Lewin, Weinstein, and Riddell’s Gastrointestinal Pathology and Its Clinical Implications Second edition VOLUME I Riddell_FM_Vol-1.indd 1 2/14/2014 6:44:05 PM Riddell_FM_Vol-1.indd 2 2/14/2014 6:44:05 PM Lewin, Weinstein, and Riddell’s Gastrointestinal Pathology and Its Clinical Implications Second edition VOLUME I Robert Riddell, MD, FRCPath, FRCPC Clinical Editors Charles N. Bernstein, MD Professor of Laboratory Medicine and Pathobiology University of Toronto Professor of Medicine Mount Sinai Hospital University of Manitoba Toronto, Ontario, Canada Head, Section of Gastroenterology Director, University of Manitoba of IBD Clinical and Research Centre Bingham Chair in Gastroenterology Dhanpat Jain, MD Winnipeg, Manitoba, Canada Professor of Pathology Director, Program in Gastrointestinal and Liver Pathology Sushovan Guha, MD, PhD Department of Pathology Associate Professor and Director of Research Yale University School of Medicine Division of Gastroenterology, Hepatology, and Nutrition New Haven, Connecticut, USA Department of Internal Medicine The University of Texas Medical School and Health Science Center at Houston Houston, Texas, USA Riddell_FM_Vol-1.indd 3 2/14/2014 6:44:08 PM Acquisitions Editor: Ryan Shaw Product Manager: Kate Marshall Production Project Manager: Marian Bellus Senior Manufacturing Coordinator: Beth Welsh Marketing Manager: Dan Dressler Designer: Stephen Druding Production Service: SPi Global © 2014 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com First Edition © 1992 by Igaku-Shoin Medical Publishers, Inc. All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, 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 pre- pared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Lewin, Weinstein, and Riddell’s gastrointestinal pathology and its clinical implications / [edited by] Robert Riddell, Dhanpat Jain. — 2nd ed. p. ; cm. Gastrointestinal pathology and its clinical implications Rev. ed. of: Gastrointestinal pathology and its clinical implications / Klaus J. Lewin, Robert H. Riddell, Wilfred M. Weinstein. c1992. Includes bibliographical references and index. ISBN 978-0-7817-2216-2 1. Gastrointestinal system—Diseases. I. Riddell, Robert H., 1943- II. Jain, Dhanpat. III. Lewin, Klaus J. IV. Lewin, Klaus J. Gastrointestinal pathology and its clinical implications. V. Title: Gastrointestinal pathology and its clinical implications. [DNLM: 1. Gastrointestinal Diseases—pathology. WI 100] RC802.9.L48 2011 616.3'3—dc22 2011011658 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from ap- plication of the information in this book and make no warranty, expressed or implied, with respect to the currency, com- pleteness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reac- tions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service represen- tatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 Riddell_FM_Vol-1.indd 4 2/14/2014 6:44:08 PM Dedication Robert Riddell To my immortal parents Harry and Joyce. To my wife Hala, who wrote the gastritis chapter, contributed to numerous others and whose constant love, support, and encouragement is greatly appreciated. To Mark, Juliet, and Mike, and grandchildren Alannah, Natalie, Paisley, and Eli, all of whom we are so proud of and who give us more pleasure than they will ever know. Dhanpat Jain To my teachers who always showed me the right path. To my parents Milap Chand and Biraj who always led me to the right path. To my wife Shilpa without whom nothing would have been possible. To my daughters Nimisha and Anisha for whom it was all worthwhile. Charles N. Bernstein I dedicate any accolades I receive for the hard work put into this book to Evelyn, Matthew, and Lexie Bernstein. They provide me with the constant entertainment, support, and love that reminds me constantly of what is really important in life. Sushovan Guha I would like to dedicate this to my wife Sarmistha, to our children Siddarth and Shivani, to my father Sukumar, and to my mother Dolly for their collective wisdom, unflinching support, utmost dedication, and unbridled joy. Also I would like to offer my deepest gratitude to Fred, Klaus, and all the great teachers that I had at UCLA. Finally I would offer my thanks to all the patients that motivated me to be a good doctor. Riddell_FM_Vol-1.indd 5 2/14/2014 6:44:09 PM Riddell_FM_Vol-1.indd 6 2/14/2014 6:44:09 PM Contributors Henry D. Appelman, MD Dhanpat