Textbook of PATHOLOGY tahir99 - UnitedVRG - vip.persianss.ir The photographs on the cover of the textbook depict images of corresponding diseases as under: Tuberculous lymphadenitis Plasma cell myeloma Nodal metastasis from breast carcinoma Apoptotic cells in squamous mucosa Aschoff body in the myocardium tahir99 - UnitedVRG - vip.persianss.ir Textbook of PATHOLOGY Seventh Edition Harsh Mohan MD, FAMS, FICPath, FUICC Professor & Head Department of Pathology Government Medical College Sector-32A, Chandigarh-160 031 INDIA E-mail: [email protected] Originally Released by tahir99 - UnitedVRG and http://vip.persianss.ir For more books visit: https://kat.cr/user/tahir99/ The Health Sciences Publishers New Delhi | London | Philadelphia | Panama tahir99 - UnitedVRG - vip.persianss.ir 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 Email: [email protected] Overseas Offices Jaypee-Highlights Medical Publishers Inc. J.P. Medical Ltd. City of Knowledge, Bld. 237, Clayton 83, Victoria Street, London Panama City, Panama SW1H 0HW (UK) Phone: +1 507-301-0496 Phone: +44-20 3170 8910 Fax: +1 507-301-0499 Fax: +044(0)20 3008 6180 Email: [email protected] Email: [email protected] Jaypee Medical Inc. Jaypee Brothers Medical Publishers (P) Ltd. The Bourse 17/1-B, Babar Road, Block-B, Shaymali 111, South Independence Mall East Mohammadpur, Dhaka-1207 Suite 835, Philadelphia, PA 19106, USA Bangladesh Phone: +1 267-519-9789 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd. Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2015, Harsh Mohan 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] Textbook of Pathology First Edition : 1992 Second Edition : 1994 Third Edition : 1998 Fourth Edition : 2000 Fifth Edition : 2005 Sixth Edition : 2010 Reprint : 2013 Seventh Edition: 2015 Assistant Editors: Praveen Mohan, Tanya Mohan, Sugandha Mohan ISBN: 978-93-5152-369-7 Printed at tahir99 - UnitedVRG - vip.persianss.ir bbbbbbbbbbbbbbbbbbbbbbbbb b b To deeds alone you have a right and b b b never at all to its fruits; b b Let not the fruits of deeds be your motive; b b Neither let there be in you b b b any detachment to performing your duty. b b    The Bhagvadgita (Chapter II, verse 47) b b bbbbbbbbbbbbbbbbbbbbbbbbb Dedicated to My loving soulmate, Praveen, for being there for me and with me always, Tanya-Vivek, for giving happiness of being together forever, Sugandha, for being the daughter who is my best friend, & To all my students and colleagues, present and past: For their enduring inspiration. tahir99 - UnitedVRG - vip.persianss.ir tahir99 - UnitedVRG - vip.persianss.ir Foreword vii F o This is the third time that I was asked to write a foreword to Dr Mohan's Textbook, and again I am at r e w a loss for words to adequately express my enthusiasm for this book which has such a long history of o r excellence. Over all those years spanning the previous six editions, it has served as an introduction d to clinical medicine to generations of medical students, and I am sure that it will continue in that function way into the twenty first century. A book of this caliber does not need introductions, forewords and endorsements for its continuous success. Its value has been proven over and over again by those for whom it was written and those who have used it in its previous editions—the medical students and their professors. For the new edition, Dr Mohan has thoroughly revised his previous text, expanding it with novel data selected judiciously from both laboratory and clinical research papers. Yet the basic structure of the book remains unchanged, with an unconditional dedication to the systematic coverage of the basics, strong clinical underpinning, and a good sense for didactics. It reflects the author's lifelong experience in the classroom and his passion for teaching of pathology to medical students. The text is illustrated with informative artists' drawings and photographs. It also contains highlighted summary boxes and valuable tables. At the end of each chapter there are clinical cases, designed to stimulate further studies and discussions. The condensed Quick Review Book, appended to the textbook as a lagniappe, will remain attractive to medical students preparing for their examinations. In a short foreword of this kind, it is not possible to mention all the strong points of this textbook. It should suffice to say that Dr Mohan's Textbook has retained all the features which have made previous editions so popular with medical students and their teachers alike. It was masterfully updated and with the new didactic elements it will be even more attractive to its readers. It will remain an essential must-have for all medical undergraduate students, serving them as a pathfinder and bridge