5 th Essential Edition PATHOLOGY for Dental Students Free! Practical Pathology for Dental Students Essential Pathology for Dental Students The photographs on the cover of the textbook depict images of diseases as follows: Tuberculous lymphadenitis Myeloma cells in bone marow aspirate Squamous cell carcinoma Osteosarcoma @LibraurL....wy \JEIу..ЬD e�n t Essential Patholoq y fOf UC:111.UI� 1.UU�ntS FifEtdhi t1i on HarsMho han MDF,A MFSI,C PFaUtIhC,C FormPerro feasnsdHo era d DepartmoefPn att hology GovernmMeendti cal aCnodHl olsepgiet al Chandigarh-160031 INDIA E-madirlh:a [email protected] SugandMhoah an BDDSD,(S N YUNCYUD,S, A ) E-masiulg:a n79d 8h7a@ gmail.com 4 � т,ь TheH ealStchi enPcueЬs/ isher NewD elIhL io ndIoP nh iladeIPl apnhaimaa Jaypee Brothers Medical Publishers (P) Ltd. Headquarters Jaypee Brothers Medical Publishers (P) Ltd. 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 E-mail: [email protected] Overseas Offices J.P. Medical Ltd. Jaypee-Highlights Medical Publishers Inc. Jaypee Medical Inc. 83, Victoria Street, London City of Knowledge, Building 235, 2nd Floor 325, Chestnut Street SW1H 0HW (UK) Clayton, Panama City, Panama Suite 412, Philadelphia, PA 19106 Phone: +44-20 3170 8910 Phone: +1 507-301-0496 USA Fax: +44(0) 20 3008 6180 Fax: +1 507-301-0499 Phone: +1 267-519-9789 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Jaypee Brothers Medical Publishers (P) Ltd. Jaypee Brothers Medical Publishers (P) Ltd. 17/1-B, Babar Road, Block-B Bhotahity, Kathmandu, Nepal Shaymali, Mohammadpur Phone: +977-9741283608 Dhaka-1207, Bangladesh E-mail: [email protected] Mobile: +08801912003485 E-mail: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2017, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photo copying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contra indications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/ or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. Inquiries for bulk sales may be solicited at: [email protected] Assistant Editor: Praveen Mohan Essential Pathology for Dental Students First Edition : 1995 Second Edition : 2002 Third Edition : 2005 Fourth Edition : 2011 Fifth Edition : 2017 ISBN 978-93-86107-74-9 Printed at Preface rLekr~ vlDr% lrre~ dk;ZZe~ deZ lekpjA vlDr% fg vkpju~ deZ ije~ vkIuksfr iq:‘k%AA Thus do your duty without attachment Perform the work that has to be done, Since the person attains supreme form By doing duty in a spirit of sacrifice. (The Bhagvatgita: Ch III, Verse 19) In keeping pace with newer developments in the field of pathology and in order to cater to the contemporary needs of users, the fifth edition of Essential Pathology for Dental Students is presented after a gap of six years since the last edition of this book. The new edition has been thoroughly updated and contains newer contents and it is expected to be highly useful and more appealing. In fact, for eager learners, the revised edition has more material than the current syllabus recommended by the Dental Council of India (DCI). The revised edition has a large number of new illustrations, line drawings, schematic drawings and newer tables, in an attempt to enhance understanding and learning of the subject readily, besides being a visual treat. A new feature incorporated in this edition is placing of Gist Boxes at the end of each topic presenting summary of the topic just covered so that the learner can quickly revise it in a short time. In addition, the present edition has been redesigned in illustrations, lay-out and in printing for a more aesthetic look as well. In doing all this, I used my discretion as a teacher in including many newer examples of diseases, especially in infections and neoplasms, and had the help of a more modern approach of my co-author (SM). In recent years, there have been widespread advancements in molecular, immunologic and genetic basis of several diseases which have heightened our understanding of the mechanisms of diseases. As a result, mention of ‘idiopathic’ in etiology and pathogenesis of many diseases in the literature is slowly disappearing. Surely, the students of 21st century need to be enlightened on these modern advances in diseases; these aspects have been dealt with in the revised edition with a simple and lucid approach. Key Features of the fifth edition