Textbook of Pathology, 6th Edition

885
  TABLE 30.3: Common Degenerative Diseases.
Region Affected Disease Main Features Predominant Pathology
I. Cerebral cortex Alzheimer’s disease Progressive senile Cortical atrophy, senile plaques (neurites),
dementia neurofibrillary tangles, amyloid angiopathy
Pick’s disease Pre-senile dementia Lobar cortical atrophy, ballooning degeneration
of neurons (Pick’s cells)
II. Basal ganglia and Huntington’s disease Progressive dementia with Atrophy of frontal lobes, fibrillary astrocytosis
brainstem choreiform movements
Parkinson’s disease Abnormalities of posture Aggregates of melanin-containing nerve cells in
and movement brainstem, intracytoplasmic neuronal inclusions
(Lewy bodies)
III. Spinal cord and Cerebellar cortical Progressive cerebellar Loss of Purkinje cells in cerebellar cortex
cerebellum degeneration ataxia
Olivopontocerebellar Cerebellar ataxia Combination of atrophy of cerebellar cortex,
atrophy inferior olivary nuclei and pontine nuclei
Spinocerebellar atrophy Gait ataxia, dysarthria Degeneration of spinocerebellar tracts,
(Friedreich’s ataxia) peripheral axons and myelin sheaths
IV. Motor neurons Motor neuron disease Syndromes of muscular Progressive loss of motor neurons, both in the
(UMN and LMN) (Amyotrophic lateral weakness and wasting cerebellar cortex (UMN) and in the anterior
sclerosis) without sensory loss horn of spinal cord (LMN)
Werdnig-Hoffmann’s Spinal muscular Loss of lower motor neurons,
disease atrophy in infants denervation atrophy of muscles


and disordered gait and posture. Parkinsonism is caused by A. HEREDITARY METABOLIC DISEASES: CHAPTER 30
several degenerative diseases, the most important being 1. Neuronal storage diseases—characterised by storage of
Parkinson’s disease; other causes of parkinsonism are a metabolic product in the neurons due to specific enzyme
trauma, toxic agents, and drugs (dopamine antagonists).
deficiency. Common examples are: gangliosidoses (e.g.
Tay-Sachs disease or GM2 gangliosidosis), mucopoly-
Grossly, the brain is atrophic or may be normal externally. saccharidoses, Gaucher’s disease and Niemann-Pick
Microscopically, the hallmark is depigmentation of disease). These conditions are described on page 262.
substantia nigra and locus ceruleus due to loss of
neuromelanin pigment from neurons and accumulation 2. Leucodystrophies—are diseases of white matter charac-
of neuromelanin pigment in the glial cells. Some of the terised by diffuse demyelination and gliosis. They are caused The Nervous System
residual neurons in these areas contain intracytoplasmic, by deficiency of one of the enzymes required for formation
eosinophilic, elongated inclusions called Lewy bodies. and maintenance of myelin. That is why these conditions
are also called dysmyelinating diseases. Common types of
leucodystrophies are: sudanophilic leucodystrophy,
Metabolic Diseases adrenoleucodystrophy, metachromatic leucodystrophy and
Metabolic diseases of the CNS result from neurochemical globoid cell leucodystrophy (Krabbe’s disease).
disturbances which are either inherited or acquired. 3. Other inborn errors of metabolism—e.g. Wilson’s
Hereditary metabolic disorders predominantly manifest in disease (hepatolenticular degeneration), glycogen-storage
infancy or childhood and include genetically-determined diseases, phenylketonuria and galactosaemia.
disorders of carbohydrate, lipid, amino acid and mineral B. ACQUIRED METABOLIC DISEASES:
metabolism. Acquired or secondary metabolic diseases are the These include the following:
disturbances of cerebral function due to disease in some other 1. Anoxic-ischaemic encephalopathy
organ system such as the heart and circulation, lungs and 2. Hypoglycaemic encephalopathy
respiratory function, kidneys, liver, endocrine glands and 3. Hyperglycaemic coma
pancreas. In addition, endogenous metabolic diseases may 4. Acute hepatic encephalopathy (Reye’s syndrome)
be caused by toxic injuries induced by metals, gases, 5. Chronic hepatic encephalopathy
chemicals, and drugs. The pathologic changes in each of these 6. Kernicterus
conditions are quite diverse and include oedema, neuronal 7. Uraemic encephalopathy
storage, degenerative changes, and sometimes parenchymal 8. Encephalopathy due to electrolyte and endocrine
necrosis. disturbances.
The predominant types of hereditary and acquired All these conditions have already been discussed in the
metabolic disorders are as under: relevant chapters.

886 Nutritional Diseases
Neurologic disorders may be caused by malnutrition from
lack of adequate diet in many developing countries and many
poor socio-economic groups. In the United States and Europe,
however, nutritionally-induced disease is chiefly found in
association with chronic alcoholism or due to defect in
absorption, transport or metabolism of dietary nutrients.
The general aspects of deficiency diseases have been
covered in Chapter 9. Some of the common neurologic
diseases included in the category of deficiency diseases are
as under:
1. Wernicke’s encephalopathy and Korsakoff’s psychosis
(vitamin B or thiamine deficiency).
1
2. Subacute combined degeneration of the spinal cord Figure 30.12 The anatomic distribution of common intracranial
(vitamin B deficiency). tumours.
12
3. Folic acid deficiency (page 304). Gliomas may be well-differentiated or poorly-differen-
4. Spinocerebellar syndrome (vitamin E deficiency). tiated. However, gliomas are never truly well-demarcated
5. Pellagra (niacin deficiency). or encapsulated and thus all grades of gliomas infiltrate the
6. Alcoholic cerebellar degeneration.
adjacent brain tissue. Gliomas are disseminated to other
parts of the CNS by CSF but they rarely ever metastasise
TUMOURS OF THE CNS
beyond the CNS.
Tumours of the CNS may originate in the brain or spinal
cord (primary tumours), or may spread to the brain from  TABLE 30.4: Classification of Intracranial Tumours.
another primary site of cancer (metastatic tumours). More
than one-quarter of the CNS tumours are secondary meta- I. TUMOURS OF NEUROGLIA (GLIOMAS)
stases arising in patients undergoing treatment for systemic 1. Astrocytoma
Oligodendroglioma
2.
cancer. Primary CNS tumours are the second commonest 3. Ependymoma
form of cancer in infants and children under the age of 15 4. Choroid plexus papilloma
SECTION III
years, exceeded in frequency only by leukaemia. Both benign II. TUMOURS OF NEURONS
and malignant CNS tumours are capable of producing 1. Neuroblastoma (page 800)
neurologic impairment depending upon their site. 2. Ganglioneuroblastoma
Primary CNS tumours or intracranial tumours include: 3. Ganglioneuroma
tumours arising from constituent cells of the brain (with the III. TUMOURS OF NEURONS AND NEUROGLIA
sole exception of microglial cells) and from the supporting Ganglioglioma
tissues. Childhood brain tumours arise from more primitive IV. POORLY-DIFFERENTIATED AND EMBRYONAL TUMOURS
cells (e.g. neuroblastoma, medulloblastoma). 1. Medulloblastoma
A classification of intracranial tumours abbreviated from 2. Neuroblastoma (page 800)
the WHO classification is given in Table 30.4. The anatomic 3. PNET (page 848)
distribution of common intracranial tumours is illustrated V. TUMOURS OF MENINGES
Systemic Pathology
in Fig. 30.12. Among the primary brain tumours, gliomas 1. Meningioma
constitute 50-60%, meningiomas 25%, schwannomas 10% 2. Meningeal sarcoma
and other primary tumours comprise the remainder. VI. NERVE SHEATH TUMOURS
Some of the important morphologic types are described 1. Schwannoma (neurilemmoma)
below. 2. Neurofibroma
3. Malignant nerve sheath tumour
GLIOMAS VII. OTHER PRIMARY INTRAPARENCHYMAL TUMOURS
1. Haemangioblastoma
The term glioma is used for all tumours arising from 2. Primary CNS lymphoma
neuroglia, or more precisely, from neuroectodermal epithelial 3. Germ cell tumours
tissue. Gliomas are the most common of the primary CNS VIII. MISCELLANEOUS TUMOURS
tumours and collectively account for 40% of all intracranial 1. Malignant melanoma (page 787)
tumours. They include tumours arising: 2. Craniopharyngioma (page 796)
from astrocytes (astrocytomas and glioblastoma 3. Pineal cell tumours
multiforme); 4. Pituitary tumours
from oligodendrocytes (oligodendroglioma); IX. TUMOUR-LIKE LESIONS
(epidermal cyst, dermoid cyst, colloid cyst)
from ependyma (ependymoma); and
from choroid plexus (choroid plexus papilloma). X. METASTATIC TUMOURS

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Figure 30.13 Anaplastic astrocytoma, showing hypercellularity of pleomorphic astrocytic cells, mitoses and vascular proliferation in fibrillary
background. Areas of necrosis are also present.

Astrocytomas (including Glioblastoma Multiforme) ii) Pleomorphic xanthoastrocytoma. It looks histologically
Astrocytomas are the most common type of gliomas. In pleomrphic and alarming but has favourable prognosis.
general, they are found in the late middle life with a peak in WHO GRADE II (WELL-DIFFERENTIATED) ASTRO-
6th decade of life. They occur predominantly in the cerebral CYTOMA. It is also called as fibrillary astrocytoma and
hemispheres, and occasionally in the spinal cord. In children is the most common form of glioma occurring in 3rd to CHAPTER 30
and young adults, pilocytic astrocytomas arise in the optic 4th decades of life.
nerves, cerebellum and brainstem. Astrocytomas have Grossly, it is a poorly defined, grey-white tumour of
tendency to progress from low grade to higher grades of variable size. The tumour distorts the underlying brain
anaplasia. Low-grade astrocytomas evolve slowly over tissue and merges with the surrounding tissue.
several years whereas higher grades (anaplastic astrocytoma
and glioblastoma multiforme) bring about rapid clinical Histologically, it is composed of well-differentiated
deterioration of the patient. astrocytes separated by variable amount of fibrillary
The diagnosis of various types of astrocytomas can be background of astrocytic processes. Based on the type of
generally made by routine H & E morphology but in difficult astrocytes, three subtypes are distinguished: fibrillary, The Nervous System
situations and poorly differentiated cases, immunohisto- protoplastic and gemistocytic astrocytoma.
chemical staining with glial fibrillary protein (GFAP) or by WHO GRADE III (ANAPLASTIC) ASTROCYTOMA.
electron microscopic demonstration of glial filaments can be It generally evolves from lower grade of astrocytoma.
done.
Grossly, it may not be distinguishable from the low-grade
MORPHOLOGIC FEATURES. Pathologically, astrocyto- astrocytoma.
mas have been conventionally divided into 3 progressive Histologically, it contains features of anaplasia such as
histologic grades: fibrillary (most common), gemistocytic hypercellularity, pleomorphism, nuclear hyper-
and protoplasmic. However, currently WHO classification chromatism and mitoses. Another characteristic feature
of astrocytomas is widely used which divides them into 4 of anaplastic variety of astrocytoma is the proliferation of
grades from grade I (low grade) to grade IV (glioblastoma vascular endothelium (Fig. 30.13).
multiforme) as under.
WHO GRADE I ASTROCYTOMA. Also called as diffuse WHO GRADE IV ASTROCYTOMA (GLIOBLAS-
astrocytoma, it is a low-grade tumour having good TOMA MULTIFORME). Although its nomenclature
prognosis and includes special histologic entities which means its origin from embryonal cells but now it is
mainly occur in children as under: known that this tumour arises by neoplastic transfor-
i) Juvenile pilocytic astrocytoma. It occur in children and mation of mature astrocytes. It is the most aggressive of
young adults in the cerebellum, third ventricle and optic astrocytomas.
nerve pathway. Grossly, it shows variegated appearance, with some areas
Grossly, it is usually cystic or solid and circumscribed. showing grey-white appearance while others are yellow
Microscopically, it is predominantly composed of and soft with foci of haemorrhages and necrosis. The
fusiform pilocytic astrocytes having unusually long, wavy surrounding normal brain tissue is distorted and
fibrillary processes. infiltrated by yellow tumour tissue.

888 in 3rd to 4th decades of life. It occurs in the cerebral
hemispheres, most commonly in the frontal lobes or within
the ventricles. X-ray examination and CT scan reveal a well-
defined mass with numerous small foci of calcification. The
tumour is generally slow-growing.
MORPHOLOGIC FEATURES. Grossly, oligodendro-
glioma is well-circumscribed, grey-white and gelatinous
mass having cystic areas, foci of haemorrhages and
calcification.
Microscopically, the tumour is characterised by uniform
cells with round to oval nuclei surrounded by a clear halo
of cytoplasm and well-defined cell membranes. Tumour
cells tend to cluster around the native neurons forming
satellitosis. Typically, there are varying degree of endo-
thelial cell hyperplasia and foci of calcification. Anaplastic
change may occur as in other gliomas.

Ependymoma
Ependymoma is not an uncommon tumour, derived from
the layer of epithelium that lines the ventricles and the central
Figure 30.14 Glioblastoma multiforme (WHO grade IV astrocytoma). canal of the spinal cord. It occurs chiefly in children and
The tumour is densely cellular having marked pleomorphism.
Characteristically, the tumour has areas of necrosis which are surrounded young adults (below 20 years of age). Typically, it is
by a palisade layer of tumour cells. encountered in the fourth ventricle (posterior fossa tumour).
Other locations are the lateral ventricles, the third ventricle,
and in the case of adults, the spinal cord in the region of
Histologically, the features are as under (Fig. 30.14): lumbar spine. Clinically, by virtue of their frequent location
i) It has highly anaplastic and cellular appearance. The in the floor of the fourth ventricle, ependymomas are asso-
cell types show marked variation consisting of fusiform ciated with obstructive hydrocephalus. The usual biologic
cells, small poorly-differentiated round cells, pleomorphic behaviour is of a slow-growing tumour over a period of years.
SECTION III
cells and giant cells. Mitoses are quite frequent and glial
fibrils are scanty. MORPHOLOGIC FEATURES. Grossly, ependymoma is
ii) It shows areas of tumour necrosis around which a well-demarcated tumour but complete surgical removal
tumour cells may form pseudopalisading. may not be possible due to close proximity to vital
iii) Microvascular endothelial proliferation is marked. structures in the medulla and pons.
Microscopically, the tumour is composed of uniform
epithelial (ependymal) cells forming rosettes, canals and
Oligodendroglioma perivascular pseudorosettes. By light microscopy under
Oligodendroglioma is an uncommon glioma of oligo- high magnification, PTAH-positive structures, blepharo-
dendroglial origin and may develop in isolation or may be plasts, representing basal bodies of cilia may be
mixed with other glial cells. The tumour commonly presents demonstrated in the cytoplasm of tumour cells (Fig. 30.15).
Systemic Pathology



























Figure 30.15 Ependymoma showing uniform ependymal tumour cells forming rosettes and canaliculi.

Most tumours are well-differentiated but anaplastic metastases to extraneural sites such as to lungs, liver, 889
variants are also recognised. vertebrae and pelvis.
Two variants of ependymoma deserve special
mention: myxopapillary type and subependymoma. MORPHOLOGIC FEATURES. Grossly, the tumour typi-
cally protrudes into the fourth ventricle as a soft, grey-
Myxopapillary ependymoma. It is a special variant of
ependymoma which is common and occurs in adults. white mass or invades the surface of the cerebellum.
Characteristically, it occurs in the region of cauda equina Microscopically, medulloblastoma is composed of small,
and originates from the filum terminale. True to its name, poorly-differentiated cells with ill-defined cytoplasmic
it contains myxoid and papillary structures interspersed processes and a tendency to be arranged around blood
in the typical ependymal cells. It is a slow-growing tumour vessels and occasionally forms pseudorosettes (Homer-
having a better prognosis. Wright rosettes). Another characteristic of the tumour is
differentiation into glial or neuronal elements.
Subependymoma. It occurs as a small, asymptomatic,
incidental solid nodule in the fourth and lateral ventricle
of middle-aged or elderly patients. Areas of microcysts OTHER PRIMARY INTRAPARENCHYMAL TUMOURS
and calcification may be encountered. Important examples of some other primary intraparen-
Histologically, it is composed of nests of uniform chymal are haemangioblastoma, CNS lymphoma and germ
ependymal cells in a stroma of very dense, acellular, finely cell tumours.
fibrillar background. Subependymoma is typically a very
slow-growing tumour. Haemangioblastoma
Haemangioblastoma is a tumour of uncertain origin and
Choroid Plexus Papilloma constitutes about 2% of all intracranial tumours. It is seen
Tumours derived from choroid plexus epithelium are more commonly in young adults and is commoner in males.
uncommon intracranial tumours. They are found in the It may occur sporadically or be a part of von Hippel-Lindau
distribution of the choroid plexus. In children, they occur syndrome (along with cysts in the liver, kidney, and benign/
most frequently in the lateral ventricles, whereas in adults malignant renal tumour). About a quarter of haemangio- CHAPTER 30
fourth ventricle is the most common site. They are invariably blastomas secrete erythropoietin and cause polycythaemia.
benign tumours and rarely ever undergo malignant
transformation. MORPHOLOGIC FEATURES. Grossly, the tumour is
usually a circumscribed cystic mass with a mural nodule.
MORPHOLOGIC FEATURES. Grossly, the tumour The cyst contains haemorrhagic fluid.
projects as rounded, papillary mass into one of the Microscopically, the features are as under:
ventricles. i) Large number of thin-walled blood vessels lined by
Histologically, choroid plexus papilloma is a papillary plump endothelium.
tumour resembling normal choroid plexus with a vascular ii) Vascular spaces are separated by groups of polygonal The Nervous System
connective tissue core covered by a single layer of cuboidal lipid-laden foamy stromal cells.
epithelium which lies upon a basement membrane.
Primary CNS Lymphoma
POORLY-DIFFERENTIATED AND
EMBRYONAL TUMOURS Lymphomas in the brain may occur as a part of disseminated
CNS tumours composed of primitive undifferentiated cells non-Hodgkin’s lymphoma (Chapter 14) or may be a primary
include medulloblastoma and glioblastoma, and rarely, CNS lymphoma. The incidence of the primary CNS
neuroblastoma (page 800) and retinoblastoma (page 512). lymphoma has shown a rising trend in patients of AIDS
Except for medulloblastoma, other examples of these and other immunosuppressed conditions. They occur in men
tumours have been described elsewhere in the text. above 5th decade of life. Primary CNS lymphoma has a poor
prognosis.
Medulloblastoma
MORPHOLOGIC FEATURES. Grossly, the tumour is
Medulloblastoma is the most common variety of primitive frequently periventricular in location and may appear
neuroectodermal tumour. It comprises 25% of all childhood nodular or diffuse.
brain tumours but a quarter of cases occur in patients over Microscopically, the features are as under:
the age of 20 years. The most common location is the i) Characteristically, the tumour grows around blood
cerebellum in the region of roof of fourth ventricle, in the vessels i.e. has an angiocentric growth pattern. Reticulin
midline of cerebellum, in the vermis, and in the cerebellar stain highlights this feature well.
hemispheres. Medulloblastoma is a highly malignant tumour ii) Typically, CNS lymphomas are diffuse, large cell type
and spreads to local as well as to distant sites. It invades with high mitotic activity.
locally and by the CSF to meninges, ventricles and iii) They are generally β-cell type.
subarachnoid space and has a tendency for widespread

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Figure 30.16 Meningioma, The tumour mass is circumscribed (arrow) with irregular surface convolutions and prominent blood vessels. It is
firm in consistency with peripherally adherent thick firm dural tissue. Cut surface of the mass is firm and fibrous.


Germ Cell Tumours Microscopically, meningiomas are divided into 5 sub-
Rarely, germ cell tumours may occur in the brain, especially types: meningotheliomatous (syncytial), fibrous
in children. Common locations are suprasellar region and (fibroblastic), transitional (mixed), angioblastic and
pineal area. Some common examples of such tumours are anaplastic (malignant).
germinoma (seminoma/dysgerminoma), teratoma and 1. Meningotheliomatous (syncytial) meningioma. This
SECTION III
embryonal carcinoma. Morphologically, they are similar to pattern of meningioma resembles the normal arachnoid
their counterparts elsewhere. cap cells. The tumour consists of solid masses of polygonal
cells with poorly-defined cell membranes (i.e. syncytial
TUMOURS OF MENINGES appearance). The cells have round to oval, central nuclei
with abundant, finely granular cytoplasm. Some amount
The most common tumour arising from the pia-arachnoid is
meningioma accounting for 20% of intracranial tumours. of collagenous stroma is present that divides the tumour
into irregular lobules.
Meningioma 2. Fibrous (fibroblastic) meningioma. A less frequent
Meningiomas arise from the cap cell layer of the arachnoid. pattern is of a spindle-shaped fibroblastic tumour in which
Their most common sites are in the front half of the head the tumour cells form parallel or interlacing bundles.
and include: lateral cerebral convexities, midline along the Whorled pattern and psammoma bodies are less common
Systemic Pathology
falx cerebri adjacent to the major venous sinuses features of this type.
parasagittally, and olfactory groove. Less frequent sites are: 3. Transitional (mixed) meningioma. This pattern is
within the cerebral ventricles, foramen magnum, cerebello- characterised by a combination of cells with syncytial and
pontine angle and the spinal cord. Meningiomas are generally fibroblastic features with conspicuous whorled pattern of
solitary. They have an increased frequency in patients with tumour cells, often around central capillary-sized blood
neurofibromatosis 2 and are often multiple in these cases. vessels. Some of the whorls contain psammoma bodies
They are usually found in 2nd to 6th decades of life, with due to calcification of the central core of whorls (Fig. 30.17).
slight female preponderance. Most meningiomas are benign Other forms of degenerative changes like xanthomatous
and can be removed successfully. Rarely, a malignant and myxomatous degeneration may also be encountered,
meningioma may metastasise, mainly to the lungs. in transitional variety.
These first three histologic patterns constitute a
MORPHOLOGIC FEATURES. Grossly, meningioma is spectrum of lesions rather than three distinct entities.
well-circumscribed, solid, spherical or hemispherical mass
of varying size (1-10 cm in diameter). The tumour is 4. Angioblastic meningioma. An angioblastic menin-
generally firmly attached to the dura and indents the gioma includes 2 patterns: haemangioblastic pattern
surface of the brain but rarely ever invades it (Fig. 30.16). resembling haemangioblastoma of the cerebellum, and
The overlying bone usually shows hyperostosis. Cut haemangiopericytic pattern which is indistinguishable from
surface of the tumour is firm and fibrous, sometimes with haemangiopericytoma elsewhere in the body. Both types
foci of calcification. of angioblastic meningiomas have high rate of recurrences.

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Figure 30.17 Meningioma, transitional type. The cells have features of both syncytial and fibroblastic type and form whorled appearance.
Some of the whorls contain psammoma bodies.



5. Anaplastic (malignant) meningioma. Rarely, a brain and spinal cord, particularly encountered in
meningioma may display features of anaplasia and invade carcinomas of the lung and breast.
the underlying brain or spinal cord. This pattern of Histologically, metastatic tumours in the brain
meningioma is associated with extraneural metastases, recapitulate the appearance of the primary tumour of
mainly to the lungs. origin with sharp line of demarcation from adjoining brain CHAPTER 30
tissue. It is usually surrounded by a zone of oedema.
METASTATIC TUMOURS
Approximately a quarter of intracranial tumours are PERIPHERAL NERVOUS SYSTEM
metastatic tumours. The clinical features are like those of a
primary brain tumour. Most common primary tumours NORMAL STRUCTURE
metastasising to the brain are: carcinomas of the lung, breast, The peripheral nervous system (PNS) consists of cranial and
skin (malignant melanoma), kidney and the gastrointestinal spinal nerves, sympathetic and parasympathetic autonomic
tract and choriocarcinoma. Infiltration from lymphoma and nervous system and the peripheral ganglia. The PNS is
leukaemias may also occur.
involved in electric transmission of sensory and motor The Nervous System
MORPHOLOGIC FEATURES. Grossly, the metastatic impulses to and from the CNS. A peripheral nerve is
deposits in the brain are usually multiple, sharply-defined surrounded by an outer layer of fibrous tissue, the epineurium.
masses at the junction of grey and white matter Each nerve is made of several fascicles enclosed in
(Fig. 30.18). A less frequent pattern is carcinomatous multilayered membrane of flattened cells, the perineurium.
meningitis or meningeal carcinomatosis in which there is Each fascicle is composed of bundles of connective tissue,
presence of carcinomatous nodules on the surface of the the endoneurium. There are 2 main types of nerve fibres or
axons comprising a peripheral nerve—myelinated and non-
myelinated. Myelinated axons are thicker (diameter greater
than 2 μm) and are surrounded by a chain of Schwann cells
which produce myelin sheath. Non-myelinated axons have
diameter of 0.2-3 μm and about ten non-myelinated fibres
may be enclosed by a Schwann cell. Nodes of Ranvier on myeli-
nated fibres are the boundaries between each Schwann cell
surrounding the fibre (Fig. 30.18). Myelinated axons have
their origin from neurons in the posterior root ganglia and
the anterior horn cell of the spinal cord, whereas non-
myelinated axons arise from neurons in the posterior root
ganglia and in the autonomic ganglia.