Jain, MD M.R. Abell Professor of Surgical Pathology Professor of Pathology Department of Pathology Director, Program in Gastrointestinal University of Michigan and Liver Pathology Ann Arbor, Michigan, USA Department of Pathology Yale University School of Medicine Charles N. Bernstein, MD New Haven, Connecticut, USA Professor of Medicine University of Manitoba Richard Kirsch, MBChB, PhD, FRCPath(SA), Head, Section of Gastroenterology FRCPC Director, University of Manitoba of IBD Clinical Associate Professor and Research Centre Department of Laboratory Medicine Bingham Chair in Gastroenterology and Pathobiology Winnipeg, Manitoba, Canada Mount Sinai Hospital Toronto, Ontario, Canada Hala El-Zimaity, MD, MS (Epidemiology) Professor Hiroyoshi Ota, MD, PhD Department of Laboratory Medicine Professor and Pathobiology Department of Biomedical and Laboratory Sciences University of Toronto Shinshu University Gastrointestinal Pathology Consultant Staff Pathologist University Health Network Department of Laboratory Medicine Toronto, Ontario, Canada Shinshu University Hospital Matsumoto, Nagano, Japan Karel Geboes, MD, PhD, AGAF Professor Emeritus Robert Riddell, MD, FRCPath, FRCPC Emeritus Clinical Chief Professor of Laboratory Medicine and Pathobiology Department of Pathology University of Toronto KU Leuven University Mount Sinai Hospital University Hospitals Gasthuisberg Toronto, Ontario, Canada Leuven, Belgium Masanori Tanaka, MD Joel Kasle Greenson, MD Director Professor of Pathology Department of Pathology and Laboratory Medicine Department of Pathology Hirosaki City Hospital University of Michigan Medical School Hirosaki, Japan Director of Gastrointestinal Pathology Department of Pathology Michael Vieth, Dr. med habil. Dr. med University of Michigan Health System Professor of Pathology Ann Arbor, Michigan Institute of Pathology University of Magdeburg Sushovan Guha, MD, PhD Magdeburg, Germany Associate Professor and Director of Research Director Division of Gastroenterology, Hepatology, Institute of Pathology and Nutrition Klinikum Bayreuth Department of Internal Medicine Bayreuth, Germany The University of Texas Medical School and Health Science Center at Houston Houston, Texas, USA vii Riddell_FM_Vol-1.indd 7 2/14/2014 6:44:10 PM Riddell_FM_Vol-1.indd 8 2/14/2014 6:44:10 PM Preface to the First Edition The decision to write a textbook of pathology coupled We have done our best not to perpetuate some of with clinical implications came primarily because of the myths of pathologist uncritically. In areas where the increasing interdependence of the pathologist and issues are controversial, we have tried to state this; clinician in the investigation and management of gas- we have also frequently offered our own “solutions” to trointestinal disorders where modern gastrointestinal these problems in situations that lack data on which pathology plays a dynamic role. In many instances, they can satisfactorily be based. it is no longer sufficient for the pathologist to simply We hope that the greatest criticism that can be lev- make a morphological diagnosis. Conversely, we hope eled against this book is that it assumes that each gas- that clinicians with gastroenterology interests will troenterologist, whether medical or surgical, adult or view this book as a requisite companion for a general pediatric, has an interested pathologist with whom to textbook of gastroenterology. work and vice versa. We know that this is frequently Pathologists can achieve their full potential by not the case. However, by appreciating the necessity understanding the clinical scenarios in which they of such a working relationship for the best in patient are playing a part and by appreciating the effect of care, we hope that pathologists and clinicians will see their decisions in clinical management. We hope that the overwhelming benefits of this relationship and the clinicians who read this book will more readily will try to foster it. maximize the information they obtain from gastro- intestinal biopsies through an understanding of the Klaus J. Lewin indications, by appreciating the need for providing Robert H. Riddell relevant clinical information, which specific ques- Wilfred M. Weinstein tions to ask the pathologist, and also to understand when biopsies are likely to be of limited value. ix Riddell_FM_Vol-1.indd 9 2/14/2014 6:44:10 PM Riddell_FM_Vol-1.indd 10 2/14/2014 6:44:10 PM