are as follows: Thorough updating: All the chapters and topics have undergone thorough revision and updating of various aspects. While most of the newer information has been inserted between the lines, a few topics have been rewritten. In doing so, the basic accepted style of the book—simple, easy-to-understand and reproducibility of the subject matter, and emphasis on clarity and accuracy, has not been changed. Reorganised contents: The revised edition has 30 chapters divided into two parts: Part A: General Pathology (4 sections) and Part B: Systemic Pathology (2 sections). This has been done in conformity with the revised recommendations in the syllabus prescribed by the DCI; however, a few additional topics have been added for an inquisitive learner. Topics such as Techniques in Pathology and Normal Values have been shifted to Practical Pathology for Dental Students where these topics belong. More and new figures/tables: There are several newer figures and tables in the revised edition. All free-hand labelled sketches of gross specimens and line-drawings of microscopic features of an entity have been placed alongside the corresponding specimen photograph and photomicrograph, respectively, enhancing the understanding of the subject for the beginners in pathology. Gist Boxes: Throughout the book, at the end of every topic, a uniquely coloured box containing summary of the topic just covered has been placed. These Gist Boxes are meant for quick revision of the topics in a short time. Since these boxes have a distinct colour scheme throughout the book, the student can revise the entire subject by quickly turning pages of the book and these boxes become readily visible without having to search for them, making the book truly user-friendly. vi vi Essential Pathology for Dental Students ACKNOWLEDGEMENTS In preparing the revised fifth edition, suggestions and corrections received from my colleagues at different places and students have been carefully taken into consideration which is gratefully acknowledged. As in my other books, liberal and skilful technical assistance rendered by Ms Agam Verma, MSc (MLT), Senior Laboratory Technician, is thankfully acknowledged. My special thanks to the team of dedicated staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, in general, and Mrs Y Kapoor (Senior Desktop Operator), in particular for acceding to my requests for amendments and insertions till the very last minute, and Mr Manoj Pahuja (Senior Graphic Designer), for all his help in skilful and appealing art work. All the team members at Jaypee who have contributed in a variety of ways deserve my gratitude—for meticulous proof-reading, for designing of cover, and for promotion of sales and marketing, etc. Finally, my gratitude to the motivating and inspiring leadership of Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Group President) of the M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who have been always conscious of quality of the final product and the results show it. In spite of my best efforts, element of human error is still likely. As in the previous editions, the readers are welcome to point out all such mistakes and render valuable suggestions for further improvements which will be gratefully acknowledged. Harsh Mohan MD, FAMS, FICPath, FUICC E-mail: [email protected] Sugandha Mohan BDS, DDS (NYUCD, NY, USA) E-mail: [email protected] Contents RevisedSyllabusinPathologyforBDSStudentsas perRecommendationsoftheDentalCouncilofIndia Part A:General Pathology Sectionl:TheCellinHealthand Disease . 1 IntroductiontoPathology 1 2. CellStructureandFunction,CellularAgeing 9 3. CellularAdaptations 18 4. CellInjury:EtiologyandPathogenesis 27 5. MorphologyofCellInjury:DegenerationsandCellDeath 36 6. IntracellularAccumulations 52 7. Amyloidosis 61 8. GeneticandPaediatricDiseases 73 9. Environmental,NutritionalandVitaminDeficiencyDisorders 85 SectionII:InflammationandHealing,Immunityand Hypersensitivity,InfectionsandInfestations . 10 Inflammation:Acute 107 11. Inflammation:ChronicandGranulomatous 129 . 12 HealingofTissues 155 . 13 InfectiousandParasiticDiseases 166 . 14 DiseasesofImmunityincludingAIDS 195 SectionIII:Fluid andHaemodynamic Disorders . 15 DerangementsofBodyFluids 222 . 16 BloodFlowVolumeDisorders 235 . 17 ObstructiveHaemodynamicDerangements 247 Section IV:Neoplasia . 