PATHOLOGIC REACTIONS TO INJURY
The peripheral nerves, unlike brain, have regenerative
Figure 30.18 Metastatic tumour deposits in the brain. They are capacity as has been discussed on page 172. The pathologic
commonly multiple, well-defined and usually located at the grey and
white matter junction. reactions of the PNS in response to injury may be in the

892




























Figure 30.19 Pathologic reaction of peripheral nerve to injury.



form of one of the types of degenerations causing peripheral around axons producing ‘onion bulbs’ found in hypertrophic
neuropathy or formation of a traumatic neuroma. There are neuropathy.
3 main types of degenerative processes in the PNS— TRAUMATIC NEUROMA. Normally, the injured axon of
Wallerian degeneration, axonal degeneration and segmental a peripheral nerve regenerates at the rate of approximately
demyelination (Fig. 30.19):
1 mm per day. However, if the process of regeneration is
SECTION III
WALLERIAN DEGENERATION. Wallerian degeneration hampered due to an interposed haematoma or fibrous scar,
occurs after transection of the axon which may be as a result the axonal sprouts together with Schwann cells and
of knife wounds, compression, traction and ischaemia. fibroblasts form a peripheral mass called as traumatic or
Following transection, initially there is accumulation of stump neuroma.
organelles in the proximal and distal ends of the transection
sites. Subsequently, the axon and myelin sheath distal to the PERIPHERAL NEUROPATHY
transection site undergo disintegration upto the next node Peripheral neuropathy is the term used for disorders of the
of Ranvier, followed by phagocytosis. The process of regene- peripheral nerves of any cause. It may be polyneuropathy,
ration occurs by sprouting of axons and proliferation of mononeuropathy multiplex, and mononeuropathy.
Schwann cells from the proximal end.
Polyneuropathy is characteristically symmetrical with
AXONAL DEGENERATION. In axonal degeneration, noticeable sensory features such as tingling, pricking,
Systemic Pathology
degeneration of the axon begins at the peripheral terminal burning sensation or dysaesthesia in feet and toes. Motor
and proceeds backward towards the nerve cell body. The features in the form of muscle weakness and loss of tendon
cell body often undergoes chromatolysis. There is Schwann reflexes may be present. Involvement of the autonomic
cell proliferation in the region of axonal degeneration. The nervous system may be associated. Most cases have origin
loss of axonal integrity occurs, probably as a result of some in acquired metabolic and toxic causes such as thiamine
primary metabolic disturbance within the axon itself. deficiency, diabetes, amyloidosis, autoimmune demyelinat-
Changes similar to those seen in Wallerian degeneration are ing disease (Guillain-Barré syndrome), and administration
present but regenerative reaction is limited or absent. of toxins and certain therapeutic agents (e.g. vincristine,
isoniazid). Besides these, a number of hereditary polyneuro-
SEGMENTAL DEMYELINATION. Segmental demyeli- pathies are described.
nation is similar to demyelination within the brain (page 884).
Segmental demyelination is loss of myelin of the segment Pathologically, polyneuropathy may be the result of
between two consecutive nodes of Ranvier, leaving a axonal degeneration (axonopathy) or segmental
denuded axon segment. The axon, however, remains intact. demyelination (demyelinating polyneuropathy). In each
Schwann cell proliferation generally accompanies demyeli- type, acute, subacute and chronic forms are distinguished.
nation. This results in remyelination of the affected axon. Guillain-Barré syndrome is the classical example of acute
Repeated episodes of demyelination and remyelination are demyelinating polyneuropathy which has probably an
associated with concentric proliferation of Schwann cells autoimmune etiology.

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Figure 30.20 Schwannoma (neurilemmoma), showing whorls of densely cellular (Antoni A) and loosely cellular (Antoni B) areas with characteristic
nuclear palisading (Verocay bodies).



Mononeuropathy multiplex or multifocal neuropathy Microscopically, the tumour is composed of fibrocellular
is defined as simultaneous or sequential multifocal bundles forming whorled pattern. There are areas of dense
involvement of nerve trunks which are not in continuity. The and compact cellularity (Antoni A pattern) alternating with
involvement may be partial or complete and may evolve over loose acellular areas (Antoni B pattern). Areas of Antoni A
days or years. Multifocal neuropathy represents part of pattern show palisaded nuclei called Verocay bodies CHAPTER 30
spectrum of chronic acquired demyelinating neuropathy. (Fig. 30.20). Nerve fibres are usually found stretched over

Mononeuropathy, on the other hand, is focal involve- the capsule but not within the tumour. Areas of
ment of a single nerve. It is generally the result of local causes degeneration contain haemosiderin and lipid-laden
such as direct trauma, compression and entrapment. macrophages. Schwann cells characteristically express
S-100 protein. A schwannoma rarely ever becomes
NERVE SHEATH TUMOURS malignant.
Tumours of the peripheral nerves are commonly benign and
include schwannoma (neurilemmoma) and neurofibroma. Neurofibromas and von Recklinghausen’s Disease
Both of them arise from Schwann cells but neurofibroma Neurofibromas may occur as solitary, fusiform cutaneous The Nervous System
contains large amount of collagen. Rarely, their malignant tumour of a single nerve, but more often are multiple
counterpart, malignant peripheral nerve sheath tumour, associated with von Recklinghausen’s disease. Solitary
develops particularly in patients with von Recklinghausen’s neurofibroma is a tumour of adults but multiple
neurofibromatosis. neurofibromas or neurofibromatosis is a hereditary disorder
with autosomal dominant inheritance. Solitary neurofibroma
Schwannomas (Neurilemmomas) is generally asymptomatic but patients with von
Schwannomas or neurilemmomas arise from cranial and Recklinghausen’s disease have a triad of features:
spinal nerve roots. An acoustic schwannoma or acoustic neuroma Multiple cutaneous neurofibromas.
is an intracranial schwannoma located within the internal Numerous pigmented skin lesions (‘cafe au lait’ spots).
auditory canal originating from vestibular portion of the Pigmented iris hamartomas.
acoustic nerve (page 515). Intraspinal schwannomas are found Neurofibromatosis type 1 is a genetic disorder having
as intradural tumours in the thoracic region. In the peripheral mutation in chromosome 17 while type 2 has mutation in
nerves, they occur as solitary nodule on any sheathed chromosome 22.
sensory, motor, or autonomic nerve. Multiple schwannomas
are uncommon and occur in von Recklinghausen’s disease MORPHOLOGIC FEATURES. Grossly, neurofibroma is
(see below). Schwannomas are tumours of adults except in an unencapsulated tumour producing fusiform enlarge-
von Recklinghausen’s disease.
ment of the affected nerve. Neurofibromatosis in von
MORPHOLOGIC FEATURES. Grossly, a schwannoma Recklinghausen’s disease is characterised by numerous
is an encapsulated, solid, sometimes cystic, tumour that nodules of varying size, seen along the small cutaneous
produces eccentric enlargement of the nerve root from nerves but may also be found in visceral branches of
where it arises. sympathetic nerves. Neurofibromatosis may involve a

894 Neurofibromas have tendency for local recurrences
after excision. Neurilemmoma virtually never turns
malignant, while sarcomatous transformation in neuro-
fibroma, particularly in neurofibromatosis, is not unusual.
It is estimated that about 3% of patients with von
Recklinghausen’s neurofibromatosis develop malignant
transformation of one of the nodules. Rarely, neurogenic
sarcoma may develop spontaneously in the absence of pre-
existing von Recklinghausen’s disease.
The contrasting features to distinguish neurofibroma
from schwannoma are listed in Table 30.5.


Malignant Peripheral Nerve Sheath Tumour
Malignant peripheral nerve sheath tumour (MPNST) is a
poorly differentiated spindle cell sarcoma of the peripheral
nerves occurring most often in adults. The tumour may arise
de novo or from malignant transformation of a pre-existing
neurofibroma than a schwannoma, generally at an early age
(20-40 years). About 50% of the tumours are seen in patients
Figure 30.21 Plexiform neurofibromatosis. The main mass is with neurofibromatosis type 1 with chromosomal deletion
multilobulated with increased fat while lower part of the image shows a
separate encapsulated gelatinous mass. Cut surface of both the masses 17p and p53 gene mutations, while some develop at sites of
shows circumscribed, gelatinous, lobulated grey-white firm masses. previous irradiation.

MORPHOLOGIC FEATURES. Grossly, the tumour
group of nerves or may occur as multiple, oval and
irregular swellings along the length of a nerve (plexiform appears as an unencapsulated fusiform enlargement of a
neurofibroma) (Fig. 30.21). nerve.
Microscopically, a neurofibroma is composed of bundles Microscopically, the tumour has the general appearance
and interlacing fascicles of delicate and elongated spindle- of tumour cells resembling a fibrosarcoma. The tumour
SECTION III
shaped cells having wavy nuclei. The cellular area is has frequent mitosis and areas of necrosis. Triton tumour
separated by loose collagen and mucoid material. Residual is the name used for MPNST which has areas of poorly-
nerve fibres (neurites) may be demonstrable (Fig. 30.22). differentiated rhabdomyosarcoma, cartilage and bone.
Histologic appearance of Antoni B pattern of schwannoma
may be seen in neurofibroma and cause diagnostic Epithelioid MPNST has plump cells resembling
difficulty. Immunohistochemically, neurofibroma is epithelioid cells and is positive for HMB-45 immuno-
positive for epithelial membrane antigen (EMA) and some stain. Most of the recurrent forms of MPNST are of
tumours express S-100 protein as schwannomas do. epithelioid type.


Systemic Pathology

























Figure 30.22 Neurofibroma, showing interlacing bundles of spindle-shaped cells separated by mucoid matrix. The cells have wavy nuclei and
a residual nerve fibre (neurite) is also identified.

  TABLE 30.5: Contrasting Features of Neurilemmoma (Schwannoma) and Neurofibroma. 895
Feature Neurilemmoma Neurofibroma
1. Location Cerebellopontine angle (vestibular branch of Dermis; along the nerve trunk
8th nerve); extradural sites
2. Number Generally solitary Solitary or multiple neurofibromatosis
3. Genetics Bilateral in association with type 2 neuro- Multiple associated with type 1 neuro-
fibromatosis having autosomal dominant fibromatosis having autosomal dominant
inheritance (chromosome 22 disorder) inheritance (chromosome 17 disorder)
4. Gross appearance Firm, encapsulated, Soft, well demarcated but unencapsulated,
c/s tan, translucent c/s mucoid, translucent
5. Microscopy Compact areas (Antoni A) and myxomatous Dense collagen fibres and abundant
areas (Antoni B), palisading tumour cells extracellular mucoid material
(Verocay bodies)
6. Infiltration Encapsulated along the edge of May infiltrate the peripheral nerve
nerve without invading it
7. Immunohistochemistry S-100 protein EMA; sometimes S-100 protein
8. Behaviour Invariably benign May turn malignant




Although relatively slow-growing, MPNST has local commonly; histology thus appears to have little correlation
recurrences and haematogenous metastasis occur with clinical behaviour of the tumour.


❑ CHAPTER 30




















The Nervous System

896

APPENDIX









Normal Values









WEIGHTS AND MEASUREMENTS OF discussion of pathologic states affecting it. Here, a
comprehensive list of generally accepted normal weights and
NORMAL ORGANS measurements of most of the normal organs in fully-
developed, medium-sized individual and a normal healthy
In order to understand the significance of alterations in newborn are compiled in Table A-1.
weight and measurement of an organ in disease, it is Single value and value within brackets are indicative of
important to be familiar with the normal values. In the the average figure for that organ. Measurements have been
foregoing chapters, normal figures are given alongside the given as width × breadth (thickness) × length. An alphabetic
normal structure of each organ/system that precedes the order has been followed.


 TABLE A-1: Weights and Measurements of Normal Organ In Adults At Birth
Organs. (wherever applicable)
Organ In Adults At Birth Volume of 10–30 ml —
(wherever applicable) pericardial fluid

Adrenal gland: Intestines:
Weight 4–5 gm 8-11 gm Length of duodenum 30 cm —
Total length of 550–650 cm —
Brain: small intestine
Weight (in males) 1400 gm 320-420 gm Length of large intestine 150–170 cm —
Weight (in females) 1250 gm —
Kidneys:
Measurements 16.5 × 12.5 cm —
(sagittal × vertical) Weight each (in males) 150 gm 20-30 gm
APPENDIX
Volume of cerebrospinal 120–150 ml — Weight each (in females) 135 gm —
fluid Measurements 3.5 × 5.5 × 11.5 cm —
Heart: Liver:
Weight (in males) 300–350 gm 17-30 gm Weight (in males) 1400–1600 100-160 gm
Weight (in females) 250–300 gm — (1500) gm
Thickness of right 0.3–0.5 cm — Weight (in females) 1200–1400 —
ventricular wall (1300) gm
Thickness of left 1.3–1.5 cm — Measurements 27 × 8 × 20 cm —
Normal Values
ventricular wall
Lungs:
Circumference of 10 cm — Weight (right lung) 375–500 (450) gm 35-55 gm
mitral valve
Weight (left lung) 325–450 (400) gm —
Circumference of 7.5 cm — Volume of pleural fluid < 15 ml —
aortic valve
Circumference of 8.5 cm — Oesophagus:
pulmonary valve Length 25 cm —
Circumference of 12 cm — (cricoid cartilage
tricuspid valve to cardia)


Contd...

 TABLE A-1: Weights and Measurements of Normal Weight 35–40 gm — 897
Organs. (in nonpregnant woman)
(Contd...) Weight 75–125 gm —
(in parous woman)
Organ In Adults At Birth
(wherever applicable)
Distance from incisors 40 cm —
to gastro-oesophageal LABORATORY VALUES OF
junction
CLINICAL SIGNIFICANCE
Ovaries:
Weight (each) 4–8 (6) gm — Currently, the concept of ‘normal values’ and ‘normal ranges’
Measurements 1 × 2.5 × 4.5 cm — is replaced by ‘reference values’ and ‘reference limits’ in
which the variables for establishing the values for the
Pancreas:
Total weight 60–100 (80) gm 3-6 gm reference population in a particular test are well defined.
Weight of 1–1.5 gm — Reference ranges are valuable guidelines for the clinician.
endocrine pancreas However, the following cautions need to be exercised in their
Measurements 3.8 × 4.5 × 18 cm — interpretation:
Parotid glands: Firstly, they should not be regarded as absolute indicators
Weight (each) 30 gm — of health and ill-health since values for healthy individuals
often overlap with values for persons afflicted with disease.
Pituitary gland (Hypophysis):
Secondly, laboratory values may vary with the method
Weight 500 mg —
and mode of standardisation used; reference ranges given
Placenta: below are based on the generally accepted values by the
Weight at term 400–600 gm — standard methods in laboratory medicine.
Prostate: Thirdly, although in most laboratories in the West and in
all medical and scientific journals, international units (IU)
Weight 20 gm —
conforming to the SI system are followed, but conventional
Spleen: units continue to be used in many laboratories in the
Weight 125–175 (150) gm 6-14 gm developing countries of the world.
Measurements 3.5 × 8.5 × 13 cm The WHO as well as International Committee for
Standardisation in Haematology (ICSH) have recommended
Stomach:
adoption of SI system by the scientific community throughout
Length 25–30 cm — world. In this section, laboratory values are given in both
Testis and epididymis: conventional and international units. Conversion from one
Weight each (in adults) 20–27 gm — system to the other can be done as follows: APPENDIX
Thymus: mmol/L × atomic weight
Weight 5–10 gm 10-35 gm mg/dl = __________________________________
10
Thyroid:
Weight 15–40 gm — mg/dl × 10
mmol/L = ___________________
Uterus: atomic weight
According to the SI system, the prefixes and conversion
factors for metric units of length, weight and volume are Normal Values
given in Table A-2.
 TABLE A-2: Prefixes and Conversion Factors in SI System. The laboratory values given here are divided into three
Units of Weight
Prefix Prefix Symbol Factor Units of Length sections: clinical chemistry of blood (Table A-3), other body
Units of Volume
fluids (Table A-4), and haematologic values (Table A-5). In
kilo- k 10 3 kilometre (km) kilogram (kg) kilolitre (kl)
general, an alphabetic order has been followed.
1 metre (m) gram (g) litre (l)
deci- d 10 –1 decimetre (dm) decigram (dg) decilitre (dl)
centi- c 10 –2 centimetre (cm) centigram (cg) centilitre (cl)
milli- m 10 –3 millimetre (mm) milligram (mg) millilitre (ml)
micro- €€€€€€μ 10 –6 micrometre (μm) microgram (μg) microlitre (μl)
nano- n l0 –9 nanometre (nm) nanogram (ng) nanolitre (nl)
pico- p 10 –12 picometre (pm) picogram (pg) picolitre (pl)
femto- f 10 –15 femtometre (fm) femtogram (fg) femtolitre (fl)
alto- a 10 –18 altometre (am) altogram (ag) altolitre (al)

898
  TABLE A-3: Clinical Chemistry of Blood.
Reference Value
Component Fluid Conventional SI Units
Alcohol, ethyl Serum/whole blood Negative Negative
mild to moderate intoxication 80-200 mg/dl
marked intoxication 250-400 mg/dl
severe intoxication >400 mg/dl
Aminotransferases (transaminases)
aspartate (AST, SGOT) Serum 12-38 U/L 0.20-0.65 μkat*/L
alanine (ALT, SGPT) Serum 7-41 U/L 0.12-0.70 μkat/L
Ammonia Plasma 19-60 μg/dl 11-35 μmol/L
Amylase Serum 20-96 U/L 0.34-1.6 μkat/L
Bilirubin
total Serum 0.3-1.3 mg/dl 5.1-22 μmol/L
direct (conjugated) Serum 0.1-0.4 mg/dl 1.7-6.8 μmol/L
indirect (unconjugated) Serum 0.2-0.9 mg/dl 3.4-15.2 μmol/L
Blood volume
total 60-80 ml/kg body weight
red cell volume, males 30 ml/kg body weight
females 25 ml/kg body weight
Plasma volume, males 39 ml/kg body weight
females 40 ml/kg body weight
Bromsulphalein (BSP) test
5 mg/kg body weight Serum <5% retention in
serum after 45 min
Calcium, total Serum 8.7-10.2 mg/dl 2.2-2.6 mmol/L
Calcium, ionised Whole blood 4.5-5.3 mg/dl 1.12-1.32 mmol/L
–
Chloride (Cl ) Serum 102-109 mEq/L 102-109 mmol/L
Cholesterol Serum
total desirable for adults <200 mg/dl <5.17 mmol/L
borderline high 200-239 mg/dl 5.17-6.18 mmol/L
high undesirable ≥240 mg/dl >6.21 mmol/L
LDL-cholesterol, desirable range <130 mg/dl <3.34 mmol/L
borderline high 130-159 mg/dl 3.36-4.11 mmol/L
high undesirable ≥160 mg/dl >4.11 mmol/L
HDL-cholesterol, protective range >60 mg/dl >1.55 mmol/L
APPENDIX
low <40 mg/dl <1.03 mmol/L
triglycerides <160 mg/dl <2.26 mmol/L
CO content Plasma 22-30 mEq/L (arterial) 22-30 mmol/L (arterial)
2
Copper Serum 70-140 μg/dl 11-22 μmol/L
C-reactive proteins Serum 0.2-3.0 mg/L 0.2-3.0 mg/L
Creatine kinase (CK), total Serum
males 51-294 U/L 0.87-5.0 μkat/L
females 39-238 IU/L 0.66-4.0 μkat/L
Normal Values
Creatine kinase-MB (CK-MB) Serum 0-5.5 ng/ml 0-5.5 μg/L
Creatinine Serum 0.6-1.2 mg/dl 53-106 μmol/L
Electrophoresis, protein Serum See under proteins
Gamma-glutamyl trans- Serum 9-58 IU/L 0.15-1.00 μmol/L
peptidase (transferase) (γ-GT)
Gases, arterial
–
Bicarbonate (HCO 3 ) Whole blood 22-30 mEq/L 22-30 mmol/L
pH Whole blood 7.35-7.45 7.35-7.45
Whole blood 22-45 mmHg 4.3-6.0 kPa
P CO 2
Whole blood 72-104 mmHg 9.6-13.8 kPa
P O 2
*μkat (kat stands for katal meaning catalytic activity) is a modern unit of enzymatic activity.
Contd...

899
  TABLE A-3: Clinical Chemistry of Blood. (Contd...)
Reference Value
Component Fluid Conventional SI Units
Glucose (fasting) Plasma
normal 70-100 mg/dl < 5.6 mmol/L
impaired fasting glucose (IFG) 101-125 mg/dl 5.6-6.9 mmol/L
diabetes mellitus >126 mg/dl >7.0 mmol/L
Glucose (2-hr post-prandial) Plasma
normal <140 mg/dl <7.8 mmol/L
impaired glucose tolerance (IGT) 140-200 mg/dl 7.8-11.1 mmol/L
diabetes mellitus >200 mg/dl >11.1 mmol/L
Haemoglobin A 1C Whole blood 4-6% 0.04-0.06 Hb fraction
Immunoglobulins Serum
IgA 70-350 mg/dl 0.70-3.50 g/L
IgD 0-14 mg/dl 0-140 mg/L
IgE <0.025 mg/dl 24-430 µg/L
IgG 700-1700 mg/dl 7.0-17.0 g/L
IgM 50-300 mg/dl 0.50-3.0 g/L
Lactate Plasma (arterial) 4.5-14.4 mg/dl 0.5-1.6 mmol/L
Lactate dehydrogenase (LDH) Serum 115-221 U/L 2.0-3.8 μkat/L
Lactate/pyruvate ratio 10/1
Lipase Serum 3-43 U/L 0.51-0.73 μkat/L
Lipids See under cholesterol
Lipoproteins Serum 0-30 mg/dl 0-300 mg/L
5- Nucleotidase Serum 0-11 U/L 0.02-0.19 μkat/L
Oxygen (% saturation)
arterial blood Whole blood 94-100%
venous blood Whole blood 60-85%
pH Blood 7.35-7.45 7.35-7.45
Phosphatases
acid phosphatase Serum 0-5.5 U/L 0.90 μkat/L
alkaline phosphatase Serum 33-96 U/L 0.56-1.63 μkat/L
Phosphorus, inorganic Serum 2.5-4.3 mg/dl 0.81-1.4 mmol/L APPENDIX
Potassium Serum 3.5-5.0 mEq/L 3.5-5.0 mmol/L
Prostate specific antigen (PSA) Serum 0-4.0 ng/ml 0-4.0 µg/L
Proteins Serum
total 6.7-8.6 g/dl 67-86 g/L
albumin 3.5-5.5 g/dl (50-60%) 35-55 g/L
globulins 2.0-3.5 g/dl (40-50%) 20-35 g/L
α globulin 0.2-0.4 g/dl (4-7%) 2-4 g/L Normal Values
1
α globulin 0.5-0.9 g/dl (7-10%) 5-9 g/L
2
β globulin 0.6-1.1 g/dl (9-15%) 6-11 g/L
γ globulin 0.7-1.7 g/dl (13-23%) 7-17 g/L
A/G ratio 1.5-3 : 1
Pyruvate Plasma (arterial) 0.35-1.14 mg/dl 40-130 µmol/L
Renal blood flow 1200 ml/min
Rheumatoid factor Serum < 30 IU/ml < 30 klU/L
Sodium Serum 136-146 mEq/L 136-146 mmol/L
Thyroid function tests
radioactive iodine uptake
(RAIU) 24-hr 5-30%
thyroxine (T 4 ) total Serum 5.4-11.7 μg/dl 70-151 nmol/L
triiodothyronine (T 3 ) total Serum 77-135 ng/dl 1.2-2.1 nmol/L
thyroid stimulating hormone (TSH) Serum 0.4-5.0 μU/ml 0.4-5.0 mU/L
Contd...

900
  TABLE A-3: Clinical Chemistry of Blood. (Contd...)
Reference Value
Component Fluid Conventional SI Units
Troponins, cardiac (cTn)
troponin I (cTnI) Serum 0-0.08 ng/ml 0-0.8 μg/L
troponin T (cTnT) Serum 0-0.01 ng/ml 0-0.1 μg/L
Urea Blood 20-40 mg/dl 3.3-6.6 mmol/L
Urea nitrogen (BUN) Blood 7-20 mg/dl 2.5-7.1 mmol/L
Uric acid Serum
males 3.1-7.0 mg/dl 0.18-0.41 μmol/L
females 2.5-5.6 mg/dl 0.15-0.33 μmol/L


  TABLE A-4: Other Body Fluids.

Reference Value
Component Fluid Conventional SI Units
Body volume, water
total 50-70% (60%)
intracellular 33%
extracellular 27%
interstitial fluid including lymph fluid 12%
intravascular fluid or blood plasma 5%
fluid in mesenchymal tissues 9%
transcellular fluid 1%
Catecholamines 24-hr urinary excretion
epinephrine < 10 ng/day
free catecholamines <100 μg/day
metanephrine <1.3 mg/day
vanillyl mandelic acid (VMA) <8 mg/day
Cerebrospinal fluid (CSF) CSF
CSF volume 120-150 ml
CSF pressure 60-150 mm water
leucocytes 0-5 lymphocytes/μl
pH 7.31-7.34
glucose 40-70 mg/dl
proteins 20-50 mg/dl
APPENDIX
FIGLU 24-hr urine <3 mg/day <17.2 μmol/day
Gastric analysis Gastric juice
24-hr volume 2-3 L
pH 1.6-1.8 1.6-1.8
basal acid output (BAO) 1-5 mEq/hr 1-5 mmol/hr
maximal acid output (MAO) 5-40 mEq/hr 5-40 mmol/hr
after injection of stimulant
BAO/MAO ratio <0.6
Glomerular filtration rate (GFR) Urine 180 L/day (about 125 ml/min)
Normal Values
5-HIAA 24-hr urinary excretion 2-9 mg/day 10-47 μmol/day
17-Ketosteroids 24-hr urinary excretion
males 7-25 mg/day
females 4-15 mg/day
Seminal fluid Semen
liquefaction Within 20 min
sperm morphology >70% normal, mature spermatozoa
sperm motility >60%
pH >7.0 (average 7.7)
6
sperm count 60-150 million/ml 60-150 × 10 /ml
volume 1.5-5.0 ml
Contd...

