THE most effective review for the USMLE Step 1 exam & Basic Science Coursework • Popular outline format makes for a more efficient review • Reinforces key topics faster with bolded key words, figures, tables, algorithms, and highlighted clinical correlations • Emphasizes board relevant information while confirming strengths and uncovering areas of weakness Stay in touch with us to find out about sales, contests, and new products! facebook.com/lwwmeded twitter.com/lwwmeded pinterest.com/lwwmeded LWW.com Pathology Pathology Arthur S. Schneider, MD Professor and Vice-chair Department of Pathology Chicago Medical School Rosalind Franklin University of Medicine and Science North Chicago, Illinois Philip A. Szanto, MD Associate Professor of Pathology (retired) Chicago Medical School Rosalind Franklin University of Medicine and Science North Chicago, Illinois With Special Contributions by Anne M. Mills, MD Sandra I. Kim, MD, PhD Todd A. Swanson, MD, PhD Publisher: Michael Tully Acquisitions Editor: Sirkka Howes Product Manager: Stacey Sebring Marketing Manager: Joy Fisher-Williams Vendor Manager: Alicia Jackson Designer: Holly Reid McLaughlin Manufacturing Coordinator: Margie Orzech Compositor: Integra Software Services Pvt. Ltd. 5th Edition Copyright © 2014, 2009, 2006, 2002, 1993 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street Two Commerce Square Baltimore, MD 21201 2001 Market Street Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via website at lww.com (products and services). Not authorized for Sale in North America or the Caribbean. 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Schneider, Arthur S. Pathology / Arthur S. Schneider, Philip A. Szanto ; with special contributions by Anne Mills, Sandra I. Kim, and Todd A. Swanson. — 5th ed. p. ; cm. — (BRS) Includes index. ISBN 978-1-4511-8889-9 I. Szanto, Philip A. II. Title. III. Series: Board review series. [DNLM: 1. Pathology—Examination Questions. QZ 18.2] RB32 616.07’076—dc23 2013010441 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. 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Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. As always and with great love and affection, To Edie (of cherished memory) To Anne Preface As in prior editions, we have updated the format and, we hope, the utility of this work by substituting and adding even more color illustrations. In the selection of images, we have held to the principle that the medical school pathology course should be aimed at building an understanding of the processes of disease and that identifica- tion of images is not an objective unto itself, but rather an important tool to illustrate mechanisms. While attempting to keep this fifth edition as short as possible, we have added what we consider to be significant material needed for updating. As before, the end- of-chapter study questions and the comprehensive examination at the end of the book are entirely cast in vignette format. This should be helpful for students preparing for similar examinations administered by national accrediting groups. ForMAT First, as indicated by the series title, Board Review Series, one of the prime purposes of the book is to serve as a source of review material for questions encountered on the USMLE and similar qualifying examinations. A certain part of such preparation consists of recognition of “key associations” that serve as the basis for many such examination questions. Accordingly, in this edition, we have again indicated such associations throughout the text with a symbol resembling a key. Even though we are strongly committed to the view that pathology is a conceptual field consisting of much more than “buzz words,” we also believe that recognition of such material is part of learning and that it helps students gain confidence in dealing with voluminous material, such as the content of standard pathology courses. The graphic designator used here should serve to identify these “high-yield” items and should be useful to the student in final preparation for board-type examinations. orgAnIzATIon The chapter organization continues to parallel that of most major texts, beginning with an initial 8 chapters covering basic or general pathology, followed by 15 chap- ters covering the pathology of the organ systems. A final chapter deals with statistical concepts of laboratory medicine. Each chapter ends with a set of review questions, and the text concludes with a Comprehensive Examination designed to emulate the content of national licensing examinations. vi Preface vii HoW To USe THIS BooK We recommend that this book not be used as a primary text, but rather, as the series title suggests, as a supplement for study and for review. Following the initial study of a unit in a pathology course, many students will find that review of the correspond- ing material in this book will aid in the identification of major concepts that deserve special emphasis. Also, this book can serve as a source for end-of-year review and for review for national examinations. Special attention is again directed to the Answers and Explanations that follow the end-of-chapter Review Test questions and the Comprehensive Examination questions at the end of the text. Much of the teaching material is emphasized in these discussions, and it is recommended that these sections be reviewed carefully as part of examination preparation. Arthur S. Schneider, MD Philip A. Szanto, MD Acknowledgments We again welcome back and thank our associates and former students, Drs. Sandra I. Kim and Todd A. Swanson, who contributed much to the vignette-style sample ques- tion sections throughout this edition. We also thank Dr. Anne Mills for her insightful additions to this new edition. Also, we express appreciation to our students and our many readers throughout the world who have used the preceding editions of this book over the past years. Their overwhelming response and helpful comments have been immensely gratifying and deeply appreciated. We again quote William Osler, who pointed out many years ago that “to study the phenomena of disease without books is to sail an uncharted sea,” and “it is easier to buy books than to read them.” Our gratification is increased since we have repeatedly heard from our readers that our book has not only been bought, but has also been thoroughly read, annotated, and read again. We express our sincere gratitude to Dr. Emanuel Rubin, Dr. Raphael Rubin, Dr. Bruce Fenderson, and their group of colleagues who collected the great majority of the illustrations generously provided to us by our publisher. We again acknowledge the continuing contributions of the editorial staff at Lippincott Williams & Wilkins, especially those of Mrs. Stacey Sebring, managing edi- tor during the development of this edition and Mrs. Sirkka Howes, acquisitions editor. We thank them all for their hard work and patience. The final product owes a great deal to their efforts. viii