during their transition from basic medical sciences to clinical medicine. Ivan Damjanov, MD, PhD Professor Department of Pathology The University of Kansas School of Medicine Kansas City, Kansas, USA tahir99 - UnitedVRG - vip.persianss.ir tahir99 - UnitedVRG - vip.persianss.ir Preface ix P As I sit down to put my thoughts into words for the 7th revised edition of my Textbook of Pathology, I look back with satisfaction re how this book has grown phenomenally since its modest beginning in 1992. During these years, successive editions of the fa c textbook have brought me closer to enumerable well-wishers, won me life-long friends, rewarded me with respect and faith e of my colleagues, got me blessings of senior professionals, and earned me affection of innumerable students and fans. It has been really highly gratifying journey so far. At the same time, such an abiding trust by users of previous editions of my textbook certainly puts an onerous responsibility on me to come up to their expectations and make it better with every new edition. It is this motivation and zeal which I pursued while preparing the thoroughly transformed and updated 7th revised edition which I am pleased to present to users. Diagnostic pathology has been growing exponentially with advances in molecular methods, cytogenetics and immunology, besides the ready availability of immunohistochemistry. In fact, in the current era, immunophenotyping and cytogenetics have been recommended as defining criteria for classification, diagnosis and prognostication of growing number of cancers. In such a scenario, it is quite natural that undergraduate students of pathology should be made aware of what is happening in the realm of diagnostic science while at the same time not forgetting to lose hold of the fundamental aspects of pathology of diseases. Thus, for beginners in pathology, for whom this textbook is primarily meant, a balanced approach for learning of pathology is recommended i.e. the students must learn basic morphologic pathology including recent knowledge of etiology and pathogenesis of diseases, and simultaneously they should know the contribution of modern diagnostic techniques mentioned above towards achieving the goal of an objective ‘final diagnosis’ that is prognostically relevant as well. This philosophy for teaching and learning of pathology has been followed in the present edition but without disturbing the basic format of the book. Some of the Key Features of the Seventh Edition are as follows: Revised and Updated Text Most of the topics in chapters have undergone revision and updating of various aspects of diseases including their newer causes and recent mechanisms by insertion of latest information between the lines. Emphasis has also been placed on contemporary diagnostic modalities in a simple and lucid manner. In doing so, the basic accepted style of the book—simple, easy-to-understand and reproduce the subject matter, and emphasis on clarity and accuracy, has not been disturbed. Considering their utility, a dozen new tables have been added in different chapters in the revised edition while many others have been updated. Reorganisation of the Book The redistribution of the textbook into three sections (General Pathology, Haematology and Lymphoreticular Tissues, and Systemic Pathology) done in the previous edition has been widely accepted and appreciated for its ease for locating material and has, therefore, been retained. In order to make space for addition of new information, topics of normal cell structure and function and laboratory techniques have been relocated, after editing them, to relevant chapters to which they belong. Newer and Revised Images Morphologic pathology has always been regarded as a highly visual branch of medicine, and therefore, there is always need and scope of doing more and making this aspect better in the new edition. In the revised edition, many newer illustrations have been added while some old ones have been replaced with better quality images or improved after eliminating their shortcomings. Inboxes have been incorporated in some photomicrographs for a close-up microscopic view. In general, the effort has been to give soft and pleasing colours for soothing visual look to the new edition. Gist Boxes In the revised edition, at the end of every topic a short summary of the subject covered has been given. These ‘Gist Boxes’ (226 in all) include salient must-know features of the covered topic in bulleted points for a rapid revision in ultrashort time. These Gist Boxes have been given a distinctive eye-catching colour throughout the book to be visible on a glance and for looking up quickly by turning the pages of the book for a last minute revision before