901
  TABLE A-4: Other Body Fluids. (Contd...)
Reference Value
Component Fluid Conventional SI Units

Stool examination Stool
coproporphyrin 400-1000 mg/day
faecal fat excretion <6.0 g/day
occult blood Negative (<2 ml blood /day)
urobilinogen 40-280 mg/day
D-xylose excretion Stool 5-8 g within 5 hrs after oral dose of 25 g
Schilling’s test 24-hr urinary excretion >10% of ingested dose of ‘hot’
(Intrinsic factor test) vitamin B 12 (Details on page 308)
Urine examination 24-hr volume 600-1800 ml (variable)
pH Urine 5.0-9.0
specific gravity, quantitative Urine (random) 1.002-1.028 (average 1.018)
protein excretion 24-hr urine <150 mg/day
protein, qualitative Urine (random) Negative
glucose excretion, quantitative 24-hr urine 50-300 mg/day
glucose, qualitative Urine (random) Negative
porphobilinogen Urine (random) Negative
urobilinogen 24-hr urine 1.0-3.5 mg/day
microalbuminuria (24 hour) 0-30 mg/24 hr 0-0.03 g/day
(0-30 µg/mg creatinine) (0-0.03 g/g creatinine)
Urobilinogen Urine (random) Present in 1: 20 dilution


  TABLE A-5: Normal Haematologic Values.
Reference Value
Component Fluid Conventional SI Units

Erythrocytes and Haemoglobin
Erythrocyte count Blood
males 4.5-6.5 × 10 /L (mean 5.5 × 10 /L)
12
12
females 3.8-5.8 × 10 /L (mean 4.8 × 10 /L)
12
12
Erythrocyte diameter 6.7-7.7 μm (mean 7.2 μm) APPENDIX
Erythrocyte thickness
peripheral 2.4 μm
central 1.0 μm
Erythrocyte indices (Absolute values) Blood (also see page 288)
mean corpuscular haemoglobin (MCH) 27-32 pg
mean corpuscular volume (MCV) 77-93 fl
mean corpuscular haemoglobin
concentration (MCHC) 30-35 g/dl Normal Values
Erythrocyte life-span Blood 120+30 days
Erythrocyte sedimentation rate (ESR) Blood
Westergren 1st hr, males 0-15 mm
females 0-20 mm
Wintrobe, 1st hr, males 0-9 mm
females 0-20 mm
Ferritin Serum
males 30-250 ng/ml 30-250 μg/L
females 10-150 ng/ml 10-150 μg/L
Folate
body stores 2-3 mg
daily requirement 100-200 μg
red cell level Red cells 150-450 ng/ml 340-1020 nmol/L
serum level Serum 6-18 ng/ml 12-40 nmol/L
Free erythrocyte protoporphyrin (FEP) Red cells 20 μg/dl
Contd...

902
  TABLE A-5: Normal Haematologic Values. (Contd...)
Reference Value
Component Fluid Conventional SI Units
Haematocrit (PCV) Blood
males 40-54% 0.47 ± 0.07 L/L
females 37-47% 0.42 ± 0.05 L/L
Haptoglobin Serum 60-270 mg/dl 0.6-2.7 g/L
Haemoglobin (Hb)
adult haemoglobin (HbA) Whole blood
males 13.0-18.0 g/dl 130-180 g/L
females 11.5-16.5 g/dl 115-165 g/L
plasma Hb (quantitative) 0.5-5 mg/dl 5-50 mg/L
haemoglobin A (HbA ) 1.5-3.5%
2
2
haemoglobin, foetal (HbF) in adults <1%
HbF, children under 6 months <5%
Iron, total Serum 40-140 μg/dl 7-25 μmol/L
total iron binding capacity (TIBC) Serum 250-406 μg/dl 45-73 μmol/L
iron saturation Serum 20-45% (mean 33%) 0.20-0.45
Iron intake 10-15 mg/day
Iron loss
males 0.5-1.0 mg/day
females 1-2 mg/day
Iron, total body content
males 50 mg/kg body weight
females 35 mg/kg body weight
Iron, storage form (ferritin and haemosiderin) 30% of body iron
Osmotic fragility Blood
slight haemolysis at 0.45 to 0.39 g/dl NaCl
complete haemolysis at 0.33 to 0.36 g/dl NaCl
mean corpuscular fragility 0.4-0.45 g/dl NaCl
Reticulocytes Blood
adults 0.5-2.5%
infants 2-6%
Transferrin Serum 200-400 mg/dl 2-4 g/L
Vitamin B 12
body stores 10-12 mg
daily requirement 2-4 μg
APPENDIX
serum level Serum 280-1000 pg/ml 280-1000 pmol/L
Leucocytes

Differential leucocyte count (DLC) Blood film/CBC counter
P (polymorphs or neutrophils) 40-75% (2,000-7,500/μl)
L (lymphocytes) 20-50% (1,500-4,000/μl)
M (monocytes) 2-10% (200-800/μl)
E (eosinophils) 1-6% (40-400/μl)
B (basophils) < l% (10-100/μl)
Normal Values
Muramidase Serum 5-20 μg/ml
Total leucocyte count (TLC) Blood
adults 4,000-11,000/μl
infants (full term, at birth) 10,000-25,000/μl
infants (1 year) 6,000-16,000/μl
Myelogram See Table 12.2 on page 287
Platelets and Coagulation
Bleeding time (BT)
Ivy’s method Prick blood 2-7 min
template method 2.5-9.5 min
Contd...

903
  TABLE A-5: Normal Haematologic Values. (Contd...)
Reference Value
Component Fluid Conventional SI Units
Clot retraction timeClotted blood
qualitative Visible in 60 min (complete in <24-hr)
quantitative 48-64% (55%)
Clotting time (CT) Whole blood
Lee and White method 4-9 min at 37°C
Euglobin lysis time 72 hr
Fibrinogen Plasma 200-400 mg/dl 2-4 g/L
Fibrin split (or degradation) Plasma <10 μg/ml <10 mg/L
products (FSP or FDP)
Partial thromboplastin time
with kaolin (PTTK) or activated
partial thromboplastin time
(APTT) Plasma 30-40 sec
Platelet count Blood 150,000-400,000/μl
Prothrombin time (PT) Plasma 10-14 sec
(Quick’s one-stage method)
Thrombin time (TT) Plasma <20 sec (control ± 2 sec)


❑ APPENDIX



































Normal Values

904

Further Readings








In compilation of the material in this textbook, books and original works Underwood, JCE: General and Systemic Pathology, 2nd ed. Edinburgh,
of several authors listed below have been consulted which are gratefully Churchill Livingstone, 1992.
acknowledged. In order to stimulate an inquisitive and indulgent reader, Walter JB, Israel MS: General Pathology, 7th ed. Edinburgh, Churchill
general references used as the resource material for the book have Livingstone, 1997.
been given below; this is followed by chapter-wise compilation of
additional references consulted. An author index in alphabetic order
has been followed. SECTION I: GENERAL PATHOLOGY AND
BASIC TECHNIQUES
GENERAL (COMMON TO ALL CHAPTERS)
Boyd, William: Pathology—Structure and Function in Disease, 8th ed. CHAPTER 1: INTRODUCTION TO PATHOLOGY
Philadelphia, Lea & Febiger, 1970.
Deodhare SG: YM Bhende’s General Pathology and Pathology of
Copstead LC, Banasik JL: Pathophysiology, 3rd Ed. St Louis, Elsevier- Systems (2 vols), 6th ed. Mumbai, Popular Prakashan, 2002.
Saunders, 2005.
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Radiographic Correlations. Philadelphia, JB Lippincott Company, London, Arnold, 1997.
1992. Kleinues P et al: WHO Classification of Tumours: Pathology and
Schajowicz F et al: WHO Histological Typing of Bone Tumours, 2nd Genetics of Tumours of the Nervous System. Lyon IARC Press,
ed. Berlin, Springer-Verlag, 1993. 2000.
Smith NM, Keeling JW: Paediatric solid tumours. In Recent Advances Mastrianni JA, Roos RP: The prion diseases. Semin Neurol 20: 337,
in Histopathology, number 17, Anthony PP et al (Eds). London, 2000.
Churchill Livingstone, pp 191, 1997.
Snaith ML: ABC of rheumatology: gout, hyperuricaemia, and crystal APPENDIX : NORMAL VALUES
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Anderson WAD, Kissane JM: Pathology, 9th ed. St Louis, The CV Mosby
Unni KK: Dahlin’s Bone Tumours, 5th ed. Philadelphia, Lippincott-Raven, Company, 1977.
1996.
Boyd, William: Pathology—Structure and Function in Diseases, 8th
ed. Philadelphia, Lea & Febiger, 1970.
CHAPTER 29: SOFT TISSUE TUMOURS
Dacie JV, Lewis SM: Practical Haematology, 7th ed. London, Churchill
Ashley DJB: Evan’s Histological Appearance of Tumours, 4th ed. Livingstone, 1991.
London, Churchill Livingstone, 1996. Fauci AS et al: Harrison’s Principles of Internal Medicine (2 vols), 17th
Fletcher CDM: Soft tissue tumours—an update. In Recent advances in ed. New York, McGraw-Hill Medical, 2008.
Histopathology, number 15, Anthony PP et al (Eds). London, Gilbert-Barness E: Potter’s Pathology of the Fetus and Infant (2 vols).
Churchill Livingstone, pp 113, 1992. St Louis, Mosby, 1997.
Leyvraz S et al: Histological diagnosis and grading of soft tissue Greer JP et al: Wintrobe’s Clinical Haematology (2 vols), 11th ed.
sarcomas. Semin Surg Oncol 4: 3, 1988. Philadelphia, Lippincott Williams & Wilkins, 2004.
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4th ed. St Louis, Mosby, 2001. Kluwer (India) Pvt Ltd, 2007.



q FURTHER READINGS



911

Index








The letter t after page number in the index below denotes Table and the letter f stands for Figure on that page.

A clinical manifestations of, 72-74, 72f thyroid, 810
CDC classification of, 71 tubular, 584
AA protein, 83-86 CNS manifestations in, 72, 878, 878t tubulovillous, 584-85
ABC staging, 589 epidemiology of, 67-68 villoglandular, 584-85
Aberrant thyroid, 812 etiologic agent of, 68 villous, 584
Abscess, 145 Kaposi’s sarcoma in, 226, 414-16 Adenoma-carcinoma sequence colon, 586-87,
amoebic liver, 188, 615 laboratory diagnosis of, 587f
apical, 529 natural history of, 70-71, 70t Adenomyosis, 732
appendix, 579 oral manifestations in, 523t Adenosis, sclerosing, 757
Bartholin’s, 721 paediatric, 73 Adenoviruses, 226
brain, 877 pathogenesis of, 69-70, 69f ADH, 98, 794
breast, 45, 755 pathologic changes in, 71-73, 72f Adhesion molecules, 25
Brodie’s, 832 pneumonias in, 474, 474t Adipose tissue, tumours of, 865-67
cold, 518 routes of transmission of, 68 Adnexal (appendageal) tumours, 785-86
crypt, 568, 569f tuberculosis in, 151 Adrenal crisis, 798
Darier-Pautrier, 790 Acrochordons, 722, 780 Adrenal gland, 796-801
liver, 614-15 Acromegaly, 793-94 cortex, 796
lung, 475-76 ACTH, 792f, 793-94, 796 in shock, 113
pelvic, 738-39 Actinic keratosis, 782 medulla, 797
perinephric, 682 Actinomycosis, 163-64 normal structure of, 796-97
peritonsillar, 518 Activated partial thromboplastin time tumours of, 799-801
psoas, 833 (APTT), 330 Adrenal virilism, 798
pyaemic, 145, 146f Acute inflammation, see under Adrenocortical hyperfunction
pyogenic, 145 Inflammation, acute, 130-147 (hyperadrenalism), 797-98
retropharyngeal, 518 Acute phase reactant proteins, 64, 83, 140-41 Adrenocortical insufficiency,
stitch, 168 Acute transforming viruses, 227 acute primary (adrenal crisis), 798
tubo-ovarian, 738-39 Adamantinoma, 841t chronic primary (Addison’s disease),
Absolute values, 288-89, 901t Adaptations, cellular, 53-59, 54f 798-99
Acanthocytosis, 293 Addison’s disease, 798 secondary, 799
Acantholysis, 769, 776 Addison, Thomas, 3 Adrenogenital syndrome, 798 INDEX
Acanthosis, 769 Addisonian anaemia, 309-10 Adult T cell leukaemia lymphoma (ATLL),
Acanthosis nigricans, 231t Addressins, 342 227-28, 379-80
Accumulations, intracellular, 37-40 Adenoameloblastoma, 532 Aeroembolism, 122-23
fatty, 37-39 Adenocarcinoma, kidney, 694-96 AgNOR, 198
glycogen, 40 Adenocarcinoma, oesophagus, 542 Aflatoxin B, 219t, 634
proteins, 39 Adenocarcinoma, prostate, 718-20 Agenesis, 256
Acetyl choline receptors (AChRs), 857, 580 Adenocarcinoma, Aggregation, platelet, 115, 328, 334
Acidophil body, 611 salivary gland, 537 Aging, cellular, 59-60
Achalasia, 538 urinary bladder, 702 organ changes in, 60
Achlorhydria, 545, 550 Adenofibroma, ovary, 745 Agranulocytosis, 76
Achondroplasia, 834 Adenoid cystic carcinoma, 537 AGUS, 272
Acid phosphatase, Adenolymphoma, 535 AIDS-dementia complex, 72, 878
bony, 830 Adenoma, Air-dried smears versus wet-
prostatic, 720 adrenocortical, 799
Acid-base balance, 94 bile duct,643 dried smears, 280t
Acid-fast staining, 149, 157 breast, 757-58 Air pollution, 236-37
Acidophil index, 269, 269t bronchial, 497t AJC staging, 205, 861
Acidosis, cortical, adrenal, 799 AL protein, 82-83, 84-85
metabolic, 103-04, 103t cortical, kidney, 693 Albinism, 40
respiratory, 103-04, 103t follicular, 810-11 Albright syndrome, 40, 838
Acinic cell carcinoma, salivary gland, 537 hepatocellular, 633 Alcian blue, 12t
Acinus, liver, 592-93, 592f Hurthle cell, 810-11 Alcoholic hyalin, 35, 621
Acinus, lung, 467 monomorphic, 535 Alcoholic liver disease and cirrhosis, 239,
Ackerman, Lauren, 5 oxyphil, 535-36 622-24
Acne vulgaris, 771 parathyroid, 817-18 alcohol metabolism in, 238, 240f, 619-20
Acoustic neuroma, 515, 893 pituitary, 795-96 hepatitis in, 621-22
Acquired immunodeficiency syndrome pleomorphic, 534-35 laboratory diagnosis of, 624
(AIDS), 67-73 sebaceous, 786 pathogenesis of, 620-21

912 risk factors in, 620 secondary systemic (reactive), 36 Anaphase lag, 258
steatosis, 621-22 senile, 37 Anaphylactic reaction, 73-76
Alcoholism, 238-40, 620 spleen, 90-91 Anaphylatoxins, 136, 137f
Aldosterone, 98, 686-87, 796 staining, characteristics of, 87-88 Anaplasia, 197-99
Alizarin red S, 13t, 51 systemic, 86-87 Anasarca, 96
Alkaline phosphatase, 595, 830 transthyretin in, 83, 87 Anatomy, morbid, 7
Alkalosis, 104 tumour-forming, 87 Androblastoma,
metabolic, 104 Amyotropic lateral sclerosis, 857 ovary, 749
respiratory, 104 Anaemia of blood loss, 294-95 testis, 713
Alkaptonuria, 40-41 Anaemia of chronic disorders, 302-03 Anencephaly, 256
Allergic vasculitis, 47f, 402-03 Anaemia, aplastic, 325-26 Aneuploidy, 258
Allergy, 66, 141 causes of, 325t Aneurysmal bone cyst, 839f, 840
Allograft, 65 clinical features of, 325 Aneurysms, 405-09
Alpha-1 antitrypsin deficiency, etiology and classification of, 325 atherosclerotic, 406
cirrhosis in, 628-29 laboratory findings in, 325-26 berry, 406, 882
emphysema, 479-80 treatment of, 326 classification of, 405
Alpha-foetoprotein (AFP), 234, 636 Anaemia, Cooley’s, 320 definition of, 405
Alpha-protease inhibitor, 479-80 Anaemia, Fanconi’s, 325 dissecting, 407-08
Alport’s syndrome, 678 Anaemia, general considerations, 291-95 syphilitic (luetic), 406-07
Alternate pathway disease, 664 classification of, 294t Angiitis, 400-05
Altitude, high, 123 clinical features of, 291-92 Angina pectoris, 429
Alveolar proteinosis, 494-95 investigations of, 292-94 Angina preinfarction, 429
Alveolar septa, 461 pathophysiology of, 291 Angina, Ludwig’s, 517
Alveolar soft part sarcoma, 869 Anaemia, haemolytic, 310-24 Angina, Vincent, 517
Alzheimer’s disease, 37, 884 acquired (extracorpuscular), 311-14 Angiodysplasia, 581
Amaurosis, 262 autoimmune (AIHA), 312-13 Angiofibroma, nasopharyngeal, 518
Ameloblastoma, 531-32 classification of, 311t Angiogenesis, 167, 199
malignant, 532 cold antibody, 312-13
American Joint Committee (AJC) staging, 205, congenital, 314-24 Angiomyolipoma, 694
861 definition of, 310 Angioneurotic oedema, 76, 97, 770
Ames’ test, 220 drug-induced AIHA, 313 Angioplasty,
Aminotransferase, 595, 898t extracorpuscular, 311-14 balloon, 459-60
Amniotic fluid embolism, 123-24 general features of, 311 Angiosarcoma, 414, 633
Amoebiasis, 187-88, 580t Heinz body, 317, 320 Angiotensin, 98, 686-87, 796
Amoeboma, 188 hereditary (intracorpuscular), 314-24 Anisocytosis, 197, 292
Ampulla of Vater, carcinoma of, 592 immunohaemolytic, 312-13 Anisonucleosis, 198
Amyloidosis, 82-92 in direct toxic effects, 313-14 Anitschkow cells, 440
AA protein, 83-84 in splenomegaly, 314 Ankyrin, 315
AL protein, 82-83 intracorpuscular, 314-24 Ann Arbor staging, 372t
alimentary tract, 92 isoimmune, 311t, 340-41 in Hodgkin’s disease, 372-73
biopsy in, 88 microangiopathic, 313 in non-Hodgkin’s lymphoma, 380
cardiac, 87, 90 red cell membrane defects, 314-16 Annexin V, 48
chemical nature of, 82-83 warm antibody, 312 Anoxia, brain, 45, 879-81
classification of, 85-87 Anaemia, haemorrhagic, 294-95 Anthracosis, 43, 44f, 488
INDEX
diagnosis of, 88 Anaemia, hypochromic, 295-300, 302t Anthrax, 178
dialysis-associated, 86-87 Anaemia, iron deficiency, 295-300 Anti D, 339
endocrine, 87 bone marrow findings in, 299-300 Antibody, 61
enhancing factor (AEF), 84f, 85 clinical features of, 298-99 Antibody-dependent cell-mediated cytotoxicity
fibril proteins in, 82-83 etiology of, 297-98 (ADCC), 64, 229-30
glycosaminoglycans, 83 iron metabolism in, 295-96 Antidiuretic hormone (ADH), 98, 794
haemodialysis-associated, 86-87 laboratory findings in, 299-300 Anti-endothelial cell antibodies (AECAs), 402
heart, 87, 90 pathogenesis of, 296-97 Anti-GBM disease, 664
heredofamilial, 87 treatment of, 300 Anti-heart antibodies, 436
immunohistochemistry in, 88 Anaemia, Mediterranean, 320-24 Anti-neutrophilic cytoplasmic antibodies
in diabetes mellitus, 822f Anaemia, megaloblastic, 303-10 (ANCAs), 402
in leprosy, 86 biochemical basis of, 305 Anti-oncogenes, 212-14, 213t
in medullary carcinoma, biochemical findings in, 307 versus oncogenes, 214t
thyroid, 87, 813-14, 815f bone marrow findings in, 307 Antigen, 61
in tuberculosis, 86 clinical features of, 306 tumour, 229
kidneys, 89-90 etiology and classification of, 305-06, 305t tumour-associated, 229
liver, 90-91 laboratory findings in, 306-09 tumour specific, 229
localised, 87 treatment of, 309 Antigen-antibody complex, 61, 662-64
metachromasia in, 87-88 Anaemia, microcytic hypochromic, 294t, 299 Antinuclear antibodies (ANAs), 78
morphologic features of, 88-92 Anaemia, myelophthisic, 326 Antioxidants, 33
non-fibrillar components in, 83 Anaemia, normocytic and normochromic, 294t, Antisperm antibodies, 76
physical nature of, 82-83 302 Antithiamines, 252
P-component of, 83 Anaemia, pernicious, 309-10 Antithrombotic factors, 114
pathogenesis of, 83 Anaemia, sideroblastic, 300-02 Antoni A and B, 893
polarising microscopy in, 89f, 91f, 813-14 classification of, 301 Aortic arch syndrome, 404
primary systemic, 86 Anal canal, tumours of, 589-90 Aortic atheroma versus
prion proteins in, 83, 878-79 Anal fissure, 581 syphilitic aortitis, 402t

Aortic valve, Asclepios, 2 B 913
atresia, 426 Ascorbic acid, 251
insufficiency, 451 ASCUS, 271 Bacteraemia, 145
stenosis, 426, 450-51 Aspergillosis, 181t, 219, 476-77, 477f, 634 Bacterial diseases, 176t, 175-81
Aortitis, syphilitic, Aspiration, bone marrow, 286-87 Bacterial endocarditis, 445-49
versus aortic atheroma, 402t Aspirin therapy, in platelet functions, 334-35 acute, 445
APC gene, 586-87 Aster-Coller staging, 589, 591t acute versus subacute, 445
Apical abscess, 529 Asteroid bodies, 165 cardiac complications in, 448
Apical granuloma, 529 Asthma, 483-84 complications and sequelae of, 447-48
Aplasia, 256 extrinsic versus intrinsic, 483t definition of, 445
Apocrine tumours, 786 Astrocytoma, 887-88 etiology of, 445-46
Apoplectic cyst, 881 Ataxia telangiectasia, 215, 770 extra-cardiac complications of, 448
Apoptosis, 46-49 Atelectasis, 465 morphologic features of, 446-47
versus necrosis, 48t Atheroma, 398-400, 427 pathogenesis of, 446
Apoptotic bodies, 45f, 47f Atheromatous plaques, 398-99, 427 predisposing factors in, 445-46
Appendicitis, 577-78 calcification in, 399 subacute, 446
Appendix, 577-79 complicated, 398-99 Bacterial index (BI), in leprosy, 158
mucocele of, 579 Atherosclerosis, 393-400 Bactericidal mechanisms, 135-36
normal structure of, 577-78 alcohol in, 395 Bagassosis, 488t, 493
tumours of, 579 calcification in, 399 Balance, acid base, 94
APUD cell system, 561, 791 Chlamydia pneumoniae in, 395 water and electrolyte, 93-94
Apudoma, 576 clinical effects of, 399-400 Balanitis xerotica obliterans, 714
Arachidonic acid metabolites, 137-38 coronary, 427-28 Balanoposthitis, 714
Argentaffin cells, 561 definition of, 393 Ball valve thrombus, 118
Argentaffinoma, 576-77 etiology of, 393-95 Ballooning degeneration, 611
Argyria, 43 homocystinuria in, 395 Banding techniques, 257
Arias-Stella reaction, 731 monoclonal hypothesis in, 397 Banti’s spleen (fibrocongestive splenomegaly),
Ariboflavinosis, 253 morphologic features of, 397-99 106-07, 108f, 387
Armanni-Ebstein lesions, 678 pathogenesis of, 395-97 Bantu’s siderosis, 42
Arnold-Chiari malformation, 873 reaction to injury Barr body, 257f, 275
Arrhenoblastoma, 749 hypothesis in, 395-96 Barrett’s oesophagus, 58f, 540-41
Arrhythmias, 435 risk factors in, 393-95, 393t Bartholin’s cyst and abscess, 721
Arsenic poisoning, 40 viruses in, 395 Basal cell carcinoma, 193t, 784-85
Arteries, normal structure of, 390, 391f Athlete foot, 773 Basedow’s disease, 806-07
Arteriolitis, necrotising, 392 Atmospheric pollutants, 236-37 Basement membrane, 170, 203f, 651
Arteriolosclerosis, 391-92 ATP, cellular, 29-30 Basophilia, 350
hyaline, 391 Atresia, punctate, 292
hyperplastic, 391-92 aortic, 426 Basophilic stippling, 292
necrotising, 392 biliary, 601-02 Basophils, 136, 141-42, 350
Arteriosclerosis, 391-400 intestinal, 561 Basosquamous carcinoma skin, 785
hypertensive, 391-92 oesophageal, 539 BAX protein, 49, 214
Mönckeberg’s, 392 pulmonary, 426 BCG vaccination, 152
senile, 391-92 tricuspid, 425-26 INDEX
Arteriovenous Atrial septal defect (ASD), 423-24 BCL-ABL gene, 210, 212, 355, 356f
BCL2, 214
malformations, 413 Atriopeptin hormone, 687
Arteritis, 400-05 Atrophy, 55 Bedsores, 50
cerebral, syphilitic, 401 brown, 43 Behaviour pattern, 395
giant cell, 403-04 testicular, 55f, 703-04 Bence Jones’ proteins, 86, 383
Heubner’s, 401 Atypical lymphocytes, 352 Benditt and Benditt, 395
hypersensitivity (allergic), 47f, 402-03 Atypical mycobacteria, 149-51 Benedict’s test, 826
infectious, 400-01 Auer rods, 364f Berger’s disease, 674
non-infectious, 402-05 Auerbach’s plexus, 561, 579 Beriberi, 252
rheumatic, 404, 443 Auspitz sign, 778 cerebral (Wernicke-Korsakoff syndrome),
syphilitic, 401-02 Australia antigen, 607 252
Takayasu’s, 404 Autocoids, 137 dry, 252
temporal (giant cell), 403-04 Autocrine motility factor, 204 heart disease in, 252
Arthritis, Autograft, 65 wet, 252
gouty, 853-55 Autohaemolysis test, 315 Bernard-Soulier syndrome, 334
osteoarthritis, 850-51 Autoimmune diseases, 77-81 Berry aneurysms, 406, 882
rheumatoid, 851-53 pathogenesis of, 77-78 Berylliosis, 493
suppurative, 853 types and examples of, 78-81, 78t Beta carotene, 247
tuberculous, 853 Autolysis, 44 Beta fibrillosis, 82
Arthus reaction, 76-77 Autophagy, 37 Beta-2 amyloid protein, 82
Asbestos bodies, 492f Autopsy pathology, 7 Beta-2-microglobulin, 83, 384
Asbestos disease, 492-93 Autosomal disorders, 260 Betel nut cancer, 206
pathogenesis of, 492 Avascular necrosis bone, 833-34 Bethesda system, 271, 726
morphologic features of, 492-93 Axial flow, 116, 133 Bezoars, 546
Aschoff cells, 440 Axonal degeneration, 892 Bichat, Xavier, 3
Aschoff nodules (bodies), 439-40 Ayre’s spatula, 276f Bicuspid aortic valve, 426, 450
Ascites, 102, 631 Azotaemia, 653 Bielschowsky silver stain, 13t

