Atlas of Surgical Pathology Grossing

102 Pages·2019·16.595 MB·English

by  Monica B. Lemos, Ekene Okoye

Monica B. Lemos
Ekene Okoye
Editors
Atlas of
Surgical Pathology
Grossing
123
Atlas of Anatomic Pathology
Series Editor
Liang Cheng
Indianapolis, Indiana, USA
This Atlas series is intended as a “first knowledge base” in the quest for diagnosis of usual and
unusual diseases. Each atlas will offer the reader a quick reference guide for diagnosis and
classification of a wide spectrum of benign, congenital, inflammatory, nonneoplastic, and
neoplastic lesions in various organ systems. Normal and variations of “normal” histology will
also be illustrated. Each atlas will focus on visual diagnostic criteria and differential diagnosis.
It will be organized to provide quick access to images of lesions in specific organs or sites. Each
atlas will adapt the well-known and widely accepted terminology, nomenclature, classification
schemes, and staging algorithms. Each volume in this series will be authored by nationally and
internationally recognized pathologists. Each volume will follow the same organizational
structure. The first Section will include normal histology and normal variations. The second
Section will cover congenital defects and malformations. The third Section will cover benign
and inflammatory lesions. The fourth Section will cover benign tumors and benign mimickers
of cancer. The last Section will cover malignant neoplasms. Special emphasis will be placed on
normal histology, gross anatomy, and gross lesion appearances since these are generally lacking
or inadequately illustrated in current textbooks. The detailed figure legends will concisely
summarize the critical information and visual diagnostic criteria that the pathologist must
recognize, understand, and accurately interpret to arrive at a correct diagnosis. This book series
is intended chiefly for use by pathologists in training and practicing surgical pathologists in
their daily practice. The atlas series will also be a useful resource for medical students,
cytotechnologists, pathologist assistants, and other medical professionals with special interest
in anatomic pathology. Trainees, students, and readers at all levels of expertise will learn,
understand, and gain insights into the complexities of disease processes through this
comprehensive resource. Macroscopic and histological images are aesthetically pleasing in
many ways. This new series will serve as a virtual pathology museum for the edification of our
readers.
More information about this series at http://www.springer.com/series/10144
Monica B. Lemos • Ekene Okoye
Editors
Atlas of Surgical Pathology
Grossing
Editors
Monica B. Lemos Ekene Okoye
Houston Methodist Hospital Houston Methodist Hospital
Houston, TX Houston, TX
USA USA
ISSN 2625-3372 ISSN 2625-3380 (electronic)
Atlas of Anatomic Pathology
ISBN 978-3-030-20838-7 ISBN 978-3-030-20839-4 (eBook)
https://doi.org/10.1007/978-3-030-20839-4
© Springer Nature Switzerland AG 2019
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My special thank you to my son, Jaymesson Bezerra,
for being with me in my moments of fear and
frustration, for always showing me the light at
the end of the tunnel.
Monica B. Lemos
To my beloved family – Chike, Chiamaka, Nkechi, and
Oluchi – for their love and support. To my amazing
mentors and colleagues in pathology, and to all the
wonderful residents and fellows I have had the
fortune of working with.
Ekene Okoye
Series Preface
One Picture Is Worth Ten Thousand Words
— Frederick Barnard, 1927
Remarkable progress has been made in anatomic and surgical pathology during the last
10 years. The ability of surgical pathologists to reach a definite diagnosis is now enhanced by
immunohistochemical and molecular techniques. Many new clinically important histopatho-
logic entities and variants have been described using these techniques. Established diagnostic
entities are more fully defined for virtually every organ system. The emergence of personalized
medicine has also created a paradigm shift in surgical pathology. Both promptness and preci-
sion are required of modern pathologists. Newer diagnostic tests in anatomic pathology, how-
ever, cannot benefit the patient unless the pathologist recognizes the lesion and requests the
necessary special studies. An up-to-date Atlas encompassing the full spectrum of benign and
malignant lesions, their variants, and evidence-based diagnostic criteria for each organ system
is needed. This Atlas is not intended as a comprehensive source of detailed clinical information
concerning the entities shown. Clinical and therapeutic guidelines are served admirably by a
large number of excellent textbooks. This Atlas, however, is intended as a “first knowledge
base” in the quest for definitive and efficient diagnosis of both usual and unusual diseases.
The Atlas of Anatomic Pathology is presented to the reader as a quick reference guide for
diagnosis and classification of benign, congenital, inflammatory, nonneoplastic, and neoplastic
lesions organized by organ systems. Normal and variations of “normal” histology are illus-
trated for each organ. The Atlas focuses on visual diagnostic criteria and differential diagnosis.
