, 905

Appendix II: Answers to Clinical Cases 906Preamble, 906

Appendix III: Normal Values 915 Weights and Measurements of Normal Organs, 915 Laboratory Values of Clinical Significance, 916

Further Reading 923

Index 931

List of Clinical Cases 954