914 Bile acids (salts), test for, 593 Bovine spongiform encephalopathy (BSE), C
Bile lakes, 599-600 878-79
Bile plugs, 599 Bowen’s disease, 714-15, 782-83 Cachexia, 230
Biliary atresia, 601-02 Bowenoid papulosis, 715 Cadherins, 25, 203
Biliary cirrhosis, 625-27 Bowman’s space, 650 cafe-au-lait spots, 40, 206, 893
contrasting features of, 627t Boyd, William, 6 Caisson’s disease, 123
Biliary system, 638-44 Boyden’s chamber experiment, 134 Calcific aortic stenosis, 450
congenital anomalies of, 638 Brain, abscess, 877 Calcification, pathologic, 51-53
normal structure of, 638 Brain, metastatic tumours, 891 dystrophic, 51-52
tumours of, 643-44 Brain, oedema, 101-02, 882, 883f dystrophic versus metastatic, 54t
Bilirubin, 42, 311, 593 Branchial cyst, 520-21 metastatic, 51, 53
conjugated versus unconjugated, 598t BRCA gene, 214, 759 Calcifying epithelioma of
tests for, 593 Bread and butter appearance, 442 Malherbe, 785
Bilirubin metabolism, 596-97 Breast, 754-67 Calcinosis cutis, 779
Biopsy, surgical, 7, 9-11 cancer, 759-67 Calcitonin, 816
Bird-breeders’ lung, 494 fibrocystic changes in, 755-57 Calcitriol, 248-49
Bird flu, 185 grading of cancer of, 765 Calcospherites, 52
Birefringence, 88, 89f, 91f inflammatory diseases of, 755 Calculi, gallbladder, 638-41
Biotin, 253-54 normal structure of, 754-55 Calculi, urinary, 690-92
Bitot’s spots, 247f prognostic markers of carcinoma, 766-67 Calculus, gum, 529
Bittner milk factor, 207, 227, 760 silicone implant in, 755 Call-Exner bodies, 749
Blackfan-Diamond syndrome, 326 staging of carcinoma of, 765-66 Callender classification, 512
Blackwater fever, 189, 313 tumours of, 757-67 Callus formation, 172
Blast crisis in CML, 358 Brenner’s tumour, ovary, 745 Cambium layer, 867
Blastomas, 193, 207 Bright, Richard, 3 Cancer cervix, invasive, 728-30
Blastomycosis, 181t Broders’ grading, 204, 784 Cancer, definition of, 192
Bleeding disorders, also see under Brodie’s abscess, 832 diagnosis of, 232-35
Haemorrhagic diatheses, 328-38 Bromsulphalein (BSP) excretion test, 593 classification of, 192-93
Blepharoplasts, 872 Bronchial carcinoid, 503 characteristics of, 194-205
Bleeding time, 329 Bronchial, brushing, 272-73 genetic mechanisms of, 208-16
Blindness, 509 washing, 272-73 grading of, 204-05
night, 247 Bronchiectasis, 484-86 immune surveillance of, 228-30
Blood film examination, 292-93 Bronchiolitis and bronchiolitis obliterans, 465 metastasis in, 200-04
Blood group antigens and antibodies, 339-41 Bronchitis, chronic, 477-78 molecular pathogenesis of, 208-16
ABO system, 339t clinical features of, 478 multistep theory of, 215
Rh system, 339 etiopathogenesis of, 477-78 pathogenesis of, 208-28
Blood transfusion, 339-40 morphologic features of, 478 staging of, 204-05
complications of, 339-40 versus emphysema, 479t Cancrum oris, 523
components in, 340 Broncho-(lobular) pneumonia, 471-72 Candidiasis, 182, 270
Blood vessels, 390-416 Bronchogenic carcinoma, 496-503 Caplan’s syndrome, 490
tumours and tumour-like lesions of, 411-16 clinical features of, 502 Caput medusae, 632
Blood volume, 93 etiology of, 497-98 Carbon tetrachloride, 34, 618t
Blood-brain barrier, 598t, 872 pathogenesis of, 498-99 Carbuncle, 145, 179
Bloom’s syndrome, 221, incidence of, 497 Carcinoembryonic antigen (CEA), 234, 709
INDEX
Blots, morphologic features of, 499-501 Carcinogenesis,
northern, 17 prognosis of, 503 biologic, 208-28
southern, 17 spread of, 501-02 chemical, 216-20
Blue-dome cysts, 756 staging of, 503 genetic theory of, 209
Boeck’s sarcoid, 164-65 Bronchopulmonary physical, 220-21
Bohr effect, 290 sequestration, 462 viral, 222-28
Boil, 145, 179 Bronzed diabetes, 42 Carcinoid heart disease, 451
Bombay blood group, 339 Brooke’s tumour, 785 Carcinoid syndrome, 451, 577
Bone Brown atrophy, heart, 43 Carcinoid tumour, 576-77
cysts, 839-40 Brown induration, lung, 41, 106 appendix, 579
lamellar, 830 Brown tumour of hyperparathyroidism, 816, bronchial, 503
metastatic tumours in, 850 836 colon, 589
normal structure of, 830-31 Bubos, 177 small intestine, 576-77
tumour-like lesions of, 837-40 Buccal smear, 257f, 274-75 stomach, 559
tumours of, 840-50 Budd-Chiari syndrome Carcinoma, acinic cell, 537
woven, 830 (hepatic vein thrombosis), 603-04 Carcinoma, adenoid cystic, 537
Bone marrow, 284-87 Buerger’s disease, 404-05 Carcinoma, adrenal cortex, 799
aspiration versus trephine, 287 Buffer system, 94 Carcinoma, breast, 759-67
aspiration, 286-87 Bullous dermatoses, 775-78 adenoid cystic, 763-64
examination, 285-87 Burkitt’s lymphoma, 225, 377-78 classification of, 760t
failure, 324-26 Burr cells, 293f colloid, 763, 764f
transplantation, 326, 365, 374 Bursa of Fabricius, 62t, 342 etiology of, 759-60
trephine biopsy, 286-87 Bursitis, 856 grading of, 765
Botryoid rhabdomyosarcoma, 519, 724, 867, 868f Button-hole appearance, 441 prognosis of, 766-67
Botulism, 181 Bypass, coronary grafting, 460 staging of, 765-66
Bouin’s fixative, 652 Byssinosis, 493-94 infiltrating duct (NOS), 761-62

infiltrating lobular, 762-63 Carcinoma, thyroid, 811-15 embryonal tumours of, 889 915
inflammatory, 764 Carcinoma, transitional cell, 700-02 infections of, 873-79
intraductal, 760-61 Carcinoma, urinary bladder, 700-02 metabolic diseases of, 885
invasive, 761-65 Carcinoma, vagina, 724 metastatic tumours of, 891
juvenile, 764 staging of, 724t normal structure of, 871-72
lobular in situ, 761 Carcinoma, vulva, 723 nutritional diseases of, 886
medullary, 763 staging of, 723t trauma to, 882-83
mucinous, 763 Cardiac death, sudden, 429f, 436-37 tumours of, 886-91
non-invasive, 760-61 Cardiac oedema, 99, 100f Centrilobular haemorrhagic necrosis, 106, 107f
papillary, 763 Cardiomyopathies, 454t Centriole, 24, 257
prognostic factors in, 766-67 congestive, 454-55 Centromere, 24, 257
secretory, 764 dilated, 454-55 Centrosome, 24
tubular, 763 hypertrophic, 455 Cerebral infarction, 127f, 880-81
Carcinoma, cervix, 58, 207, 224-25, 728-30 idiopathic, 454-56 Cerebral malaria, 189, 313
cytology of, 271-72, 282f ischaemic, 436 Cerebral oedema, 101-02
staging of, 730t restrictive, 455-56 Cerebrospinal fluid (CSF), 873-76
Carcinoma, colorectal, 586-89 secondary, 456 findings in meningitis, 876t
clinical features of, 589 Cardiospasm, 538 cytology of, 276
etiology of, 586 Caries, dental, 528-29 Cerebrovascular disease, 879-82
morphologic features of, 587-88 Caries, spine, 833f, 838 Ceruloplasmin, 628
pathogenesis of, 586-87 Caroli’s disease, 638 Cerumen gland tumour, 514
spread of, 588-89 Carotenaemia, 43 Cervical intraepithelial neoplasia (CIN), 271-72,
staging of, 589, 590f, 591t Carotid body tumour, 521 725-28
Carcinoma, cortical, adrenal, 799 Carrier state, hepatitis, 609-10 Cervicitis, 724-25
Carcinoma, definition of, 192 Cartilage-forming tumours, 843-46 Cervix, 724-30
Carcinoma, embryonal, testis, 710-11 Cartilage normal structure of, 831 carcinoma of, 728-30
Carcinoma, endometrium, 735-37 Caruncle, urethral, 702 normal structure of, 724
staging of, 737t Caseous necrosis, 45, 153, 155-56 tumours of, 725-30
Carcinoma, extra-hepatic duct, 644 Castleman’s disease, 343-44 Chagas’ disease, 187t, 580
Carcinoma, gallbladder, 643-44 Casts, 652 Chalazion, 508
Carcinoma, hepatocellular, 633-36 Cat-scratch disease, 186 Chancre, 162
Carcinoma in situ, 58 Cataract, 510 Charaka, 2
breast, 760-61 Catarrhal inflammation, 144 Charcot-Leyden crystals, 484f
bronchus, 496-503 Catenins, 586-87 Chediak-Higashi syndrome, 349
cervix, 207, 271, 726, 727f Cavitary lesions of lung, 155-56, 156f Chemical carcinogenesis, 216-20
oral cavity, 525-26 C-cells, 816 initiation of, 216-18
skin, 714-15, 782-83 CD markers, 25, 62t, 63-64 initiators of, 219t
urinary bladder, 701 Cell adhesion molecules (CAMs), 25 promoters of, 219t
Carcinoma, kidney, 694-96 Cell aging, 59-60 promoter versus initiator, 220t
Carcinoma, liver, 633-36 Cell cycle, 26-27, 27f promotion of, 218
Carcinoma, lung, 496-504 labile cells in, 166 stages of, 216-20
acinar, 501 permanent cells in, 166 tests for, 220
adenocarcinoma, 500-01 stable cells in, 166 Chemical carcinogens, 219t INDEX
adenosquamous, 501 Cell death, 30-31, 44-53 Chemical injury, 33-34
bronchiolo-alveolar, 501 Cell injury, 21-53 Chemical mediators of inflammation, 136-40
epidermoid, 499-500 chemical, 33-34 Chemoattractants, 134
etiology of,497-98 enzyme markers of, 32t Chemodectoma, 521
pathogenesis of, 498-99 etiology of, 27-28 Chemokines, 26, 134
hilar, 499 free-radical, 31-33 Chemotaxis, 134
large cell, 501 hypoxic, 29-33 Chickenpox, 186
metastatic, 504
oat cell, 500 immunologic, 28, 73-77 Chikungunya, 184
peripheral, 499 irreversible, 30-31 Childhood tumours, 207, 264t, 265t
scar, 500 ischaemic, 29-33 Chlamydiae, 508
small cell, 500 microbial, 28, 174-91 Chloasma, 40
squamous cell, 499-500 morphology of, 34-37 Chloroma, 363
Carcinoma, mucoepidermoid, 536 pathogenesis of, 28-34 Chocolate cyst of ovary, 733
Carcinoma, nasopharyngeal, 225-26, 511-12 physical, 34 Cholangiocarcinoma, 636-37
Carcinoma, nose and paranasal sinuses, 518-19 reperfusion, 31-33 Cholangioma, 633
Carcinoma, oesophagus, 541-43 reversible, 29-30 Cholangitis, 614
Carcinoma, oral cavity, 526-27 Cell membrane, 21-22, 289 primary sclerosing, 626, 627t
Carcinoma, pancreas, 647-48 Cell structure, 21-24 pyogenic, 614
Carcinoma, parathyroid, 818 Cell-mediated reaction, 62t, 63, 77 Cholecystitis, 641-43
Carcinoma, penis, 715-16 Cellular adaptations, 53-59 acute, 641-42
Carcinoma, prostate, 718-19 Cellular swelling, 34-35 chronic, 642
Carcinoma, skin, 783-85, 787-90 Cellulitis, 145 glandularis, 642
Carcinoma, stomach, 555-60 Celsus, 2 Cholecystokinin, 639
clinical features of, 557-58 Cementomas, 532 Choledocholithiasis, 641
etiology of, 555 Cementum, 528 Cholelithiasis (gallstones), 638-41
incidence of, 555 Central nervous system (CNS), 871-91 Cholestasis, 599-600
morphologic features of, 555-57 degenerative diseases of, 884-85 extrahepatic, 599-600
spread of, 557 demyelinating diseases of, 883-84 intrahepatic, 599

916 Cholesteatoma (keratoma), 514-15 pathogenesis of, 618 Congenital heart diseases, 422-26
Cholesterolosis, 641f pigment, 627-28 acyanotic, 423-24
Choline, 254 portal hypertension in, 630-32 cyanotic, 424-26
Choline esterase, 857 post-hepatitic, 624-25 malpositions, 423
Chondroblastoma, 845 post-necrotic, 624-25 obstructive, 426
Chondrocytes, 839 Wilson’s disease, 628 Congestion, 105-08
Chondrodermatitis, 514 Clara cells, 461 local venous, 106-07
Chondroma, 844 Clark’s levels, 789 passive, 105-07
Chondromalacia, 514 Claude Bernarde, 93 systemic venous, 105f
Chondromyxoid fibroma, 845 Clear cell sarcoma, 869 Congestive heart failure (CHF), 105f, 419-22,
Chondrosarcoma, 845-46 Clear cell tumours, ovary, 745 420f
Chordoma, 849 Clefts, facial, 522 Congestive splenomegaly, 106-07, 387
Chorea minor, 443 Clinging carcinoma, breast, 766 Congo red, 88, 89f, 91f, 815f, 822f
Chorioadenoma destruens, 753 Clinicopathologic correlation (CPC), 3 Conjugated versus unconjugated bilirubin, 598t
Choriocarcinoma, 753 Cloning, 7 Conjunctivitis, 508
gestational, 753 Clostridial diseases, 180-81 Conn’s syndrome, 797-98
nongestational, 748 Clotting system, 116f, 139, 329-30 Consolidation, 468-71
testis, 711 Clotting time, 330 Consumptive coagulopathy, 337-38
Choristoma, 193, 796 Cloudy swelling, 34-35 Contraceptives, oral, 239t, 633
Choroid plexus papilloma, 889 CNS tumours, 886-91 Contractures, 170
Christmas disease, 335-36 Coagulation disorders, 335-38 Coombs’ test, 76, 311, 341
Chromaffin tumour, 799-800 Coagulation system, 116f, 139, 329-30 Copper metabolism, 254, 628
Chromatin, sex, 257f, 275 Coagulation tests, 329-31 Cor bovinum, 252
Chromogens, 15 Coagulative necrosis, 45 Cor pulmonale, 437-38
Chromosomes, 6, 22-23 Coal-workers’ pneumoconiosis, 488-90 Cord factor, 152
Chronic inflammation, 147-65 Coarctation of aorta, 426, 687 Coronary artery disease (CAD),
(also see under Inflammation) Coccidioidomycosis, 181t (also see under IHD), 427-37
Chronic ischaemic heart disease, 436 Codman’s triangle, 842 Coronary syndromes, acute, 428
Chronic lymphocytic leukaemia (CLL), 375-77 Coeliac disease, 575 Corpora amylacea, 718f, 872
Chronic myeloid leukaemia (CML), 357-59 Coeliac sprue, 575 Corrigan’s pulse, 451
blastic phase in, 358 Coelomic epithelium, 739 Cortical necrosis kidney, 690
juvenile CML, 357 ovarian tumours of, 741-45 Councilman (acidophil) body, 611
Chronic obstructive pulmonary disease Coffee-bean nuclei, 745 CPC, 3
(COPD), 477-86 Cohnheim, 5 Craniopharyngioma, 796, 886t
bronchial asthma, 483-84 Cold abscess, 153 Craniotabes, 249
bronchiectasis, 484-86 Cold agglutinin disease, 312-13 Crescents, 668
chronic bronchitis, 477-78 Colitis, 580t CREST syndrome, 80-81
emphysema, 478-83 amoebic, 187-88, 572-73 Cretinism, 803
versus restrictive lung disease, 486t pseudomembranous, 573 Creutzfeldt-Jakob disease, (CJD), 878-79
Chronic restrictive pulmonary disease, 486-96 ulcerative, 565-69 Cri du chat syndrome, 259
collagen vascular disease, 495 Collagen, 170 Cribriform pattern, 537, 781
idiopathic pulmonary fibrosis, 495-96 Collagen diseases, 77-81, 78t Crigler-Najjar syndrome, 601
immunologic lung disease, 493-95 Collagen vascular disease, 77-81 Crinopectins, 26
pneumoconiosis, 487-93 lung, 495 Cristae, 24
INDEX
versus COPD, 486t Collapse lung, 465 Crohn’s disease versus ulcerative colitis, 566t
Chronic venous congestion (CVC), 105-08 Colliquative necrosis, 45 Cronkhite-Canada syndrome, 585
kidney, 107 Colloid carcinoma, Crux of heart, 418
liver, 106-07 breast, 763, 764f Cryoprecipitate, 340
lungs, 106 stomach, 557 Crypt abscess, 568, 569f
spleen, 106-08 Colloids, plasma, 95, 97 Cryptococcosis, 176f, 181t, 876
Chutta cancer, 218 Colloid pressure, 95, 96-97 Cryptorchidism, 703-05
Chyle, 97, 410 Colony-stimulating factor, 25, 285 CSF, source and circulation of, 873, 874f
Chylothorax, 97, 411 Colorectal polyps, 582-86, 582t Curling’s ulcers, 550
Chyluria, 411 cancer, 586-89 Curschmann’s spiral, 484f
Cicatrisation, 170 neoplastic versus non-neoplastic, 585t Cushing’s syndrome, 797
Cilia, 24 Coma, nonketotic, 825 Cushing’s ulcers, 550
Circle of Willis, 406, 882 Combined (fast) smears, 268 Cyanmethaemoglobin method, 292
Cirrhosis, liver, 618-30 Comedo pattern, 761 Cyanocobalamin, 253, 303
alcoholic, 619-24 Comedones, 771 Cyclin dependent kinases (CDKs), 26, 27f
alpha-antitrypsin deficiency, 628 Commensals, 174 Cyclins, 26, 212
biliary, 625-27, 627t Common cold, 515 Cyclo-oxygenase pathway, 137, 138f
cardiac, 628-29 Complement system, 139-40, 664 Cylindroma, 786
classification of, 619t Complicated plaques, 398-99 Cystic diseases of kidney, 656-60
clinical manifestations and complications Components, blood, 341 Cystic fibrosis, pancreas, 645
of, 630 Computers in pathology lab, 19 Cystic hygroma, 412, 521
cryptogenic, 629 Concato’s disease, 458 Cystic hyperplasia, endometrium, 733, 734f
haemochromatosis, 627-28 Concentration and dilution tests, Cystic medial necrosis of Erdheim’s, 407
Indian childhood (ICC), 629 kidney, 652-53 Cysticercosis, 187t, 190, 879f
macronodular, 619, 624f Conchoid bodies, 165 Cystine stones, 692
micronodular, 618-19, 623f Concussion, 883 Cystitis, 699
mixed forms, 618 Condyloma acuminatum, 714, 722, 772 Cystitis cystica, 699