18 GeneralAspectsofNeoplasia 265 . 19 EtiologyandPathogenesisofNeoplasia 282 20. Host-TumourRelationshipandDiagnosisofNeoplasms 311 . 21 CommonSpecificTumours 321 viii EssentialPathologyforDentalStudents Part B:Systemic Pathology SectionV:HaematologyandLymphoreticularTissues 22. DisordersofErythroidSeries:Anaemias 357 . 23 PlateletsandBleedingDisorders 400 . 24 DiseasesofLeucocytesandLymphoidTissues 415 SectionVI:SelectedTopicsfrom Systemic Pathology . 25 DiseasesofCardiovascularSystem 467 26. DiseasesofOralCavityandSalivaryGlands 514 27. Jaundice,HepatitisandCirrhosis 532 . 28 HypertensionanditsConsequences 559 . 29 DiabetesMellitusanditsComplications 569 30. CommonDiseasesofBones,CartilageandJoints 584 Index 615 Revised Syllabus in Pathology for BDS Students as per Recommendations of the Dental Council of India COURSE CONTENTS IN THEORY A. GENERAL PATHOLOGY Adaptive Disorders of Growth: Atrophy and hypertrophy, hyperplasia, metaplasia and dysplasia. Introduction to Pathology: Terminologies, the cell in health, the normal cell structure, the cellular functions. General Aspects of Neoplasia: Definition, terminology, classification; differences between benign and malignant Etiology and Pathogenesis of Disease: Cell injury, types— neoplasms; the neoplastic cell; metastasis; etiology and congenital, acquired, mainly acquired causes of disease pathogenesis of neoplasia, carcinogenesis; tumour (hypoxic injury, chemical injury, physical injury, biology; oncogenes and anti-oncogenes; precancerous immunological injury). lesions; common specific tumours—squamous papil- Degenerations: Amyloidosis, fatty change, cloudy swelling, loma and carcinoma, basal cell carcinoma, adenoma and hyaline change, mucoid degeneration. adenocarcinoma, fibroma and fibrosarcoma, lipoma and Cell Death and Necrosis: Apoptosis; definition, causes, liposarcoma. features and types of necrosis; gangrene—dry, wet, gas; pathological calcifications (dystrophic and metastatic). B. SYSTEMIC PATHOLOGY Inflammation: Definition, causes, types and features; acute inflammation—the vascular response, the cellular Anaemias: Iron deficiency anaemia, megaloblastic anaemia. response, chemical mediators, the inflammatory cells, fate; chronic inflammation; granulomatous inflam- Leukaemias: Acute and chronic leukaemias, diagnosis and mation. clinical features. Healing: Regeneration, repair—mechanisms, healing Diseases of Lymph Nodes: Hodgkin’s disease, non-Hodgkin’s byprimary intention, healing by secondary intention, lymphoma, metastatic carcinoma. fracture healing, factors influencing healing process, Diseases of Oral Cavity: Lichen planus, stomatitis, complications. leukoplakia, squamous cell carcinoma, dental caries, Tuberculosis: Epidemiology, pathogenesis (formation of dentigereous cyst, ameloblastoma. tubercle), pathological features of primary and secondary Diseases of Salivary Glands: Normal structure, sialadenitis, TB, complications and fate. tumours. Syphilis: Epidemiology, types and stages of syphilis, Hepatitis pathological features, diagnostic criteria, oral lesions. Typhoid: Epidemiology, pathogenesis, pathological features, Hypertension: Definition, classification; pathophysiology, diagnostic criteria. effects in various organs. Thrombosis: Definition, pathophysiology, formation, Diabetes Mellitus: Definition, classification, pathogenesis, complications and fate of a thrombus. pathology in different organs. Embolism: Definition, types, effects. Common Diseases of Bone: Osteomyelitis, metabolic bone Ischaemia and Infarction: Definition, etiology, types; diseases, bone tumours—osteosarcoma, osteoclastoma infarction of various organs. (giant cell tumour), Ewing’s sarcoma, fibrous dysplasia, Derangements of Body Fluids: Oedema—pathogenesis, aneurysmal bone cyst. different types. Diseases of Cardiovascular System: Cardiac failure, Disorders of Circulation: Hyperaemia, shock. congenital heart disease—ASD, VSD, PDA, Fallot’s Nutritional Disorders: Common vitamin deficiencies. tetralogy, infective endocarditis, atherosclerosis, ischaemic heart disease. Immunological Mechanisms in Disease: Humoral and cellular immunity, hypersensitivity and autoimmunity, Haemorrhagic Disorders: Coagulation cascade, coagulation AIDS disorder, platelet function, platelet disorders.