facing an evaluation in examination. Clinical Focus on Learning A novel modality of learning and self-assessment has been added in the revised edition by including 30 structured clinical cases. At the end of most of the chapters, one or more clinical cases with history and findings of examination have been given based on a common or an important disease pertaining to the system of that chapter. Questions framed at the end of these cases have been rationally answered and discussed in an analytical manner in Appendix II. Revised Pathology Quick Review and MCQs The 7th edition of textbook is accompanied with the new revised baby-book popular with many students and interns. This small book has been found profoundly useful by the students just before practical examination to face viva voce when they need to revise huge course content in a short time, or by those preparing to take postgraduate entrance examinations. The revised edition has over 50 more new MCQs while some old ones have either been edited or replaced. A Word on Foreword Professor Ivan Damjanov, MD, PhD, Kansas University, USA, has been very generous and gracious in writing Foreword for the last three successive editions of my textbook which has brought the textbook closer to users in other tahir99 - UnitedVRG - vip.persianss.ir x parts of the world, which is appreciated and gratefully acknowledged. He is gifted with qualities of perfection, clarity of mind and meticulous approach, besides having an excellent knack for choosing measured words in his language. I wholeheartedly express my gratitude to this adorable teacher and an eminent author and editor. y g In essence, the revised edition is a comprehensive text of pathology meant primarily for students of pathology; however, o ol the practicing clinicians and students of other branches of medicine, dentistry, pharmacy, alternate system of medicine, and h paramedical courses may also find it useful. t a P f ACKNOWLEDGEMENTS o k The magnitude of work pertaining to revision of the textbook after 5 years is massive and would not have been possible without o o active cooperation and support from friends and well-wishers in general, and my departmental colleagues in particular. b t The task of fresh photomicrography for the present edition was ably assisted by my colleagues, Dr Shilpa, Senior Resident, x e Department of Pathology; and Ms Agam Verma, Senior Lab Technician, which is greatly appreciated. Here, I wish to recall T and put on record the sincere and selfless services rendered by my former students and colleagues in preparation of images in earlier editions of the book and thank them once again. As always, I remain indebted to those from whom I had the opportunity to learn basics of pathology—Professor K Joshi, MD, PhD, formerly at PGIMER, Chandigarh, Late Professor TS Jaswal, MD, and Professor Uma Singh, MD, formerly at PGIMS, Rohtak, Haryana, India. Constant strategic encouragement and support extended by the Department of Medical Education and Research, Chandigarh Administration, during the completion of this academic work is gratefully acknowledged. I have strived to be as accurate and perfect as possible, and in doing so, I may have been quite harsh and demanding with Production team at the M/s Jaypee Brothers Medical Publishers (P) Ltd. But I must appreciate their patience, cooperation and commitment in general, and Mr Manoj Pahuja, Senior Graphic Designer and Mrs Y Kapoor, Senior Desktop Operator, in particular, for acceding to all my requests for amendments smilingly and ungrudgingly till the very last minute, and to Mr Sunil Dogra, Production Executive, for overseeing the entire project vigilantly and efficiently. Lastly, the passionate involvement of Shri Jitendar P Vij (Group Chairman) and enthusiasm of Mr Ankit Vij (Group President), M/s Jaypee Brothers Medical Publishers (P) Ltd, in the revised edition of the textbook has raised the bar for a high standard for which I am deeply thankful to both of them. While the content and product quality of the revised edition of the textbook are of an uncompromising quality, the book continues to be of reasonable volume and has been kept affordable. Finally, I owe gratitude to the users of previous editions who have been generous in giving feedback and suggestions. Every suggestion helps me to introspect and attempt to make the textbook better. I request all the users of present edition to continue giving their valuable suggestions and point out errors, if any, to help me to improve it further. Government Medical College Harsh Mohan, MD, FAMS, FICPath, FUICC Sector-32A, Chandigarh-160031 Professor & Head INDIA Department of Pathology E-mail: [email protected] tahir99 - UnitedVRG - vip.persianss.ir