Cystosarcoma phyllodes, 758-59 role of, 266-67 Desmosomes, 25 917
Cysts, semen examination, 274 Developmental defects, 256-57
acquired renal, 659t staining in, 277 Devil’s pinches, 331
apoplectic, 881 techniques of, exfoliative cytology, 275-77 Dextrocardia, 423
Bartholin’s, 721 urinary tract, 273 Diabetes insipidus, 653, 795
biliary, 638 Cytomegaloviruses, 183t, 190-91 Diabetes mellitus, 818-28
bone, 839-40 Cytometry, flow, 18-19 atherosclerosis in, 394, 826
branchial (lymphoepithelial), 520-21 Cytoskeleton, 23-24 bronzed, 42
congenital pulmonary, 462 Cytosol, structure of, 23-24 chemical, 826
dental, 530 Cytotactin, 170 classification of, 818t
dentigerous, 530 Cytotoxic reaction, 76 clinical features of, 823-24
dermoid, 520, 746, 781-82 criteria for diagnosis of, 825t
echinococcal, 187t, 616-17 D complications of, 824-26
epidermal, 781 diagnosis of, 826-28
eruption, 530 Dane particle, 606 gestational, 819
follicular, 740 Darier’s disease, 770 MODY, 819
Gartner’s duct, 723 Darier-Pautrier abscess, 790 normal insulin metabolism in, 819-20
gingival, 530 DeBakey clasification, aneurysms, 407, 408f risk factors for, 819t
globulomaxillary, 531 Debridement, 169 morphologic features of, 822-23
hepatic, 632-33 Decay accelerating factor, 314 pathogenesis of, 819-22
implantation, 169, 781 Decidual reaction, 731 Diabetic ketoacidosis, 825, 826t
jaw, 529-31 Decompression sickness, 123 Diabetic microangiopathy, 826
kidney, 656t Defibrination syndromes, 337-38 Diabetic nephropathy, 826
lateral cervical, 520-21 Degenerations, 34-36 Diabetic neuropathy, 826
lung, 462 albuminous, 34-35 Diabetic retinopathy, 826
luteal, 740 fibrinoid, 46, 47f Diagnosis of cancer, 232-35
lymphoepithelial, 520-21 hyaline, 35 Dialysis-related bone disease, 836-37
mesenteric, 591 hydropic, 34-35 Diapedesis, 107, 134
midline cervical, 520 mucoid, 35-36 Diarrhoea, antibiotic-associated, 573
nasolabial, 530 vacuolar, 34-35 Diazo reaction, 593
nasopalatine, 530 Wallerian, 892 Diet and cancer, 254-55
neck, 520-21 Degenerations, peripheral nervous system, Differentiation of neoplastic cells, 197
odontogenic, 530 891-92 Diffuse alveolar damage (DAD), 463
pancreatic, 647 axonal, 891 Diffuse axonal injury, 883
pararenal, 659-60 segmental, 891 Dilatation, cardiac, 421-22
parathyroid, 521 Wallerian, 891 Diphtheria, 517
pilar (trichilemmal and sebaceous), 781 Degenerative joint disease (DJD), 850-51 Disease, definition of, 1
primordial, 530 Dehydration, 102 Dissecting aneurysm, 407-08
radicular, 530 Delayed hypersensitivity, 75f, 77, 152 Disseminated intravascular coagulation (DIC),
sebaceous, 781 Deletions, chromosomal, 259 337-38
simple renal, 659 Demyelinating diseases, 883-84 Disseminated (multiple) sclerosis, 883-84
thymic, 521 Dendrites, 871f Diuretic phase, 654
thyroglossal, 520 Dendritic cells, 64, 385 Divers’ palsy, 123 INDEX
trichilemmal, 781 Denervation atrophy, 857-58 Diverticula,
Wolffian, 723 Dengue fever, 184 Meckel’s, 561-62
oesophageal, 539
Cytocentrifuge, 277 Dense deposit disease, 664, 671-72 Diverticulosis coli, 581
Cytochemistry, 362t Dentin, 528 DNA chromosomal instability syndrome, 587
Cytogenetics, 257-59 Denver classification, 23, 257 DNA oncogenic viruses, 224t
Cytohormonal evaluation, 269 Dependent oedema, 99 DNA, structure of, 6f, 23
Cytokeratin, 23, 262f DeQuervain’s thyroiditis, 805-06 Doderlein bacilli, 269
Cytokines, 25-26, 138-39 Dermatitis (eczema), 770, 771f Dohle bodies, 348
Cytology, diagnostic, 266-83 Dermatitis herpetiformis, 777 Dominant pattern, 260
biopsy sediment, 283 Dermatofibrosarcoma protuberans, 789-90, 864 Donath-Landsteiner antibody, 313
branches of, 267 Dermatomyositis-polymyositis, 81, 495 Donovan bodies, 179
buccal smear, 274-75 Dermatophytes, 183, 713-14 Dopa reaction, 40
cerebrospinal fluid, 274 Dermatoses, 769-79 Down’s syndrome, 258
collection of sample for, 275-76 connective tissue, 774-75 Downey cells, 352
crush smear, 283 genetic, 769-70 Drabkin’s fluid, 292
effusions, 273-74 granulomatous, 774 Drepanocytes, 293
exfoliative, 267-77 infectious, 771-74 Dressler’s syndrome, 436
exfoliative versus interventional, 267t metabolic, 778-79 Dropsy, 96
female genital tract, 267-72 non-infectious bullous, 775-78 Drug abuse, 241
fine needle aspiration (FNAC), 277-83 non-infectious inflammatory, 770-71 Drug injury, 28, 238, 239t
fixation and fixatives, 276-77 scaling, 778 Drumstick appendage, 257f, 275
fluids, 273-74 Dermoid cyst, 520, 746, 781-82 Dry gangrene, 49-50
gastrointestinal tract, 273 ovary, 746 Dry tap, 287t, 326
imprint, 283 testis, 712 Dubin Johnson syndrome, 601
interventional, 277-83 Desmin, 23, 861 Duct ectasia, 755
interventional versus exfoliative, 267t Desmoid tumours, 863 Dukes’ staging, 589, 590f, 590t
Pap smear, applications of, 267-72 Desmoplasia, 199 Duodenal ulcer, 550-54
respiratory tract, 272-73 Desmoplastic small cell tumour, 591 versus gastric ulcer, 551t

918 Dupuytren’s contracture, 170 classification of, 120t Endocrine system, 791-829
Dura mater, 872 fat, 121-22 Endodermal sinus tumour,
Durozier sign, 451 gas, 12-23 ovary, 748
Dust diseases, lung, 487-93 miscellaneous, 124 testis, 711
Dwarfism, paradoxical, 119 Endometrial carcinoma, 735-37
achondroplasia, 833 pulmonary, 120-21 Endometrial hyperplasia, 733-34
hypothyroid, 803 retrograde, 120 Endometrioid tumours, ovary, 744-45
pituitary, 795 saddle, 120 Endometriosis, 732-33
Dysenteries, 572-73 systemic, 121 Endometritis, 732
amoebic, 572-73 thromboembolism, 120-21 tuberculous, 732
bacillary, 572 tumour, 124 Endometrium, 730-38
Dysfunctional uterine bleeding (DUB), 731-32 venous, 120t cyclic changes in, 730, 731f
Dysgenetic gonads, 707 Embolus, 119 effects of hormones on, 730-31
Dysgerminoma ovary, 747 Embryoma, 193, 637 in menopause, 731
Dyskeratosis, 769 Embryonal carcinoma testis, 710-11 normal structure of, 730
Dyslipidaemia, 393-94, 661 Embryonal tumours, 206-07 pregnancy changes in, 731
Dysplasia, Emigration, 134 Endomyocardial biopsy, 459
bronchopulmonary, 465 Emphysema, 478-83 Endomyocardial fibrosis, 456
cervical, 271-72, 725-28 bullous, 480f Endophthalmitis, 508
developmental, 256 centriacinar, 481 Endoplasmic reticulum, 24
fibromuscular, arteries, 409 centrilobular, 481 Endotoxin, 109, 175
fibrous, 837-38 classification of, 478t Enteric fever, 571-72
mammary, 756-57 clinical features of, 480-81 Enterochromaffin cells, 561
oral cavity, 525-26 etiopathogenesis of, 479-80 Enterocolitis,
renal cystic, 657 interstitial, 483 infective, 569-73
skeletal, 834 irregular, 482 ischaemic, 565
Dystraphic anomalies, 256, 873 morphologic features of, 480-82 membranous, 564-65
Dystrophic calcification, 52 morphology of individual types of, 481-82 necrotising, 565
Dystrophy, muscular, 858-59 overinflation, 482-83 pseudomembranous, 573
Dystrophy, vulval, 721, 722f panacinar, 481-82 Enteropathy, protein-losing, 576
D-xylose test, 574 paraseptal, 482 Environmental chemicals, 242
senile, 482 Environmental diseases, 236-43
surgical, 483 Eosinophilia, 141, 350
E versus predominant bronchitis, 479 Eosinophilia, pulmonary, 456, 494
Empty-sella syndrome, 794-95 Eosinophilic granuloma, 385
Ear, 513-15 Empyema, Eosinophils, 141, 350
cauliflower, 514 appendix, 579 Eotaxin, 134
normal structure of, 513-14 gallbladder, 642 Ependyma, 872
tumours and tumour-like lesions of, 514-15 nasal sinus, 515 Ependymoma, 888-89
Ecchymoses, 107, 331 thoracis, 504 Epidermis, structure of, 768-69
Eccrine hidradenoma, 786 Enamel, 528 Epidermodysplasia
Eccrine, poroma, 786 Encephalitis, 877-79 verruciformis, 224, 772
spiradenoma, 786 bacterial, 877 Epidermoid carcinoma, 192f
Eccrine tumours, 786 fungal, 879 cervix, 728-29
INDEX
Echinococcosis, 187t, 616-17 HIV, 878 lung, 499-500
Ectopia, 256 protozoal, 879 oesophagus, 541-42
Ectopia vesicae (exstrophy), 698 viral, 877-78 oral cavity, 526-27
Ectopic hormone production, 232, 502, 696 Encephalocele, 873 penis, 715-16
Ectopic tubal pregnancy, 739 Encephalomalacia, 126 skin, 783-84
Eczema, 770 Encephalomyelitis, vulva, 723
Effusions, pleural, 505 acute disseminated, 884 Epidermolysis bullosa, 522
cytology of, 273-74 perivenous, 884 Epididymitis, 705
Ehler-Danlos syndrome, 331 Encephalopathy, hepatic, 632 Epididymo-orchitis, 705
Ehrlich, Paul, 4f Encephalopathy, ischaemic-hypoxic, 879-80 Epidural haematoma, 882, 883f
Elastic fibres, 170 Encephalopathy, spongiform, 878 Epispadias, 714
Elastofibroma, 862 Enchondroma, 844-45 Epithelioid cells, 152-53
Electrical injury, 28, 242 Encrustation theory, 395 Epithelioid sarcoma, 869
Electrolytes, disturbances of, 93-94, 103 End-stage kidney, 674-75 Epstein-Barr virus, 183t, 225, 350, 377, 518
Epulis, 524
Endarteritis obliterans, 400-01
Electron microscope, 14-15 Endocardial fibroelastosis, 455 Erdheim’s medial degeneration, 36, 407
Electrophoresis, haemoglobin, 324, 383 Endocarditis, 444-49, 447t ER/PR, 765
Electrophoresis in myeloma, 383 atypical verrucous, 444 Erythema marginatum, 443
Elephantiasis, 97, 411, 706 bacterial, 445-48 Erythema multiforme, 777
Elliptocytosis, cachectic, 444-45 Erythema nodosum and induratum, 771
hereditary, 293f, 315 infective, 445-49 Erythema nodosum leprosum (ENL), 160
Embden-Meyerhof pathway, 289, 317f Libman-Sacks, 444 Erythroblastosis foetalis, 76, 341
Embolism, 119-24 Löeffler’s, 456 Erythrocytic sedimentation rate (ESR), 294
air, 122-23 marantic, 444-45 Erythrocytosis, 359
amniotic fluid, 123-24 nonbacterial thrombotic (NBTE), 444-45 Erythroid series,
arterial, 120f rheumatic, 441 development of, 287-88
atheromatous, 124 tuberculous, 448 disorders of, 287-326

Erythrophagocytosis, 571 Fever, Flow cytometry, 18 919
Erythroplasia, 525 enteric, 571-72 Fluid compartments, 93
Erythroplasia of Queyrat, 715 dengue, 184 Fluorescent microscope, 14
Erythropoiesis, 287-88 viral haemorrhagic, 183-84 Fluorochrome, 15
Erythropoietin, 288 yellow, 183-84 Fluorosis, skeletal, 837
Esthesioneuroblastoma, 517 Fibril protein, 82-83 FNAC, 277-83
Ethanol, 38, 238-40, 619-21 Fibrin-split products (FSP), 116, 330, 338 Foam cell, 160, 397f,
Euchromatin, 23 Fibrinogen, 116, 330, 338 Focal glomerulonephritis, 672-74
Eumycetoma, 182 Fibrinoid necrosis, 46, 79 Focal necrosis, liver, 604-05
Evan’s syndrome, 312 Fibrinolysis, 331, 337-38 Foetal alcohol syndrome, 256
Ewing’s sarcoma, 848-49 Fibrinolytic defects, 337 Folate, 253, 304-06
Ewing’s, James, 5 Fibrinolytic system, tests for, 331 Folin-Wu method, 827
Exanthemata, viral, 186, 713 Fibroadenoma, breast, 757-58 Follicular adenoma, thyroid, 810-11
Exfoliative cytology (see also under Cytology), Fibrocystic change, breast, 755-57 Follicular hyperplasia, lymph node, 343-44
267-77 Fibrocystic disease, pancreas, 645 Folliculitis, 179
Exfoliative versus interventional cytology, 267t Fibrohistiocytic tumours, 864-65 Fontana-Masson, 13t, 788
Exostosis, osteocartilaginous, 843 benign, 864 Food poisoning, 181, 572
Exotoxin, 109, 175 malignant, 864-65 Foot process disease, 669-70
Exstrophy (ectopia vesicae), 698 Fibrolamellar carcinoma, liver, 635-36 Fordyce’s granules, 522
Extracellular fluid compartment, 93 Fibroma, Fracture healing, 171-72, 834
Exudate versus transudate, 96t ameloblastic, 532 Franklin’s disease, 384
Exudation, 144 cementifying, 532 Franzen handle, 278f
Eye, 507-13 chondromyxoid, 845 Free radicals, 32
congenital lesions of, 507-08 non-ossifying, 838 Frost-bite, 242
inflammatory conditions of, 508 oral mucosa, 524 Frozen section, 10-11
metastatic, 513 ovary, 749 Fungal diseases, 181-83
miscellaneous conditions of, 510-11 renal, 694t Fungal infections, 181t
normal structure of, 507 soft tissue, 861-62 lungs, 476-77
tumours and tumour-like lesions of, 511-13, Fibromatosis, skin, 773-74
511t colli, 521 Fungal stains, 175t, 176f
vascular lesions of, 508-10 desmoid, 863 Furuncle, 145, 179
gingivae, 525
palmar and plantar, 862-63
F retroperitoneal, idiopathic, 591 G
Fibromuscular dysplasia, arteries, 409
FAB classification, Fibronectin, 170 Galactocele, 755
acute leukaemia, 362 Fibrosarcoma, 863-64 Galactorrhoea, 794
myelodysplastic syndrome, 361 Fibrosclerosis, multifocal, 591, 806 Galen, Claudius, 2
Fabricius, 3 Fibrosis, idiopathic pulmonary, 495-96 Gallbladder carcinoma, 643-44
Fabry’s disease, 678 Fibrous cortical defect, 838 Gallstones, 638-41
Facial clefts, 522 Fibrous dysplasia of bone, 837-38 Gamma glutamyl transpeptidase (g-GT), 595
Faecolith, 578 Fiedler’s myocarditis, 453 Gamna-Gandy bodies, 106-07, 108f
Fallopian tube, 738-39 FIGLU test, 308 Ganglion cyst, 855-56 INDEX
normal structure of, 738-39 FIGO classification, Ganglioneuroma, 801
Fallopius, Gabriel, 3 cervical cancer, 730t Gangrene, 49-51
Fallot’s tetralogy, 425 endometrial carcinoma, 737t dry versus wet, 51t
Familial Mediterranean fever, 37 ovarian carcinoma, 751t gas, 59
Familial polyposis coli syndrome, 206, 585, 586 vaginal carcinoma, 724t Gap junctions, 25
Fanconi’s anaemia, 325 vulval carcinoma, 723t Gardner’s syndrome, 585-86
Farmer’s lung, 493 Filariasis, 97, 190 Gartner duct cyst, 723
FAS receptors, 48, 49f Fine needle aspiration cytology Gastric acid, 544-45
Fascitis, nodular, 862 (FNAC), 277-83 Gastric analysis, 544-45
Fast (combined) smear, 268 advantages of, 278 Gastric canal, 543
Fat aspiration, 88, 282f applications of, 278 Gastric carcinoma,
Fat embolism, 121-22 complications of, 281 early (EGC), 556
Fat necrosis, 45-46 contraindications of, 281 Gastric lavage, 273
breast, 755 limitations of, 283 Gastric ulcer, 549-54
Fat-soluble vitamins, 247-51 method of, 278-79 benign versus malignant, 557
Fat stains, 12t, 38 precautions in, 281 versus duodenal ulcer, 551t
Fatty change, 37-39, 621-22 procedure of, 278-79 Gastrin, 545
Fatty infiltration, stromal, 39 smear preparation, 279 Gastrinoma, 829
Fatty liver, 37-39, 621-22 Fish-mouth appearance, 441 Gastritis, 546-49
Favism, 316 Fissure, anal, 581 acute, 546-47
Felty’s syndrome, 852 Fistula in ano, 581 atrophic, 547, 548-49
Fenton reaction, 32f Fistula, tracheo-oesophageal, 538 autoimmune, 547
Fernandez reaction, 159 Fite-Faraco staining, 157 chronic, 547-49
Ferric-ferrocyanide, 41 Fixatives in cytology, 276-77 chronic superficial, 548
Ferrireductase, 295 Flagella, 24 classification of, 547
Ferritin, 300, 301 Flavonoids, 254 H. pylori,547, 548f
Ferroportin, 295 Flea-bitten kidney, 666, 688 hypertrophic, 549
Feulgen, Robert, 5 Floppy valve syndrome, 450 type A, 547

920 type AB, 547 primary, 665-75 actinomycosis, 163-64
type B, 547 rapidly progressive, 667-69 examples of, 149-65
Gastroenteropathy, secondary, 675-78 leprosy, 157-61
haemorrhagic, 564-65 Glomerulosclerosis, sarcoidosis, 164-65
Gastrointestinal stromal tumour (GIST), 554-55 collapsing sclerosis, 674 skin, 774-75
Gastrointestinal tract, 538-91 diffuse, 677 syphilis, 161-63
Gaucher’s disease, 262-63 focal segmental, 673-74 prostate, 717
G-cell tumour, 829 nodular, 678 tuberculosis, 149-57
Genetic diseases, 256-63 Glomerulus, structure of, 650 uveitis, 508
Genetic disorders, 256-63 Glomus jugulare tumour, 515 Granulopoiesis, 345-47
Genome, human, 7 Glomus tumour (glomangioma), 412-13 Granulosa cell tumour,
Germ cell tumours, 193 Glossitis, 523 ovary, 748-49
ovary, 745-48 Glucose tolerance test (GTT), 827f testis, 713
testis, 709-13 Glucose 6-phosphate dehydrogenase (G6PD) Granulosa-theca cell tumour, 749
Ghon’s complex, 153-54 deficiency, 316-17 Graves’ disease, 806-07
GI bleeding, 591t Glucosuria, 826-27 Grawitz tumour, 694-96
Giant cell lesions of bone, 847-48 alimentary (lag storage), 827 Grossing, 10
Giant cell tumour of bone, 846-48 renal, 827 Ground glass nuclei, 813
Giant cell tumour of tendon sheath, 885 Glutathione-S-transferase (GST), 597 Growth factors, 210-11
Giant cells, 143-44 Gluten-sensitive enteropathy, 575 receptors for, 212
foreign body, 143 Glycocalyx, 21 Growth, adaptive disorder of, 53-59
Langhans’, 143 Glycogen stains, 12t, 40 Guillain-Barre syndrome, 892
Touton, 143 Glycogen storage diseases, 261-62 Gum hypertrophy, 363, 524
tumour, 143-44 Glycogenoses, 261t Gumma, 163f
Gibbs-Donnan equilibrium, 94 Glycolipids, 152 Gynaecomastia, 757
Giemsa, 12t, 277 Glycophorine, 289 Gynandroblastoma, 749
Gigantism, 793-94 Glycoproteins, adhesive, 170
Gilbert’s syndrome, 600 Glycosaminoglycans, 83, 170, 262
Gingivitis, 529 Glycosylated Hb (Hb A1C), 828 H
GIST (Gastrointestinal stromal tumour), 554-55 Goitre, 807-10
Gitter cells, 872 adenomatous, 808-10 5-Hydroxy tryptamine (HT), 136-37
Glanzman’s disease, 334 colloid, 807-08 H-substance, 339
Glaucoma, 510-11 diffuse toxic, 806-07 Haber-Weiss reaction, 136
Gleason’s staging, prostate, 720 endemic, 807 Haemangioblastoma, 414, 889
Glial fibrillary acidic protein (GFAP), 24 nodular, 808-10 Haemangioendothelioma, 413-14
Glioblastoma multiforme, 887-88 simple, 807-08 Haemangioma, 411-12
Gliomas, 886-90 sporadic, 807-08 capillary type, 411-12
Gliosis, 45, 881 Goitrogens, 807 cavernous type, 412
Glisson’s capsule, 592 Golgi apparatus, 24 granulation tissue type, 412
Global, hypoxic-ischaemic Gomori’s methenamine silver, 12t, 175, 176f liver, 633
encephalopathy, 879-80 Gonadoblastoma, mouth, 524
Globi, 158f ovary, 750 nose, 517
Glomerular basement membrane (GBM), 650, testis, 713 Haemangiopericytoma, 414
651f Goodpasture’s syndrome, 494, 667-68 Haematemesis,
INDEX
Glomerular diseases, 660-78 Gout and pseudogout, 853-55 of gastric origin, 554
classification of, 660t G-proteins, receptors, 26, 212 of oesophageal origin, 539-40
clinical manifestations of, 660-62 Grading of tumours, 204-05 Haematin, 42
contrasting features of, 676t Graft rejection, 65-66 Haematocele, 706f
definition of, 660 Graft versus host reaction, 66 Haematogenous spread of tumours, 201-02
pathogenesis of, 662-65 Graft, vascular, 460 Haematological neoplasms, 353-56
specific types of, 665-78 Gram Christian, 4 classification of, 353-54
Glomerular filtration rate (GFR), 653 Granular cell myoblastoma, 525, 869 etiology, 354-55
Glomerular injury, Granular cell tumour, posterior pathogenesis, 355-56
pathogenesis of, 662-65 pituitary, 796 Haematological values, 901t
Glomerulonephritis (GN), 665-75 Granulation tissue formation, 166-67 Haematoma, 107
acute, 665-67 Granulocytes, 141, 345 dissecting, 407-08
chronic, 674-75 Granuloma, 148-49 epidural, 882
crescentic, 667-69 annulare, 774 subdural, 882-83
distinguishing features of, 676t apical, 529 Haematopoiesis, 284-85
end stage, 674-75 eosinophilic, 385 extramedullary, 285, 360
focal, 672-74 caseating, 148-49 Haematopoietic stem cells, 285-86
IgA, 674 gravidarum, 412, 524 Haematoxylin bodies of Gross, 79, 444
mechanisms of, 662-65 inguinale, 178-79 Haematuria, 661-62, 691, 696
membranoproliferative, 671-72 lethal midline, 380, 403, 517 Haemochromatosis, 42, 627
membranous, 669-71 non-caseating, 164-85 Haemodialysis-associated amyloid, 86-87
minimal change disease (lipoid nephrosis), plasma cell, 384 Haemodynamic disturbances, 104-29
669 pyogenicum, 412, 524 Haemoglobin, 292
necrotising focal, 673 reparative, 816, 836 Haemoglobin disorders, 317-25
non-streptococcal, 667 sarcoid, 164-65 Haemoglobinopathies, 317-25
oedema in, 661 spermatic, 705-06 Haemoglobinopathy, unstable, 320
post-streptococcal, 665-67 Granulomatous inflammation, 150t Haemoglobinuria, 311

cold, 313 by repair, 166-67 Hephaestin, 295 921
march, 313 by second intention (secondary union), Hereditary haemorrhagic telangiectasia, 331
paroxysmal nocturnal (PNH), 314 168-69 Hereditary hyperbilirubinaemia, 600-01
Haemoglobinuric nephrosis, 679 complications of, 169-70 Hereditary persistent of fetal haemoglobin, 322
Haemolysis, general features of, 310-11 factors influencing, 170-71 Hernia, 562-63
Haemolytic anaemia, see under fracture, 171-72 hiatus, 538-39
Anaemias, haemolytic, 310-24 mucosal surfaces, 173 incisional, 170
Haemolytic disease of newborn (HDN), 340-41 muscle, 172-73 strangulated, 563
Haemolytic uraemic syndrome, 331, 334, 689t nervous tissues, 172, 891-92 Herpes simplex virus, 186, 773
Haemopericardium, 457 solid epithelial organs, 173 Herpes virus, 225
Haemophilia, 335-36 specialised tissues, 171-73 Herpes zoster, 186, 773
A, 335-36 wound, 167-71 Herring-bone pattern, 864
B, 336 Health, definition of, 1 Hess capillary test, 329
Haemoprotein-derived pigments, 41-43 Heart, 417-60 Heterochromatin, 23
Haemoptysis, causes of, 502t blood supply of, 418 Heterophagy, 37
Haemorrhage, 107-08 brown atrophy of, 43 Heterophile antibody, 352
intracerebral, 881-82 cardiac interventions, 459-60 Heterotopia, 256
intracranial, 881-82 congenital diseases of, 422-26 Heterotopia, pancreatic, 545, 554
pulmonary, 121 infarcts, (also see under Myocardial Heterotopic calcification, 51-53
subarachnoid, 882 infarction), 429-36 Hexose-monophosphate (HMP) shunt, 289, 317f
Haemorrhagic diatheses (bleeding disorders), malpositions of, 423 Heymann’s nephritis, 663-64
328-38 normal structure of, 417-18 Hibernoma, 865
coagulation disorders, 335-38 transplant, 460 Hidradenoma, 786
DIC, 337-38 tumours of, 459 vulva, 722
investigations of, 328-31 Heartburn, 434, 546 Hippocrates, 2
platelet count disorders, 331-34 Heart failure, 100f, 105f, 419-22 Hirano bodies, 884
platelet function disorders, 334-35 Heart failure cells, 106 Hirschsprung’s disease, 580
vascular disorders, 331 Heat-shock protein (HSP), 26 Histamine, 136-37
Haemorrhagic disease of newborn (HDN), Heavy chain diseases, 384-85 Histiocytes, 64, 143, 346, 385-86
340-41 Heberden’s nodes, 851 cardiac, 440
Haemorrhagic fevers, viral, 183-84 Heinz body anaemia, 317, 320 Histiocytic neoplasms, 385-86
Haemorrhagic gastroenteropathy, 564-65 Heinz bodies, 311, 317, 320 Histiocytoma,
Haemorrhoids, 581, 632 Helicobacter pylori, 548, 550, 555 benign fibrous, 864
Haemosiderin, 41-42, 296 Henoch-Schonlein’s purpura, 331 malignant fibrous, 864-65
Haemosiderosis, 42, 627 Hepadenoviruses, 226, 606-07 Histiocytosis-X (Langerhans’ cell
Haemostasis, screening tests of, 329-31, 329t Hepar lobatum, 163 histiocytosis), 385-86
Haemostasis, vascular, 331 Hepatic arterial obstruction, 604-05 Histochemistry, 11-13
Haemostatic function, 328-31 Hepatic coma, 602, 613, 632, 692 Histocompatibility leucocyte antigens (HLA),
Haemostatic disorders, laboratory findings in, Hepatic failure, 602-03 64-65
338t Hepatic tumours and tumour-like lesions, Histoplasmosis, 476
Haemothorax, 505 632-37 HIV, structure of, 68-69
Hageman factor, 139, 320f Hepatic venous obstruction, 603-04 infection, see under AIDS, 67-73
Hair follicle, tumours of, 785-86 Hepatisation, lung, 468-70 lymphadenopathy, 716 INDEX
Hairy cell leukaemia, 378-79 Hepatitis, clinico-pathological spectrum of, HLA system, 64-65
Ham’s test, 311, 314 609-14 Hodgkin cells, 370
Hamartoma, 193 activity score, 612-13 Hodgkin’s disease, 369-73
Hamartoma, pulmonary, 503-04 acute, 610-11 classification of, 369
Hamartomas, vascular, 411 autoimmune, 611, 629 clinical features of, 371-72
Hamman-Rich syndrome, 496 carrier state, 609-10 etiopathogenesis of, 354-55
Hand-Schuller-Christian disease, 385-86 chronic, 611-12 morphologic features of, 370-71
Hansen, GHA, 4, 157 chronic active, 612 other laboratory findings in, 372
Hapten, 61 chronic persistent, 612 prognosis of, 373
Harrison’s sulcus, 249 contrasting features of, 605 staging of, 372
Hashimoto’s thyroiditis, 804-05 fulminant, 613-14 versus non-Hodgkin’s lymphoma, 373t
Hashitoxicosis, 805 lupoid, 611 Hodgkin, Thomas, 3
Hassall’s corpuscle, 388 massive to submassive, 613-14 Hollander’s test, 545
Hay fever, 493, 515 neonatal, 601-02 Homeostasis, 93-96
Hay’s test, 594 Hepatitis vaccines, 614 Homing receptor, 342
Hb Barts’ hydrops foetalis, 321 Hepatitis, viral, 605-14 Homogentisic acid, 40-41
Hb Constant Spring, 321 A, 606 Honey-comb lung, 499t
Hb D disease, 320 B, 606-07 Hookah smoking, 237
Hb Lepore syndrome, 323 classification of, 605 Hordeolum, 508
Hb H disease, 321 C, 608-09 Hormones in cancer, 207-08
HBsAg, 607 D, 607-08 Hormones, effect on endometrium, 730-31
HBx Ag, 607 E, 609 Hour-glass deformity, 553
hCG, 709, 751-53 G, 609 Howell-Jolly bodies, 293
HDL, 83, 393-394 Hepatoblastoma, 637 H. pylori, 176f, 222, 547, 548f, 549f
Head injury, 882-83 Hepatocellular carcinoma, 633-36 Human genome project, 7
Healing, 165-73 Hepatolenticular degeneration, 628 Human herpes virus (HHV), 225, 226, 415
by first intention (primary union), 168 Hepatorenal syndrome, 603 Human immunodeficiency virus (HIV), 67-73
by regeneration, 165-66 Hepatotoxicity, 617-18 Human leucocyte antigen (HLA), 64-65

922 Human papilloma virus (HPV), 224-25, 270, immediate type, 73-77 Immunodeficiency diseases, 67-73
714, 722, 726-27, 771-72 Hypersplenism, 387 Immunodeficiency syndrome,acquired,
Human T cell lymphotropic virus (HTLV), 68, Hypertension, portal, 630-32 (AIDS), (also see under AIDS), 67-73
227 Hypertension, pulmonary, 466-67 Immunofluorescence, 14
Hunner’s cystitis, 699 Hypertension, systemic, 685-88 Immunoglobulins, serum, 383, 595, 899
Hunter, John, 3 atherosclerosis in, 394 Immunohistochemistry, 15-16
Hurthle cells, 804-05, 810-11 classification of, 685t, 686t Immunologic lung disease, 493-95
Hutchinson’s teeth, 163 definition of, 685 Immunologic tissue injury, 28, 73-77
Hyaline, alcoholic, 35, 621-22 effects of, 687-88 Immunology of tumours, 228-30
Hyaline change, 35 etiology, 686-87 Immunosurveillance of cancer, 228-30
Hyaline membrane disease, 462-65 in dissecting haematoma, 407 Immunopathology, 62-92
Hybridisation, in situ, 17 kidney in, 685-88 Immunoprophylaxis, hepatitis, 614
filter, 17-18 malignant, 685, 688 Immunotherapy, 230
Hybridoma, monoclonal antibodies, 15, 383 pathogenesis of, 686-87 Impaired glucose tolerance (IGT), 828
polyclonal antibodies, 15, 383 renovascular, 686 Impaired fasting glucose, 826t
Hydatid disease liver, 187t, 616-17 Hypertensive heart disease, 437 Impetigo, 771
Hydatid sand, 617 Hypertensive retinopathy, 509-10 Implantation cyst, 169
Hydatidiform mole, 751-52 Hypertensive vascular disease, 391, Inborn errors of metabolism, 260-63
versus choriocarcinoma, 752t Hyperthermia, 242 Incompetence, valvular, 449-52
Hydrocele, 706 Hyperthyroidism, 802-03 Incontinence, pigment, 769
Hydrocephalus, 873-74 Hypertrophic scar, 170 Indian-file arrangement, 761, 762-63
Hydrolytic enzymes, 30, 44-45, 348 Hypertrophy, 55-56 Infarction, 126-29
Hydronephrosis, 692-93 asymmetric, septal, 454-55 definition, 126
Hydropericardium, 457 cardiac, 55-56, 420-22 etiology of, 126
Hydropic change, 34-35 concentric, 421-22 morphology in organs, 126-29
Hydrops foetalis, 321 eccentric, 421-22 pathogenesis of, 126
Hydrostatic pressure, 95 SER, 37 types of, 126
Hydrothorax, 505 Hyperuricaemia, 692, 854 Infarcts,
5-Hydroxytryptamine (5-HT), 137 Hyperviscosity, 359 border zone, 880
Hyperadrenalism, 797-98 Hypervitaminosis A, 248 brain, 45, 880-81
Hyperaemia, 105-07 Hypervitaminosis D, 250 cerebral, 880-81
active, 105 Hyphema, 509f common sites, 127f
passive, 105-07 Hypoadrenalism, 798-99 heart, 429-36
Hyperaldosteronism, 797-98 Hypoaldosteronism, 799 intestine, 563-65
Hyperbilirubinaemia, 597-601 Hypocalcaemia, 816, 836 kidney, 127-28
conjugated, 599-600 Hypochromasia, 292, 299 liver, 128-29
hereditary, 600-01 Hypoglycaemia, 820, 825, 828 lung, 126-27
unconjugated, 598 Hypoparathyroidism, 817 myocardial, 429-36
unconjugated versus conjugated, 598t Hypopigmentation, 40 retinal, 510
Hypercalcaemia, 53, 816-17 Hypopituitarism, 794-95 septic, 126, 146f
Hypercholesterolaemia, 393-94, 661 Hypoplasia, 256 spleen, 128
familial, 394 Hypoprothrombinaemia, 337 watershed, 880
Hyperchromatism, 198 Hypospadias, 714 Infections, 174-91
Hypercoagulability of blood, 117, 661 Hypothalamus-pituitary axis, 792f pulmonary,
INDEX
Hypereosinophilic syndrome, 494 hyperfunction of, 794 Infectious agent, 174
Hypergastrinaemia, 545 hypofunction of, 795 factors relating to, 174-75
Hyperglycaemia, 818, 821, 827 Hypothermia, 242 identification of, 175t
Hyperinsulinism, 828 Hypothyroidism, 803-04 Infectious mononucleosis, 350-52
Hyperkeratosis, 769 Hypoxic cell injury, 29-31 Infertility, male, 704-05
Hyperlipidaemia, 393-94, 661 irreversible, 30-31 Infestations, 187t
Hypernephroma, 694-96 reversible, 29-30 Infiltrations, 37
Hyperosmolar non-ketotic coma, 825 Hypoxic-ischaemic Inflammation, acute, 130-47
versus diabetic ketoacidosis, 825t encephalopathy, 879-80 cardinal signs of, 130
Hyperparathyroidism, 816-17 causes of, 130
Hyperphosphataemia, 816, 836 I cellular events, 133-36
Hyperpigmentation, 40 definition of, 130
Hyperpituitarism, 793-94 Icthyosis, 769-70 factors determining variation in, 144
Hyperplasia, 56-57 Idiopathic pulmonary fibrosis, 495-96 fate of, 147f
atypical, 58 Idiopathic retroperitoneal fibrosis, 591 fever in, 145
breast, epithelial, 756-57 Idiopathic thrombocytopenic purpura (ITP), 322 haemodynamic changes in, 130-31
denture, 524 IgA nephropathy, 674 healing, 146
endometrial, 733-34 Illness, definition of, 1 inflammatory cells in, 141-45
focal nodular, liver, 633 Image analyser, 19 leucocytosis in, 145-46
microglandular, cervix, 725 Immotile cilia syndrome, 484, 705 mediators of, 136-40
prostate, nodular, 717-18 Immune complex disease, 76-77 morphology of, 144-45
skin, pseudocarcinomatous, 56f, 57, 784 kidney, 662-64 regulation of, 140-41
squamous, vulva, 732 Immune complex reaction, 76-77 resolution of, 146
thyroid, primary, 806-07 Immune system, organs of, 61-64 signs of, 130
Hyperprolactinaemia, 794 cells of, 61-64 systemic effects of, 145-46
Hypersensitivity reactions, 73-77 Immunity, types of, 144
delayed type, 77 diseases of, 66-81 vascular events in, 130-33

Inflammation, chronic, 147-65 effects of, 125-26 Ketonuria, 827 923
granulomatous, 149-65, 150t etiology of, 124 Kidney, 649-98
Inflammatory bowel disease, 565-69 factors determining, 125 adenocarcinoma of, 694-96
Inflammatory cells, 141-44 myocardial, 428 biopsy, 652
Inflammatory response, Ischaemic bowel disease, 563-65 clearance tests, 653
factors determining, 144 Ischaemic brain damage, 879-81 concentration test, 652-53
Influenza viruses, 184-86 Ischaemic heart disease (IHD), 427-37 congenital malformations of, 656-60
In situ hybridisation, 17 chronic, 436 CVC, 107
Insecticides, 219t, 242 coronary atherosclerosis in, 427 cystic disease of, 656-60
Insufficiency, valvular, 449-52 effects of, 428 dilution test, 652-53
aortic, 451 etiopathogenesis of, 427-28 end-stage, 674-75
mitral, 450 lesions in, 429-37 flea-bitten, 666, 688
Insulin metabolism, 819-20 sudden cardiac death in, 436-37 function tests, 652-53
Insulinoma, 826 Islet cell changes in diabetes, 822-23 horse shoe, 656
Insulitis, 822 Islet cell tumours, 828-29 infarcts, 127-28
Integrins, 25, 203 Isochromosome, 259 large white, 667
Interferon, 25, 138-39 Isograft, 65 normal structure of, 649-52
Interleukin, 25, 138-39 Ito cells, 593, 618 papilla of, 649, 682
Intermediate filaments, 16, 23-24 shock, 113, 679
Internal environment, 93-94 J small contracted, 687
Interphase, 26 stones, 690-92
Interstitial cell tumour, testis, 713 Jamshidi needle, 286 tumours, 693-98
Interstitial lung diseases (ILDs), 487t Janeway’s spots, 448 Kiel classification, 366
defintion of, 486 Jaundice, 42, 596-600 Killing, bacterial, 135-36
with connective tissue diseases, 495 classification of, 597-98 Kimmelstiel-Wilson lesions, 677-78
with immunologic lung diseases, 493-95 conjugated hyperbilirubinaemia, 599-600 Kinin system, 139
with smoking, 496 Klinefelter syndrome, 258, 704
Interstitial tumour, medullary, 694 neonatal, 600-01 Knock knee, 249
unconjugated hyperbilirubinaemia, 598
Intestinal biopsy, 574-76 Jaw, lumpy, 163 Knudson two-hit hypothesis, 213
Intestinal obstruction, 562-63 cysts of, 529-31 Koch’s bacillus, 149
Intestine, large, 579-90 Jenner, Edward, 3 Koch’s phenomenon, 152
normal structure of, 579 Jodbasedow disease, 802 Koch, Robert, 4
polyps, 581-86 KOH preparation, 183
Intestine, small, 560-71 Joints, disease of, 850-56 Koilocytosis, 271-72
Joint mice, 851
atresia of, 561 Joint, normal structure of, 850 Korsakoff psychosis, 240, 252
adhesions of, 562 Jones’ criteria, revised, 443 Kraurosis vulvae, 721
bands of, 562 Jugular paraganglioma, 515 Krukenberg tumour, 202-03, 750
biopsy, 574 Junctions, intercellular, 24-25 Kulchitsky cells, 561
malrotation of, 561 Juvenile melanoma, 787 Kupffer cells,143, 593
normal structure of, 560-61 Juvenile (retention) polyps, 582-83 Kussmaul’s respiration, 104
obstruction of, 562-63 Juvenile polyposis syndrome, 586 Kviem test, 165
tumours of, 576-77 Kwashiorkor, 246
Intra-abdominal desmoplastic small cell Juvenile rheumatoid arthritis, 852 INDEX
Juxtaglomerular apparatus, 650-51
tumour, 591 L
Intracellular accumulations, 37-40 tumour of, 694
of fat, 37-39 Laboratory values of clinical significance,
of glycogen, 40 K 897-903
of proteins, 39 Lacis cells, 651
Intracellular fluid compartment, 93 Kallikrein, 140f Lactate dehydrogenase (LDH), 30, 434-35
Intracerebral haemorrhage, 881-82 Kangri cancer, 218, 783 Laennec’s cirrhosis, 622-24
Intracranial haemorrhage, 881-82 Kaposi’s sarcoma, 225, 226, 415-16 Laennec, RTH, 3
Intraepithelial neoplasia, 207 Kartagener’s syndrome, 484, 705 Lambl’s excrescences, 444
breast, 760-61 Karyolysis, 30 Laminin, 170
bronchus, 498f Karyorrhexis, 30 Landsteiner, Karl, 5
cervix, 271-72, 725-28 Karyotypic abnormalities, 257-59 Langerhans’cells, 64, 143, 385-86
skin, 782 Karyotyping, 257 Langerhans’cell
vulval, 723 Kawasaki’s disease, 404 histiocytosis (histiocytosis-X), 385-86
Intratubular germ cell neoplasia, 709 Keloid, 170 Langhans’ giant cells, 143, 153
Intravascular haemolysis, features of, 311 Keratoconjunctivitis, 508 Laryngitis, 519
Intrinsic factor (IF), 303, 308, 545 Keratohyaline granules, 772 Larynx, 519-20
Intussusception, 563 Keratoma, 514-15 carcinoma of, 520
Inversions, chromosomal, 259 Keratomalacia, 247 normal structure of, 519
Involucrum, 832 Keratosis follicularis, 770 oedema of, 519
Ionising radiation, 34, 221 Keratosis, solar, 782 papilloma, 519
Iron cycle, 296f Keratosis palmaris et plantaris, 770 polyp of, 519
Iron metabolism, 295-96 Keratosis, smokers’, 525 tuberculosis of, 519
Irreversibility of shock, 112 solar, 782 tumours of, 519
Irreversible cell injury, 30-31 Kerley lines, 101 Laser microdissection, 19
Ischaemia, 124-26 Kernicterus, 42, 600-01 Lateral aberrant thyroid, 812
brain, 879-81 Ketoacidosis, diabetic, 825 Lateral vaginal smear, 267t, 268
definition of, 124 versus non-ketotic coma, 825t Lavage, gastric, 273

924 LE cell phenomenon, 79 Leukoplakia, 525-26, 714, 721-22 acute, 343
Lead poisoning, 240-41 Leukotrienes, 138 chronic, 343-45
Lecithin, 639 Lewis experiment, 134 Lymphadenopathy, angioimmunoblastic, 344
Leeuwenhoek, von, 3 Lewy bodies, 885 angiofollicular, 343-44
Legionnaire’s disease, 474 Leydig cell tumour, 713, 749 dermatopathic, 344
Leiomyoblastoma, 559 Leydig cells, 703 HIV-related, 344-45
Leiomyoma, 737 Libman-Sack endocarditis, 444-45 Lymphangioma, 412, 521
epithelioid cell, 559 Lichen planus, 778-79 Lymphangiosarcoma, 414
Leiomyosarcoma, 559, 737-38 Lichen sclerosis et atrophicus, 714, 721-22, 775 Lymphangitis, 97, 410
Leishman, Sir William, 5 Li-Fraumeni syndrome, 213, 759, 860 Lymphatic obstruction, 97, 410
Lentigo, 40, 787 Ligandin, 597 Lymphatic spread of tumours, 200-01
Leonardo da Vinci, 3 Line of separation, 49, 50 Lymphatics, 410-11
Lepra reaction, 159-60 Lines of Zahn, 117 Lymphoblast, 347
Lepromin test, 159 Linitis plastica, 557, 559f, 560f Lymphoblast versus myeloblast, 347t
Leprosy, 157-61 Lipid cell tumour, ovary, 749-50 Lymphocytes, 61, 142, 349
bacterial index (BI) in, 158 Lipiduria, 661 atypical, 352
borderline, 160-61 Lipoblast, 866 differences between T and B, 62t
causative organism of, 157 Lipodystrophy, intestinal, 576 subpopulations of, 61-64
classification of, 159 Lipofuscin, 43 Lymphocytosis, 142, 179, 349
clinical features of, 161 Lipogranuloma, 39, 621 Lymphoedema, 97, 410, 706
histopathology of, 160-61 Lipoid nephrosis, 669-70 Lymphogranuloma venereum (LGV), 186
immunology of, 158-59 Lipoma, 865-66 Lymphoid hyperplasia, 343-44
incidence of, 158 Lipooxygenase pathway, 137-38 angiofollicular, 343-44
indeterminate, 161 Lipopolysaccharides, 110 follicular, 342
lepromatous, 160 Lipoproteins, 339-40 Lymphoid neoplasms, 365-84
lepromatous versus tuberculoid, 159t HDL, 394 classifications, 365-68
multibacillary, 158 LDL, 394 general comments, 368-69
nose, 517 VLDL, 394 Hodgkin’s disease, 369-73
paucibacillary, 158 Liposarcoma, 866-67 peripheral (mature) B cell malignancies,
reactions in, 159-60 Liver, 592-637 374-79
Ridley-Jopling classification, 159 abscess, 614-15 peripheral (mature) T cell malignancies,
Leptocytosis, 293 biopsy, 596 379-80
Leptomeninges, 872 chemical and drug injury, 617-18 precursor (immature) B and T cell
Lesions, definition of, 1 coagulation disorders, 336-37 leukaemia-lymphomas, 373-74
Lethal midline granuloma, 380, 403, 517 CVC, 106-07 Lymphoid series, 347
Letterer Siwe disease, 386 fatty change, 37-39, 621-22 Lymphokines, 138
Leucocytes in health and disease, 347-50 metastasis in, 637 Lymphomas, general, 353-56
Leucocytoclastic vasculitis, 403, 404 normal structure of, 592-93 adult T cell (ATLL), 227-28, 379-80
Leucocytosis, 145, 147-51, 348 tumours and tumours-like lesions, 632-37 bowel,
Leucodema, 522 Liver cell necrosis, types of, 604-05 Burkitt’s, 225, 377-78
Leucoderma, 40 bridging, 612 classifications, 353-54, 365-68, 368t
Leucodystrophy, progressive multifocal, 878 piecemeal, 611 CNS, 889
Leucoerythroblastic reaction, 326 Liver function tests, 593-96, 594t contrasting features of, 373t
Leucopenia, 347-51 Lobar pneumonia, 468-71 cutaneous T cell, 379
INDEX
Leukaemias-lymphomas, Lobule, liver, 592 etiology, 354-55
classifcation of, 353-54 Lock jaw, 180 gut, 559-60
etiology of, 354-55 Löeffler’s endocarditis, 456 Hodgkin’s, 369-73
general aspects, 353-56 Löeffler’s syndrome, 494 nasopharynx, 380
pathogenesis of, 355-56 Loose bodies, joints, 851 non-Hodgkin’s (NHL), 373-80
Leukaemia, lymphoid, 354 Lordosis, 249 pathogenesis, 355-56
acute (ALL), 373-74 Ludwig’s angina, 517 staging of, 372t, 380
ALL versus AML, 375t Lukes-Collins classification, 366 testis, 713
chronic lymphoid (CLL), 375-77 Lung, 461-504 WHO classification of, 368t
etiology of, 354-55 abscess, 475-76 Lymphopenia, 349
FAB classification of, 366t CVC, 106 Lymphopoiesis, 347
hairy cell (HCL), 378-79 fungal infections, 476-77 Lyon hypothesis, 257
pathogenesis of, 355-56 normal structure of, 461-62 Lysosomal components, 138
WHO classification of, 368t oedema, 100-01 Lysosomal storage diseases, 261-62
Leukaemia, myeloid, 354 paediatric disease, 462-65 Lysosomes, 24, 37
acute (AML), 362-65 shock, 113 changes in, 37
AML versus ALL, 375t tuberculosis, 155-57
chronic myeloid (CML), 357-59 tumours, 496-504
classification of AML, 362t Lupus erythematosus (LE) cell, 79 M
etiology of, 354-55 Lupus nephritis, 80t, 675-77
FAB classification of, 362t Lupus vulgaris, 774 M-band, 383
pathogenesis of, 355-56 Lupus, nose, 517 MacCallum’s patch, 441
WHO classification of, 357t Luteal phase defect, 732 Macrocytes, 292, 306
Leukaemoid reaction, 352-53 Lymph nodes, 342-85 Macroglossia, 522
lymphoid, 353 metastatic tumours, 385 Macrophage,
myeloid, 353 structure of, 342 alveolar, 106, 143
versus CML, 354 Lymphadenitis, reactive, 343-45 Macular degeneration, retina, 510

Madura foot, 182 uveal, 512 Milroy’s disease, 97, 410 925
Maffucci’s syndrome, 844 versus nevus, 788 Minimal change disease, 669
Major histocompatibility complex, 64-65 versus retinoblastoma, 513 Mitochondrial changes, 37
Malabsorption syndrome, 573-76 Melanosis coli, 40 Mitosis, 26-27, 165-66
classification of, 573 Membrane attack complex (MAC), 76, 139-40 Mitotic counts, 18
Malakoplakia, 699 Membrane damage, cell, 30 Mitotic figures, 198
Malaria, 188-89, 313 Membrane filter, 134 Mitral stenosis and insufficiency, 450-51
Malformations, 256-57 Membranous colitis, 181, 565, 580t Mitral valve prolapse, 451-52
arteriovenous, 413 Memory cells, 62 Mitsuda reaction, 159
Malignant melanoma, skin, 787-88 MEN syndrome, 206, 829 Mixed salivary tumour, 534-35
uveal, 512 Mendelian disorders, 259-60 malignant, 537
Malignant peripheral nerve Ménétrier’s disease, 549 MMTV, 207, 227, 760
sheath tumour (MPNST), 894-95 Meningioma, 890-91 Mole, hydatidiform, 751-53
Mallasez cells, 529 Meningitis, 874-76 Molecular genetics, cancer, 208-16
Mallory hyaline, 35, 621-22 CSF in, 876t Molecular pathology, 17-18
Mallory Weiss syndrome, 540 Meningocele, 873 Molluscum contagiosum, 773
Malpighi, Marcello, 3 Meningomyelocele, 873 Mönckeberg’s arteriosclerosis, 52, 392
MALT, 61, 142, 342 Mercury chloride nephropathy, 680 Moniliasis, 182, 270, 723
Malt-workers’ lung, 494 Merkel cells, 769 Monoblast, 346
MALToma, 378 Mesangial cells, 650 Monoclonal gammopathy, 380-85
small intestine, 576 Mesonephroid tumour, ovary, 745 of undetermined significance (MGUS),
stomach, 559-60 Mesothelioma, 505-06, 591 384-85
Mammary duct ectasia, 755 Metachromasia, 87-88 Monoclonal hypothesis, 397
Mammary dysplasia, 755-57 Metamyelocyte, 345 Monoclonality of tumours, 208
Mantoux test, 152 Metaphyseal fibrous defect, 838 Monocyte-macrophage series, 64, 143, 346
Maple-bark disease, 494 Metaplasia, 57 Monocytes, 349-50
Mapping, human genome, 7 cartilaginous, 58 Monocytosis, 350
Marasmus, 245f bronchus, 57, 498f Monokines, 139, 143, 346
Marble bone disease, 834 cervix, 57, 269, 725 Mononuclear phagocyte system, 64, 143, 346
Marek’s disease virus, 225 columnar, 57 Mononucleosis cells, 352
Marfan syndrome, 36, 331, 407, 451 epithelial, 57 Monosomy, 258
Margination, 116, 133 intestinal, 57, Morphometry, 19
Marjolin’s ulcer, 207, 783 mesenchymal, 58 Morgagni, Giovanni, 3
Markers in hepatitis B, 607 oesophagus, 57-58 Mostofi classification, 701
Masson, Pierre, 5 osseous, 58 M-protein, 383
Mast cells, 136, 141-42, 350 squamous, 57, 269, 497 Mucinous tumours of ovary, 743-44
Mastitis, 755 Metastasis, 200-04 Mucocele,
granulomatous, 755 biology of, 203-04 appendix, 579
plasma cell, 755 haematogenous, 201-02 gallbladder, 641
Masugi’s nephritis, 664 lymphatic, 200-01 oral cavity, 524
Matrix, extracellular, 170 mechanisms of, 203-04 sinus, 515
Maturation index (MI), 269t prognostic markers in, 204 Mucocutaneous syndrome lymph node, 404
M. avium-intracellulare, 72, 151, 155 retrograde, 201-02 Mucoepidermoid carcinoma, 536-37 INDEX
May-Grunwald, 4 routes of, 200-03 Mucoid degeneration, 35-36
McArdle’s disease, 262 skip, 200 Mucopolysaccharidoses, 262
McClintock, Barbara, 6 transcoelomic, 202-03 Mucormycosis, 176f, 181t
MCH, 289, 901t Metastatic calcification, 51, 53 Mucoviscidosis, 645
MCHC, 289, 901t Metatypical carcinoma, 785 Multifactorial inheritance, 263
MCV, 289, 901t Michaelis-Gutmann bodies, 699 Multiple endocrine neoplasia (MEN), 206, 829
Meckel’s diverticulum, 561 Microalbuminuria, 687 Multiple myeloma, 86, 380-84
Medial calcific sclerosis, 392 Microangiopathy, thrombotic, 689 Multiple (isseminated) sclerosis, 883-84
Medial necrosis, cystic, Microarrays, 7, 19 Mumps, 533
Erdheim’s, 36, 407 Microcytes, 292, 299, 323 Munro abscess, 778
Mediators of inflammation, 136-40 Microfilaments, 23 Muramidase, serum, 364
Medullary sponge kidney, 658-59 Microfilaria, 190 Muscle, skeletal, diseases of, 856-59
Medullary, definition of, 199 Microglia, 872 Muscular dystrophies, 858-59
Medulloblastoma, 889 Microglossia, 522 Mushroom-workers’ lung, 494
Megacolon, 569, 580 Microorganisms, identification of, 175t Mutagenesis, 220, 222-24
Megakaryocyte, 327 MicroRNAs in cancer, 216 Mutations, 208-09, 259-60
Megakaryopoiesis, 327 Microsatellite instability mechanism, 587 Mutator gene, 215
Megaloblasts, 307 Microscopy, Myasthenia gravis, 857
Megamitochondria, 37 basic, 13-14 Mycetoma, 182
Meigs’ syndrome, 505, 749 light, 13-14 Mycobacteria, atypical, 72, 149-51
Meissner’s corpuscle, 769 electron, 14-15 Mycobacteriosis, 72, 149
plexus, 561, 579 fluorescent, 14 Mycobacterium,
Melaena, 554, 591t Microtubules, 24 avium intracellulare, 72, 151
Melanin, 40 Microvilli, 23 Mycobacterium leprae, 157
Melanocytic tumours, 787-89 Mikulicz syndrome, 81, 511 Mycobacterium tuberculosis, 72, 149
Melanoma, 787-89 Miliaria, 771 Mycosides, 152
oesophagus, 542 Milk spots, 458-59 Mycosis fungoides, 379, 790
skin, 787-89 Milk-alkali syndrome, 53 Mycosis, superficial, 183, 773-74

926 Mycotoxin, 219, 222, 634 Myositis ossificans, 869-70 mercuric chloride, 680
MYC gene, 211t, 212 Myxoedema, 803-04 myeloma, 382, 684
Myelin figures, 31f Myxoma heart, 459 reflux, 682
Myeloblast, 345 Myxoma, odontogenic, 532 Nephrosclerosis, 687-89
Myeloblast versus lymphoblast, 347t Myxomatosis, 226 benign, 687-88
Myelocele, 873 Myxomatous degeneration of cardiac valves, malignant, 688-89
Myelocyte, 345 451-52 Nephrotic syndrome, 99, 660
Myelodysplastic syndrome (MDS), 361-62 versus nephritic syndrome, 662t
FAB classification of, 361 Nerve sheath tumours, 893-95
WHO classification, 361 N Nervous system, 871-95
Myelofibrosis, 325-26 central, 871-91
Chronic idiopathic, 360-61 Naevi, naevocellular, 41f, 787 healing of, 172, 891-92
Myelogram, 287t Naevus sebaceus, 785 normal structure of, 871-72
Myeloid metaplasia, 360-61 Nail-patella syndrome, 678 peripheral, 891-95
Myeloid neoplasms, 356-65, 357t Nasopharyngeal carcinoma, anaplastic, 225-26, Neurilemmoma, 893
acute myeloid leukamia, 362-64 518-19 versus neurofibroma, 895t
chronic idiopathic myelofibrosis, 360-61 Natural killer (NK) cells, 64, 230, 368, 380 Neuroblastoma, 517, 800-01, 886t
chronic myeloid leukaemia, 357-59 Neck, 520-21 Neuroendocrine system, 791-829
essential thrombocytosis, 360 cysts of, 520-21 Neurofibrillary tangles, 884
myelodysplastic syndromes, 361-62 tumours in, 521 Neurofibroma, 893-94
polycythaemia vera, 359 Necrosis, 44-46 plexiform, 894
Myeloid series, 345-46 avascular, bone, 833-34 versus schwannoma, 895t
Myelolipoma, 800 bridging, 611-12 Neurofibromatosis, 206, 893
Myeloma, 380-84 caseous, 45, 155 Neurofibrosarcoma, 894-95
kidney, 382, 684 centrilobular, haemorrhagic, 106 Neurofilaments, 16, 23-24
multiple, 380-84 coagulative, 45 Neuroglia, 871-72
neuropathy, 382 colliquative, 45 Neurohypophysis, 793
Myeloma cells, 382f cortical, renal, 690 Neuronophagia, 872
Myeloproliferative disorders, 357-61 fat, 45-46 Neuroma, acoustic, 515, 893
Myoblastoma, granular cell, 525, 869 fibrinoid, 46 traumatic, 893
Myocardial blood supply, 418 liquefactive, 45 Neuromuscular diseases, 857-59
Myocardial depressant factor (MDF), 112 liver cells, 604-05 Neuropathy, peripheral, 892-93, 826
Myocardial infarction, 429-38 massive, 613-14 Neuropeptide, 137
changes in early, 434 piecemeal, 611 Neuropil, 871
chemical and histochemical, 434 submassive, 613-14 Neurosyphilis, 163
changes in, 431-34 types of, 45-46 Neutropenia, 141, 348
clinical features of, 434-35 versus apoptosis, 48t Neutrophil alkaline phosphatase (NAP), 353,
complications of, 435-36 Necrotising enterocolitis, 181, 565 358
CK in, 434 Necrotising papillitis, 678, 682 Neutrophilia, 141, 348
diagnosis of, 434-35 Negri bodies, 186 Neutrophils, 64, 141, 347-49
ECG changes in, 434 Neonatal hepatitis, 601-02 toxic granules in, 349f
electron microscopic changes in, 434 Neoplasia, (also see under Tumours), 192-235 vacuoles in, 349f
enzyme determination in, 434-35 characteristics of, 194-205 Nexus, 25
etiopathogenesis of, 429-30 classification of, 193t Niacin, 253
INDEX
gross changes in, 431-33 clinical aspects of, 228-35 Niemann-Pick disease, 262-63
incidence of, 429 definition of, 192 Nissl substance, 871
LDH in, 434-35 diagnosis of, 232-35 Nitric oxide mechanism, 139
location of, 430-31 epidemiology of, 205-08 Nitrosamines, 219, 555
myoglobin in, 435 etiology of, 208-28 NK cells, 64, 230, 368, 380
morphologic features of, 431-33 intraepithelial, 207 Nodular fascitis, 862
serum cardiac markers in, 434-35 pathogenesis of, 208-28 Nodule, vocal, 519
transmural versus subendocardial, 430t Neoplastic cells, 196-99 Noma, 523
troponins in, 435 Neovascularisation, 167, 199, 215 Non-Hodgkin’s lymphomas (NHL), 373-380
types of, 430 Nephritic syndrome, 99, 660 adult T cell (ATLL), 379-80
Myocardial ischaemia, non-infarct effects of, versus nephrotic syndrome, 662t anaplastic large cell (ALCL), 380
429f Nephritic versus nephrotic oedema, 99t, 662t Burkitt type, 377-78
Myocarditis, 452-54 Nephritis, hereditary, 678 CD markers in, 367f
classification of, 452t Nephritis, tubulointerstitial, 680-85 classification of, 365-68
Fiedler’s, 453 Nephroblastoma, 696-98 etiology of, 354-55
granulomatous, 453 Nephrocalcinosis, 53f, 684-85, 816 pathogenesis of, 355-56
idiopathic, 453 Nephrolithiasis, 690-92 extranodal, 378
in connective tissue diseases, 453 Nephroma, mesoblastic, 694 follicular, 377
infective, 453 Nephron, structure of, 649-52 maltoma, 378
miscellaneous types of, 453-54 Nephronophthiasis-medullary marginal zone, 378
rheumatic, 441-42 cystic kidney disease mycosis fungoides, 379-80
Myofibroblast, 167, 396 complex, 659 mantle cell, 378
Myoglobin, 435 Nephropathy, mature B cell type, 374-79
Myometritis, 732 analgesic (phenacetin abuse), 681t mature T cell type, 379-80
Myometrium, 730-38 diabetic, 677-78 monocytoid, 379
normal structure of, 730 IgA, 674 periperal B cell type, 374-79
Myopathies, 858-59 lupus, 675-76 peripheral T cell type, 379-80

precursor B and T cell type, 377-78 muscular dysfunctions of, 538-39 Osteosarcoma, 841-43 927
splenic margina;l zone, 379 normal structure of, 538 central, 841-43
SLL/CLL, 375-77 rings of, 539 central versus surface, 844t
staging of, 380 rupture of, 540 juxtacortical, 843
versus Hodgkin’s disease, 373t tumours of, 541-43 medullary, 841-43
working formulations for clinical usage, 366 varices, 539-40 surface, 843
WHO classification, 367-68, 368t webs of, 539 periosteal, 843
Noncirrhotic portal fibrosis, 629-30 Oestrogen, 207, 731 parosteal, 843
Nondisjunction, 258 Oligodendrocytes, 872 telangiectatic, 842
Nonossifying fibroma, 838-39 Oligodendroglioma, 882 Otitis media, 514
Normal values, 896-903 Oliguria, 654, 679f Otic polyp, 514
in clinical chemistry, 898-900 Ollier’s disease, 844 Otosclerosis, 514
in haematology, 901-03 Omega-3 fatty acids, 394 Ovalocytosis, 315
other body fluids, 900-01 Oncocytoma, 37, 535-36, 694 Ovarian tumours, 740-51
weights and measurements of organs, Oncofoetal antigens, 234, 709 clinical features of, 741
896-97 Oncogenes, 209-12 classification of, 742t
Normoblastaemia, 292 versus anti-oncogenes, 214 etiopathogenesis of, 740-41
Normoblasts, 287-88 Oncogenesis, (also see under Carcinogenesis), germ cells, 745-48
Nose and paranasal sinuses, 515-17 208-28 metastatic, 750
carcinoma of, 517 Oncogenic viruses, 222-28 miscellaneous, 749-50
inflammatory conditions of, 515-17 DNA, 224t sex cord stromal, 748-49
normal structure of, 515 RNA, 227t staging of, 751t
tumours of, 517 Oncology, 192 surface epithelial, 741-45
Notochord, 849 Oncomirs in cancer, 216 Ovary, 739-51
Nucleocytoplasmic ratio, 197-98, 271 Oncotic pressure, 95, 96-97 non-neoplastic cysts of, 740
Nucleolar organiser regions (NORs), 198 Ontogenesis, 264 normal structure of, 739-40
Nucleolus, 23 Opportunistic infections, 72f, 181, 449, 523t tumours of, 740-51
Nucleotides, 23 Opsonins, 135 Overhydration, 102-03
Nucleus, structure of, 22-23 Opsonisation, 135 Overinflation, lung, 482-83
Nutmeg liver, 106-07 Oral soft tissues, 522-27 Oxygen dissociation, 290f
Nutritional diseases, developmental anomalies of, 522 Oxygen-derived radicals, 31-33, 139
of brain, 886 normal structure of, 522 Ozone, 236
tumours of, 523-27
white lesions of, 522
O Orchitis, 705 P
granulomatous, 705
Oat cell carcinoma, lung, 500 tuberculous, 705 Paan, in oral cancer, 206
Obesity, 243-44 Organelles, 23-24 Pacinian corpuscles, 769
Occupational lung diseases Organoid pattern, 814 P-component, 83, 88
(also see under Pneumoconiosis), 43, 487-93 Ormond’s disease, 591 Paediatric diseases, 263-65
Ochronosis, 40-41 Osler’s nodes, 448 Paediatric lung disease, 462-65
Odontogenic tumours, 531-32 Osler-Weber-Rendu disease, 331, 525, 860 Paediatric tumours, 206-07, 263-64
Odontomas, 532 Osmolality, 94 Paget’s disease, INDEX
Oedema, 96-102 Osmolarity, 94 of bone, 837
angioneurotic, 76, 97, 770 Osmotic fragility, 315, 324 of nipple, 764-65
cardiac, 99-100 Osmotic pressure, 95 of vulva, 722
cerebral, 101-02 colloid, 95 Pancarditis, rheumatic, 440-42
definition and types of, 96 crystalloid, 95 Pancoast’s syndrome, 502
dependent, 99 Ossification, 839 Pancreas, 644-48
hepatic, 102 Osteitis deformans, 837 carcinoma, 647-48
high altitude, 101 Osteitis fibrosa cystica, 835-36 cystic fibrosis of, 645
inflammatory, 97 Osteoarthritis, 850-51 endocrine, 818-29
morphology of, 99-102 Osteoblast, 830 exocrine, 644-48
nephritic, 99, 660 Osteoblastic tumours, 840-43 fat necrosis of, 45-46
nephrotic, 99,660 Osteoblastoma, 841 heterotopia, 545
nephritic versus nephritic, 99t Osteochondroma, 843-44 normal structure of, 644-45
pathogenesis of, 96-99 Osteoclastoma, 846-48 pseudocyst of, 647
pitting versus non-pitting, 99 Osteocyte, 830 Pancreatitis, 646-48
postural, 97 Osteodystrophy, renal, 836-37 acute, 646
pulmonary, 100-01 Osteogenesis, 831,842
nutritional, 102 Osteogenesis imperfecta, 834 chronic, 646-47
renal, 99 Osteoid osteoma, 841 Pancytopenia, 325t
Oesophagitis, 540-41 Osteoma, 841 Panhypopituitarism, 794-95
Barrett’s, 540-41 Osteomalacia, 250 Panniculitis, 771
infective, 541 Osteomyelitis, 831-33 Pannus formation, 852
reflux (peptic), 540 pyogenic, 831-33 Papanicolaou, George, 5, 266
Oesophagus, 538-43 tuberculous, 833 Papanicolaou’s (Pap) smear, 268-72, 275-76
atresia of, 538 Osteonecrosis, 833-34 stain, 277
cancer, 541-43 Osteopetrosis, 834 Papillitis, necrotising (papillary
congenital anomalies of, 538 Osteophytes, 851 necrosis), 678, 683
diverticula of, 539 Osteoporosis, 835 Papilloedema, 511

928 Papilloma, 193t Permeability factors, 136-40 rheumatoid, 490
breast, intraductal, 759 Permeability, vascular, 131-33 silicosis, 490-91
choroid plexus, 889 Pertussis, 178 Pneumocytes, 461-62
juvenile, 224 Petechiae, 107, 329, 331 Pneumonia, 467-75
larynx, 519 Peutz-Jeghers syndrome, 582 aspiration, 474-75
mouth, 524 Peyronie’s disease, 170 atypical, 472-74
nose and paranasal sinuses, 517 p53 gene, 213 bacterial, 468-71
skin, 780 pH of blood, abnormalities of, 103-04 broncho (lobular), 471-72
urinary bladder, 701 Phagocytes, 64, 143 caseous, 156
Papilloma viruses, 224-25 Phagocytosis, 64, 134-36, 143 classification of, 468t
Papillomatosis, florid, 224, 757 Phagolysosome, 135f hypostatic, 475
Papovaviruses, 224-25 Phagosome, 135f Legionella, 474
Pappenheimer bodies, 300 Pharynx, 517-19 lipid, 475
Paradoxical embolus, 119 Phase reactant proteins, 83, 140 lobar, 468-71
Paraganglioma, extra-adrenal, 801 Pheochromocytoma, 79-800 lobar versus bronchopneumonia, 473t
Parakeratosis, 769 Philadelphia chromosome, 199, 353, 355, 356f, lobular, 471-72
Paranasal sinuses, 515-17 358 pathogenesis of, 467-68
Paraneoplastic syndrome (PNS), 231-32, 502 Phimosis and paraphimosis, 714 Pneumocystis carinii, 474
Paraphimosis, 714 Phlebothrombosis, 409 primary atypical, 472-74
Paraproteinaemias, 380-85 Phlebotomy, 359 viral and mycoplasmal, 472-74
Parasitic diseases, 187-91 Phlegmasia, 410 Pneumonitis, 467-75
Parasitism, 174 Phocomelia, 256 allergic, 493-94
Parathormone, 816 Phosphatidylserine, 48 hypersensitivity, 493-94
Parathyroid gland, 815-18 Phthisis bulbi, 510 interstitial, 472-74
normal structure of, 815-16 Phyllodes tumour, 758-59 rheumatic, 443
tumours of, 817-18 Physaliphorous cells, 849 Pneumothorax, 505
Parkinsonism, 884-85 Physical carcinogenesis, 220-22 Podocytes, 650, 669
Paronychia, 182 Physical injury, 28, 34, 242-43 Poikilocytosis, 292
Paroxysmal cold haemoglobinuria (PCH), 313 Pica, 298 Poisoning,
Paroxysmal nocturnal haemoglobinuria (PNH), Pickwickian syndrome, 244-45 aluminium phosphide, 242
314 Pigmented villonodular synovitis, 855 carbon monoxide, 241
Partial thromboplastin time with kaolin (PTTK), Pigments, 40-44 cyanide, 242
330 malarial, 42 lead, 240-41
Pasteur, Louis, 4 wear and tear, 43 mercuric chloride, 680
Patent ductus arteriosus (PDA), 424 Piles, 581 organophosphate, 242
Patent truncus arteriosus, 425 Pilomatricoma, 785 Pollutants, 236-37
Pathology, definition of, 1 Pinguecula, 510 Polyarteritis nodosa (PAN), 402
evolution of, 1-7 Pinocytosis, 143 Polyarthritis, 442-43, 851
history of, 1-7 Pituitary gland, 792- 96 migratory, 442-43
subdivisions of, 7-8 normal structure of, 792-93 Polychondritis, relapsing, 514
Paul-Bunnel test, 352 tumours of, 795-96 Polychromasia, 292
Pavementing, 116, 133 Placenta, 751-53 Polyclonal, 15, 383
Pelger-Huet anomaly, 349 normal structure of, 751 Polycystic kidney disease, 657-58
Pellagra, 253 Plague, 175-77 adult, 657-58
INDEX
Pelvic inflammatory disease (PID), 738-39 Plaque, bacterial, 528 infantile, 658
Pelvis, kidney, 649 Plaque, pericardial, 458-59 Polycystic ovary disease, 740
tumours of, 700-02 Plaques, atheromatous, 398-99 Polycythaemia vera, 359
Pelviureteric junction (PUJ) obstruction, 690t, Plasma cell, 63, 142-43, 349, 380 Polyembryoma, 711, 742t
692 granuloma, 384 Polyglandular autoimmune syndromes, 829
Pemphigoid, 777 Plasma cells, disorders of, 380-84 Polymerase chain reaction (PCR), 6, 18
Pemphigus, 776-77 Plasmacytoma, localised, 384 Polymorphonuclear neutrophils (PMN), 64,
Penis, 714-16 Plasmacytosis, reactive, 382 141, 347-49
carcinoma of, 715-16 Plasmin, 116f, 139, 141f, 330f Polymyositis-dermatomyositis, 81, 495
normal structure of, 715 Platelet, 327-28 Polyol mechanism in diabetes, 825
Pepsin, 545 activating factor (PAF), 138 Polyoma virus, 225
Peptic ulcer, 549-54 adhesion, 115, 328 Polyploidy, 258
acute (stress), 550 aggregation, 115, 328 Polyps,
benign versus malignant, 557 release reaction, 115, 327 adenomatous, 584
chronic duodenal versus gastric, 551 tests for, 329 antrochoanal, 515-16
duodenal, 550-54 Pleomorphic adenoma, salivary gland, 534-35 aural, 514
gastric, 550-54 Pleomorphism, 197 cervical, 725
Pericardial fluid accumulations, 456-57 Pleura, 504-06 colorectal, 582-86
Pericardial plaques, 458-59 tumours of, 505-06 endometrial, 735
Pericarditis, 457-59 Pleuritis, (pleurisy), 504-05 fibroepithelial, 722, 780
Periodontal disease, 529 Plummer-Vinson syndrome, 298, 526, 539, 541 gastric, 554
Periodontal tissue, Pneumoconiosis, 487-93 hamartomatous, 554, 582
normal structure of, 527-28 asbestos disease, 492-93 hyperplastic, 554, 582
Peritoneal bands and adhesions, 562-63 berylliosis, 493 inflammatory, 583
Peritoneum, 590-91 Caplan, 490 juvenile, 582, 586
tumors, 591 classification of, 488t lymphoid, 583
Peritonitis, 590-91 coal-workers’, 488 retention, 582

nasal, 515-16 Pseudocartilage, 535 Raynaud’s disease and phenomenon, 405 929
neoplastic, colorectal, 583-85 Pseudocyst of pancreas, 647 RB gene, 213
Peutz Jeghers, 582 Pseudogout, 855 REAL classification, 366-67
stomach, 554 Pseudolymphoma, 81, 560 Recessive inheritance, 260
stromal, 722, 780 Pseudomembrane, 181, 565 Red blood cells, 287-326
Polyribosomes, 24 Pseudomembranous inflammation, 144 Red cell membrane, 289
Polyserositis, 458 Pseudomyxoma peritonei, 203, 579, 743 hereditary abnormalities of, 314-15
Pompe’s disease, 262 Pseudopolyp, 568 Red line response, 131
Porcelain gallbladder, 642 Pseudotumour, inflammatory, 511 Reed-Sternberg (RS) cell, 369-70
Pores of Kohn, 462 Pseudoxanthoma elasticum, 31 Reflux nephropathy, 682
Porphyria, 42-43 Psoriasis, 778-79 Regeneration, 165-66
Porphyrins, 42-43 PTEN gene, 759, 787 Regurgitation, valvular, 449-51
Porta hepatitis, 592 Pterygium, 510 Reid index, 478
Portal hypertension, 630-32 Ptyalism, 533 Reidel’s struma, 805-06
Portal venous obstruction, 604 Pulmonary embolism, 120-21 Reinke’s crystals, 703
Portwine stain, 411 Pulmonary eosinophilia, 456, 494 Reiter’s syndrome, 81-82, 699
Post-myocardial infarction syndrome, 436 Pulmonary fibrosis, idiopathic, 495-96 Rejection reactions, 65-66
Pott’s disease, 833 Pulmonary hypertension, 466-67 Renal cell carcinoma, 694-96
Pott, Sir Percival, 3 Pulmonary oedema, 100-01 Renal clearance tests, 653
Poxviruses, 186, 226 Pulmonary tuberculosis Renal cortical necrosis, 690
PPD test, 152 (see under Tuberculosis), 149-57 Renal cysts (also see under Cysts, kidney),
Precocious puberty, 794, 838 Pulmonary valve, atresia, 426 656-60
Predisposing factors in tumours, 205-08 stenosis, 426 Renal dysplasia, 657
Pregnancy tumour, 412, 524 Pulpitis, 529 Renal failure, 653-56
Preleukaemic syndrome, 361-62 Pulseless disease, 404 acute (ARF), 654
Premalignant lesions, 207 Punctate basophilia, 292 chronic (CRF), 654-56
Pre-proinsulin, 819 Pure red cell aplasia, 326 Renal function tests, 652-53
Pressure gradients, 94-95 Purines, 23 Renal osteodystrophy, 836-37
Primary complex, 153-55 Purpura, 107, 331-34 Renal pelvis, tumours of, 702
Primitive neuroectodermal tumour (PNET), Henoch-Schonlein, 331 Renal vascular disease, 685-90
836t idiopathic thrombocytopenic (ITP), 332-34 Renin-angiotensin-aldosterone
Prinzmetal’s angina, 429 thrombotic thrombocytopenic (TTP), 334 mechanism, 98, 686-87, 796
Prion proteins, 83, 174, 878 Pus, 145 Reninoma, 694
Probe, 17, 18 Putrefaction, 49 Repair, 166-73
Procallus, 171-72 Pyaemia, 145 Reperfusion injury, 31-33
Proerythroblast, 287 Pyelitis, 681 in myocardial infarction, 433
Progeria, 60 Pyelonephritis, 680-84 Residual bodies, 24, 43
Progestrogen, 208, 731 acute, 680-82 Resistance, 66
Progressive massive fibrosis, 489-90 chronic, 682-84 Respiratory burst, 135
Progressive multifocal leucoencephalopathy diabetic, 678 Respiratory distress syndrome (RDS), 462-65
(PML), 878 obstructive, 682 adult, 462-65
Progressive systemic sclerosis, 80-81 tuberculous, 684 neonatal, 462-65
Proinsulin, 819 xanthogranulomatous, 683 Respiratory syncytial virus (RSV), 472 INDEX
Prolapse, mitral valve, 451-52 Pyknosis, 30 Response-to-injury hypothesis, 395-97
Promyelocyte, 345 Pyknotic index, 269 Reticulocyte, 288
Pronormoblast, 287 Pyloric stenosis, 546 Reticuloendothelial system (RES), 64, 143
Properdin, 664 Pyogenic granuloma, 412, 524 Retinal detachment, 510
Prostacyclin, 137 Pyonephrosis, 682 Retinitis pigmentosa, 507
Prostaglandins, 137 Pyorrhoea, 529 Retinoblastoma, 512-13
Prostate, 716-20 Pyridoxine, 253 versus malignant melanoma, 513t
acid phosphatase (PAP), 720 Pyruvate kinase (PK) deficiency, 317 Retinol, 247-48
carcinoma, 718-20 Retinopathy,
cytology of, intraepithelial neoplasia Q diabetic, 508-09, 826
(PIN), 719 hypertensive, 509-10
nodular hyperplasia, 717-18 Quality control in histopathology, 11 prematurity, 507
normal structure of, 716-17 Quick’s one stage method, 330 Retrolental fibroplasia, 507
specific antigen (PSA), 720 Quinacrine banding, 257 Retroperitoneal fibromatosis, 591
Prostatitis, 716-17 Quinsy, 518 Retroviruses, 183, 227-28
granulomatous, 717 Reversible cell injury, 29-30
Protease inhibitor, 479-80, 628 R morphology of, 34-36
Protease-antiprotease hypothesis, 479-80 Reye’s syndrome, 38, 602
Protein, serum, 595 Rabies, 186 Rhabdomyoma, 455, 867
Protein-energy malnutrition (PEM), 245-46 Rachitic rosary, 249 Rhabdomyosarcoma, 867-68
Proteinuria, 99t, 652, 660-61 Radiation carcinogenesis, 34, 220-22, 242 embryonal, 867
highly selective, 660, 669 Radicals, free, 31-33, 139 Rhesus system, 339
non-selective, 660, 671 Radioautography, 18 Rheumatic fever and RHD, 438-44
Proteoglycans, 83, 170, 262 Radiolysis, 34f acute stage, 440
Prothrombin time, 330 Ranula, 524 cardiac lesions in, 439-42
Prothrombotic factors, 114 Rappaport classification, 365 causes of death in, 443-44
Prussian blue reaction, 13t, 41, 301 RAS gene, 210-11 chronic stage, 441
Psammoma bodies, 52, 813, 890 Ray fungus, 164 clinical features of, 443-44

930 definition of, 438 Schwannoma, 893-95 Siderosis, 42, 627
endocarditis, 441 acoustic, 515, 893 Sigmoid curve, 289
etiopathogenesis of, 438-39 versus neurofibroma, 895t Signal transduction proteins, 212, 216f
extra-cardiac lesions in, 442-43 Scirrhous tumours, 199, 557, 762 Signet ring carcinoma, 557, 560f
incidence of, 438 Scleroderma (systemic sclerosis), 80-81 Silicosis, 490-91
morphologic features of, 439-43 Sclerosing adenosis, breast, 757 Silo-filler’s disease, 494
myocarditis in, 441-42 Scotomas, 509 Simmond’s syndrome, 794
pericarditis in, 442 Scurvy, 251-52 Simple cyst, bone, 839-40
pleuritis, 443 Sebaceous gland tumours, 785-86 Single gene defect, 259-60
pneumonitis, 443 Seborrheic keratosis, 780, 781f Sinus histiocytosis, 344
stigmata of, 443 Seed-soil theory, 201 Sinusitis, 515
valvulitis in, 440-41 Selectin, 25, 134 Sipple syndrome, 829
vasculitis in, 443 Semen examination, 703, 900t Sjögren’s syndrome, 81, 533
vegetations in, 441, 442f, 447t Seminoma, spermatocytic, 710 Skeletal muscles, structure of, 856-57
Rheumatoid arthritis, 78t, 851-53 Seminoma, classic, 709-10 tumours, 867-68
Rheumatoid factor, 851 Senile keratosis, 782 Skeletal system, 830-56
Rheumatoid nodules, 852 Senile plaques, 87, 884 Skin, 768-90
Rheumatoid pneumoconiosis, 490 Sentinel lymph node, 765 dermatoses, 769-79
Rheumatoid spondylitis, 853 Septicaemia, 145 normal structure of, 768-69
Rhinitis, 515 Sequestration, bronchopulmonary, 462 tumours of, 779-90
Rhinoscleroma, 516 Sequestrum, 832 Slow releasing substance of anaphylaxis
Rhinosporidiosis, 181t, 516 Serotonin, 137 (SRS-A), 137
Riboflavin, 253 Serous tumours of ovary, 742-43 Slow transforming viruses, 227
Ribosomes, 24 Sertoli cell tumour, 713, 749 Sludge, biliary, 639f
Rickets, 249 Severe acute respiratory syndrome (SARS), 185 Small cell carcinoma lung, 500-01
Ridley-Jopling classification, 159 Sex chromatin, 23, 257f, 275 versus non-small cell carcinoma, 500t
Ring chromosome, 259f Sex chromosomes, 23, 257 Small cell tumour, desmoplastic, 591
RNA oncogenic viruses, 227t Sex cord-stromal tumours, Smog, 236
Rodent ulcer, 784-85 ovary, 748-39 Smoking, 218, 237, 480f, 497-98
Rokitansky’s protuberance, 746 testis, 713 passive, 237
Rokitansky, Carl F, 4 Sezary syndrome, 379, 790 Sodium and water, 94, 687
Rokitansky-Aschoff sinus, 642 Sheehan’s syndrome, 794 deficiency of, 103
Romanowsky, DL, 4 Shift-to-left, 348, 353 retention of, 97
Rosettes, 62t Shift-to-right, 307, 348-49 Soft tissue tumours, 860-70
Rotor’s syndrome, 601 Shigella, disentery, 176t, 572 classification of, 860
Rouleaux formation, 382 Shingles, 185, 773 diagnostic criteria of, 860-61
Round cell tumours, 848, 861 Shock, 108-13 etiology and pathogenesis of, 860
RS cell marker, 369, 371f adrenal in, 113 general features of, 860
Russell bodies, 35, 382 anaphylactic, 73, 109 staging and grading of, 861
Rye classification, 371 brain in, 112-13 Solar keratosis, 782
cardiogenic, 109, 110 Soldiers’ spots, 459
clinical features of, 113 Solitary cyst, bone, 839-40
S compensated (reversible), 111-12 Solitary rectal ulcer syndrome, 581
complications of, 113 Somogyi effect, 825
INDEX
Sacrococcygeal teratoma, 264t decompensated (irreversible), 112-13 Sorbitol mechanism, 824-25
Saddle nose deformity, 163 definition of, 108 Southern blot, 17
Saddle thrombus, 120 etiology and classification of, 109 Special stains, 11-13
Salah bone marrow needle, 287f hypovolaemic, 109 Spectrin, 289, 314-15
Salivary glands, 533-37 inflammatory mediators of, 111f Speech recognition system, 19
normal structure of, 533 kidney in, 113 Spermatic granuloma, 705-06
tumours of, 534-37 lungs in, 113 Spherocytosis, 314-15
tumours of minor, 534t morphologic features in, 112-13 Spina bifida, 256, 873
Salmonellosis, 176t, 572 neurogenic, 109 Spinal cord defects, 256, 873
Salpingitis, 738-39 pathogenesis of, 109-11 Spiradenoma, 786
tuberculous, 739 septic, 109, 110-11 Spleen, 386-88
Salt deficiency, 103t stages of, 111-12 CVC of, 106
Saponification, 46 true, 108 normal structure of, 386
Saprophytism, 174 Shock, kidney, 113, 679 Splenectomy, effects of, 387-88
Sarcoidosis, 164-65 Shock, lung, 113 Splenic rupture, 388
Sarcoma, botryoides, 519, 724, 867, 868f Shunts, heart, 423-26 Splenic tumour, acute, 388
Sarcoma, definition of, 192 left to right, 423-24 Splenitis, 388
SARS, 185 right to left, 424-26 Splenomegaly, 387t
Scab, 169 Sialadenitis, 533-34 congestive, 387
Scar, hypertrophic, 170 Sialolithiasis, 533 Splenosis, 388
Schaumann bodies, 165 Sialorrhoea, 533 Spondylitis, 853
Schiller Duval body, 748 Sicca syndrome, 81, 533 Spongiform encephalopathy, 878
Schiller’s test, 727 Sickle cell syndrome, 318-19 Spongiosis, 769
Schilling test, 308, 545,901t Sideroblasts, 300-01 Spread of tumours, 200-03
Schistocytosis, 293 ring, 300f Sprue, 575
Schistosomiasis, 222, 700, 722 Siderocytes, 301 Sputum examination, 272, 275-76
Schwann FT, 5 Siderofibrotic nodule, 106-07, 108f Squamocolumnar junction, 724

Squamous cell carcinoma, 192f Sydney classification, gastritis, 548 Thromboangiitis obliterans 931
cervix, 728-29 Symbiosis, 174 (Buerger’s disease), 404
lung, 499-500 Sympathetic ophthalmia, 508 Thrombocytopenias, 332-34
oesophagus, 541-42 Sympathicoblastoma, 800 drug-induced, 332-34
oral cavity, 526-27 Synovial sarcoma, 868-69 heparin-induced, 332
penis, 715-16 Synovioma, benign, 855 immune, 332-34
skin, 783-84 Synovitis, villonodular, 855 thrombotic, 334
vulva, 723 Syphilis, 161-63 Thrombocytosis, 334
Squamous intraepithelial lesions (SIL), aortitis, 401 essential, 360
H-SIL, 271 cardiovascular, 163 Thromboembolism, 120-21, 435
L-SIL, 271 causative organisms of, 161 Thrombogenesis, 114-17
Squamous metaplasia, 57, 269, 497 congenital, 163 Thrombogenic theory, 395
Staghorn stone, 691 immunology of, 161-62 Thrombolytic therapy, 433
Staging of tumours, 205, 861 mode of transmission of, 162 Thrombomodulin, 114
AJC, 205, 861 nose, 163 Thrombophlebitis, 409-10
Enneking’s, 861 primary, 162 migrans, 410
TNM, 205, 861 secondary, 162 Thrombopoiesis, 327-28
Staphylococcal infections, 179-80 stages of, 162-63 Thrombopoietin, 327
Starling’s hypothesis, 420 tertiary, 162-63 Thrombosis, 113-19,
Starvation, 245 Syphilitic aortitis versus aortic atheroma, 402t clinical effects of, 119
Stasis, vascular, 131 Syringobulbia, 873 coronary, 430
Steatocystoma multiplex, 782 Syringomyelia, 873 definition of, 113-14
Steatohepatitis, Syringomyelocele, 873 fate of, 118-19
morphology of, 117-18
alcoholic, 37-39, 621-22 Syrinx, 873 pathophysiology of, 114-17
non-alcoholic (NASH), 629 Systemic lupus erythematosus (SLE), 78-80,
predisposing factors in, 117
Steatorrhea, 574 495, 675-77 Thrombospondin, 328
Steatosis, 37-39, 621-22 heart in, 444 Thrombotic microangiopathy, 689
Stein-Leventhal syndrome, 740 Systemic sclerosis, 80-81, 495 Thrombotic thrombocytopenic,
Stem cells, haematopoietic, 285 purpura (TTP), 334
Stem cell research, 7 T Thromboxane, 137
Stenosis, valvular, 425-26, 449-51 Thrombus, 113
aortic, 426, 450-51 Tabes dorsalis, 163 antemortem versus postmortem, 118t
mitral, 449-50 Tabes mesenterica, 154, 570 arterial versus venous, 118t
pulmonary, 426 Takayasu’s arteritis, 404 ball valve, 118
tricuspid, 425-26 Tamm-Horsfall protein, 382, 652 morphology of, 117-18
Stevens-Johnson syndrome, 522, 777 Target cell, 293 Thrush, oral, 182, 523
Stitch abscess, 168 Tart cell, 79 Thymocytes, 388
Stomach, 543-60 Tattooing, 44 Thymoma, 388-89
acute dilatation of, 546 Teare’s disease, 454-55 Thymus, 388-89
cancer of, 555-60 Teeth, normal structure of, 527-28 Thyroglossal cyst, 520
normal structure of, 543-44 Telepathology, 19-20 Thyroid cancer, 811-15
rupture of, 546 Telomerase, 215 etiolopathogenesis of, 812
tumours and tumour-like Telomere, 59 follicular, 813 INDEX
lesions of, 554-60 Tenascin, 170 medullary, 813-14
Stomatitis, 522-23 Tenosynovitis, nodular, 855 papillary, 812-13
Stomatocytosis, 316 Teratogens, 256 undifferentiated (anaplastic), 814-15
stomatin in, 316 Teratology, 256 Thyroid gland, 801-15
Stones, gallbladder, 638-41 Teratoma, function tests, 802
Stones, kidney, 690-92 of ovary, 746-47 functional disorders of, 802-04
Storage diseases, 260-63 of testis, 711-12 normal structure of, 801-02
neuronal, 885 sacrococcygeal, 264t tumours of, 810-15
Storage iron, 295 Testicular tumours, 706-13 Thyroiditis, 804-06
Storiform pattern, 860, 864-65 Testis, 703-13 autoimmune, 804-05
Stout, AP, 5 normal structure of, 703 deQuervain’s, 805
Streptococcal infections, 180-81 torsion of, 706 granulomatous, 805
Stroke syndrome, 400, 879 tumours of, 706-13 Hashimoto’s, 804-05
Stromal fatty infiltration, 39 Tetanus, 180 infectious, 805
Struma ovarii, 747 Tetralogy of Fallot, 425 lymphocytic, 805
Struvite (staghorn) stone, 691 Thalassaemias, 320-24 Riedel’s, 805-06
Sty, 508 alpha, 321 Thyrotoxicosis (hyperthyroidism), 802-03
Subarachnoid haemorrhage, 882 anaemia in, 320 Tinea, 773-74
Subependymoma, 889 beta, 322-24 Tissue tension, 95
Sudden cardiac death, 429f, 436-37 classification of, 321t TNM staging, 205, 861
Sulfur granules, 164 definition of, 320 Tobacco smoking, 218, 237, 480f, 497-98
Suppuration, 145 Thalidomide malformations, 256 Tocoferol, 250-51
Surfactant, 462 Thecoma, 749 Tolerance, immune, 77
Surgical pathology, protocol, 9-11 Thermal injury, 34, 242 Tongue, lesions of, 522-23
Sushruta, 3 Thiamine, 252 Tonsillitis, 517-18
Suture tracks, 168 Thioflavin, 88 Tooth, 527-32
Sweat gland tumours, 786 Thrombasthenia, 334 diseases of, 528-32
Swine flu, 185-86 Thrombin time, 320, 329t normal structure of, 527-28

932 Tophi, 854f meninges, 876 stress, 550
TORCH complex, 190-91 miliary, 162 Ulcerative colitis, versus Crohn’s disease, 566t
Torsion testis, 706 nose, 517 Ultimate carcinogens, 218
Torticollis, 521 open, 155 Ultraviolet light, 34, 221
Toxic granules, in neutrophils, 348 oral cavity, 523 Unicameral, bone cyst, 839-40
Toxic shock, 109, 110-11 primary, 153-55 Union, wounds, 168-69
Toxoplasmosis, 191 pulmonary, 154-56 primary, 168
TP53 gene, 213 secondary, 155-56 secondary, 168-69
Trace elements, 254 sinus tracts in, 153 Urachal abnormalities, 698
Tracheo-oesophageal fistula, 538 spread of, 151-52 Urachal cyst, 698
Trachoma, 508 transmission of, 151 Uraemia, 655-56
Tram-track appearance, 671 Tuberculous meningitis, 876 Uraemic manifestations, 655-56
Transaminases, 595, 898 Tubular necrosis, acute (ATN), 679-80 Urate nephrolithiasis, 692
Transcellular fluid, 93 Tubules, Ureter, normal structure of, 698
Transcobalamin, 253, 303-04 diseases of, 678-80 Ureterocele, 698
Transcoelomic spread, 202-03, 750 structure of, 651-52 Urethra, normal structure of, 698
Transferrin, 295 Tubulointerstitial disease, 680-85 Urethral carcinoma, 702
Transfusion, of blood, 339-40 Tumoral calcinosis, 779 Urethral caruncle, 702
complications of, 339-40 Tumour host interrelationship, 228-32 Urethritis, 699-700
Transient ischaemic attacks (TIA), 879 Tumour markers, 233-34, 709, 720 Uric acid stones, 692
Transitional cell carcinoma, Tumour necrosis factor (TNF), 25-26, 109, Urinary bladder, 698-700
nasopharynx, 518-19 138-39, 146, 230, 381 normal structure of, 698
urinary bladder, 700-02 Tumours (also see under Neoplasia), 192-235 tumours of, 700-702
Translocations, 199, 259, 353, 355, 356f, 358 anaplasia in, 197 Urinary calculi, 690-92
reciprocal, 259 angiogenesis in, 199, 215 Urinary cytology, 273, 276
Robertsonian, 259 benign versus malignant, 194 Urinary tract infection (UTI), 681, 682, 698
Transplant rejection, 65-66 characteristics of, 194-204 Urinary tract, lower, 698-702
Transplantation, 65 classification of, 193t Urine analysis, 652
cardiac, 460 cytomorphology of, 197-99 Urobilinogen, 593
bone marrow, 326, 365, 374 diagnosis of, 232-35 Urolithiasis, 690-92
Transposition of great arteries, 425-26 differentiation in, 197 Uropathy, obstructive, 690-93
Transthyretin, 83 epidemiology of, 205-07 Urothelial tumours, 700-02
Transudate versus exudate, 96t etiology and pathogenesis of, 208-28 Urticaria, 97, 770
Trauma to brain, 882-83 functional changes in, 198 Urticaria pigmentosa, 770
Trephine, 286-87 genetic abnormalities in, 199 Uveal melanoma, 512
Treponema, 161 grading of, 204 Uveitis, 508
Trichoepithelioma, 785 gross features of, 196
Trichomoniasis, 270f growth rate of, 194-96
Trigone, 698 inflammatory reaction in, 199-200 V
Triphenyl tetrazolium chloride (TTC), 432 invasion of, 200-04
Triple response, 131f metastasis in, 200-04 Vaccines, hepatitis, 614
Trisomy, 258 microscopic features of, 196-200 Vaccinia, 186, 773
Tropical pulmonary eosinophilia, 456, 494 phenotype of, 196 Vagina, 723-24
Troponins, cardiac, 417, 435 spread of, 200-04 normal structure of, 723
INDEX
Trouisier’s sign, 557 staging of, 205 tumours of, 723-24
Trousseau’s syndrome, 232, 410, 503, 648 stem cells in, 196 Vaginal smear, 268-72, 275
Truncus arteriosus, persistent, 425 stroma of, 199 Vaginitis, 723
Trypanosomiasis, 453, 538, 580 vascular invasion of, 201-02 monilial, 270, 723
Tryptophan, 243 Tunicae, arteries, 390 Valvular deformities, 426, 449-51
Tubercle, 152-53, Turban tumour, 786 Valvulitis, rheumatic, 440-41
evolution of, 152-53, 155, 156 Turbulence, 116, 133 van den Bergh diazo reaction, 593
hard and soft, 153 Turcot’s syndrome, 586 Vanillyl mandellic acid (VMA), 800
Tubercle bacillus, 149 Turk cell, 349 Varicella-zoster infection, 186, 773
Tuberculin test, 152 Turner’s syndrome, 258 Varices, 539-40, 631-32
Tuberculoma, brain, 877 Typhoid fever, 571-72 Varicocele, 706
Tuberculosis, 149-57 Typhoid ulcers, 572f Varicosities, 409
brain, 877 Tyrosinase, 40 Variola, 186, 773
caseous necrosis in, 45, 153, 155, 156 Vasa recta, 650
caseous pneumonia in, 156 Vasa vasora, 390
causative organism in, 149 U Vascular purpuras, 331
cavitary, 155-56 Vascular permeability, 130-33
clinical features of, 156-57 Ubiquitin, 26 alterations of, 131
dystrophic calcification in, 52f UICC staging, 205 mechanisms of, 131-33
fibrocaseous, 155-56 Ulcer, Vascular tumours, 411-16
hypersensitivity and immunity in, 152 amoebic, 187-88 Vasculitis, 400-05
incidence of, 151 aphthous, 522-23 allergic, 402-03
intestinal, 569-71 Curling’s, 113, 550 hypersensitvity, 402-03, 404
kidney, 156, 684 Cushing’s, 550 leucocytoclastic, 403f
liver, 162, 615-16 peptic, 549-54 lymphocytic, 403
lymph node, 45, 154f rodent, 784-85 Vasoactive amines, 136-37

Vasopressin, 98, 794 flavonoids, 254 Wilmut, Ian, 7 933
VDRL, 162 folate, 253 Wintrobe, MM, 6
Vegetations, distinguishing features of, 447t folate metabolism, 304-05 Wolffian cyst, 723
Veins, 409-11 K, 250-51 Working formulation for clinical usage, 366
normal structure of, 409 niacin, 253 Wound,
varicose, 409 water-soluble, 251-54 complications of, 169-70
Vena caval syndrome, 410 Vitellointestinal duct, 561-62 contraction of, 167
Venous congestion, 105-06 Vitiligo, 40 healing of, 167-73
Ventricular hypertrophy, 55, 421-22 Vocal nodules, 519-20 strength, 170
Ventricular septal defect (VSD), 423 Volkman’s ischaemic Woven bone callus, 830
Verocay bodies, 893 contracture, 172 Wry neck, 521
Verrucae, 224, 440, 771-72 Volvulus, 563 Wuchereria bancrofti, 97, 190
Verrucous carcinoma, 527, 542, 784 von Gierke’s disease, 261-62
Vesalius, 3 von Hippel-Lindau syndrome, 694, 829 X
Vesico-ureteric reflux, 682 von Kossa stain, 13t, 51
Vessels, 390-416 von Recklinghausen’s disease, 206, 893 X-chromosome, 23, 257
tumour and tumour-like lesions of, 411-16 von Willebrand’s disease, 336
Villonodular tenosynovitis, 855 Vulva, 721-24 X-linked disorders, 260t
X-ray crystallography, 82
Villous atrophy, 575 normal structure of, 721 Xanthelasma, 39
Vimentin, 16, 23-24, 861 tumours of, 722-24 Xanthine stones, 692
Vincent’s angina, 517 Xanthofibroma, 855
Viral diseases, 183t Xanthogranuloma, 864
Viral hepatitis, (also see under Hepatitis, viral), W Xanthogranulomatous pyelonephritis, 683
605-14
Viral oncogenesis, 222-28 Waldenstrom’s Xanthomas, 39, 626
Xenograft, 65
DNA, 222, 224-26, 224t macroglobulinaemia, 384 Xeroderma pigmentosum, 215, 770, 783
RNA, 223-24, 227-28, 227t Wallerian degeneration, 172, 892
Virchow cells, 160 Walthard cell rests, 738 Xerophthalmia, 247
Xerostomia, 81, 533
Virchow’s node, 200 Warthin’s tumour, 535
Virchow’s sign, 557 Warts, 224, 771-72
Virchow-Robin space, 872 Wassermann reaction, 162 Y
Virchow, Rudolf, 5 Water-soluble vitamins, 251-54
Virilism, adrenal, 798 Water, total body, 93 Y-chromatin, 257, 275
Virtual microscopy, 19 deficiency of (dehydration), 102 Yellow atrophy, acute, 613
Viruses and human cancer, 228 excess of (overhydration), 102 Yellow fever, 183-84
Viruses, diseases caused by, 183t Watershed (border zone) infarcts, brain, 880 Yolk sac tumour,
Vital reaction, 44 Watson, Crick, 6 ovary, 748
Vital staining, 288 Wax-D, 152 testis, 711
Vitalism, theory of, 3 Wear and tear pigment, 43
Vitamins, disorders of, 246-55 Webs, oesophageal, 539 Z
A, 247-48 Wegener’s granulomatosis, 403, 495, 517
B1, 252-53 limited form, 402 Zahn, infarct of, 129
B2, 253 Weights and measurements, lines of, 117 INDEX
B3, 253 normal organs, 896-97 Zarda, 237
B6, 253 Wermer’s syndrome, 829 Zeiss glands, 508
B12, Wernicke’s encephalopathy, 252 Zenker’s degeneration, 35
B-complex, 252 Wet-fixed versus air-dried smear, 280t Zenker’s fluid, 371
B12 metabolism, 303-04 Wheal, 131 Ziehl-Neelsen staining, 149, 157
biotin, 253-54 Whipple’s disease, 576 Zollinger-Ellison syndrome, 545, 829
C, 251-52 White blood cells, diseases of, 342-86 Zonal necrosis, liver, 604-05
choline, 254 White lesions, 525-26, 714, 721-22 Zones, hepatic lobules, 592f
D, 248-50 Whooping cough, 178 Zonula adherens, 25
E, 250 Wilms’ tumour, 696-98 Zonula occludens, 24-25
fat-soluble, 247-51 Wilson’s disease, 628 Zoster virus infection, 186, 773