The organization is intended to provide quick access to images and confirmatory tests for each
specific organ or site. The Atlas adopts the well-known and widely accepted terminology,
nomenclature, classification schemes, and staging algorithms.
This book series is intended chiefly for use by pathologists in training and practicing surgi-
cal pathologists in their daily practice. It is also a useful resource for medical students, cyto-
technologists, pathologist assistants, and other medical professionals with special interest in
anatomic pathology. We hope that our trainees, students, and readers at all levels of expertise
will learn, understand, and gain insight into the pathophysiology of disease processes through
this comprehensive resource. Macroscopic and histological images are aesthetically pleasing
in many ways. We hope that the new series will serve as a virtual pathology museum for the
edification of our readers.
Indianapolis, IN, USA Liang Cheng, MD
vii
Preface
The idea for this book came from Dr. Alberto Ayala, my mentor. He called me into his office
and said “Monica, you should write a grossing manual.” Immediately my answer was “I don’t
know how to do that!” He said very calmly, “Just put on paper everything that you have been
teaching the residents.” At first, I freaked out; I did not want to disappoint him. But then I
started to think about it, and the first idea that came to my mind was the image of a specimen
with a white background, giving the resident, PA, or fellow that would open this book the
impression that the specimen was right there in front of them. The second idea was that it
should be predominantly pictures, following a step-by-step approach, trying to lessen the fear
of a person who is just beginning to gross specimens, and also lessen doubts they might have
about more complex specimens. The idea is to gross in a simple and efficient way. Knowing
how to gross thoroughly and efficiently is incredibly important.
The focus of this Atlas is intentionally on the images of actual gross specimens, as opposed
to solely illustrations of gross specimens. The images highlight key features of various types
of gross specimens. The use of actual gross images will allow the reader to more readily apply
the grossing tips to actual specimens that they encounter at the grossing bench. This book
contains many grossing tips, as well as sample dictations, that complement and complete the
visual grossing lessons this book provides.
The goal of this book is to help pathology trainees (residents, fellows, pathology assistant
students) learn how to gross a variety of specimens, and to give more experienced practitio-
ner’s additional ideas for how to gross in the most efficient manner. Thus in addition to pathol-
ogy trainees, we hope that attending pathologists and practicing pathologist assistants may
also benefit from this book.
Finally, always think about how you would like a case to be grossed as if the patient were a
member of your own family. With that thought in mind, you will always perform a gross
examination with care and efficiency.
Houston, TX, USA Monica B. Lemos
Ekene Okoye
ix
Acknowledgments
Teaching residents has become my heart. Working as a PA in Houston Methodist Hospital and
also continuing part time at MD Anderson is for me the basis of my accomplishments. Along
the path I met people who gave me so much knowledge and support for everything that I have
achieved as a PA. Thank you to all the residents and fellows along these 4 years (2012–2016):
Drs. Sergio Pina, Miguelina De La Garza, Daniel Wimmer, Jana Wimmer, Nicole Nelles,
Suzanne Crumley, Natasha Golardi, Andreia Barbieri, Ziad El-Zaatari, and Ahmed Shehabeldin.
To the Department of Pathology and Genomic Medicine at Houston Methodist Hospital for all
the amazing support from the attendings: Drs. Alberto Ayala, Dina Mody, Steven Shen, Patricia
Chevez Barrios, April Ewton, Ekene Okoye, Blythe Gorman, Mary Schwartz, Donna Coffey
(for her unconditional friendship and support), Michael Deavers, Roberto Barrios, and Mukul
Divatia (for his vast knowledge and for always going completely out of his way to help me).
Also, thank you to the attendings from MD Anderson who became part of my life: Drs. Aysegul
Sahin, Nour Sneige, Patricia Troncoso, Elvio Silva, Victor Prieto, Fraser Symmans, and Stanley
Hamilton. I also thank Dr. Michelle Williams for her guidance. And especially to the person
who started my history in this country, Dr. Janet Brunner.
Many thanks to Dr. Ziad El-Zaatari for his great assistance and work on the digital image
editing for this book. We greatly thank Dr. Sasha Pejerrey for her assistance.
I especially want to thank Dr. Alberto Ayala. This book is your idea, the seed that you
planted with love and care. The only thing I want is for you to be proud. Thank you for believ-
ing in me, for pushing me through my fears, and for holding my hand through my career. You
are a real teacher, a teacher and mentor of us all, the example of character, knowledge, patient
care, love, and dedication. As a daughter to a father, I want to say with all my heart: Thank you,
Dr. Ayala.
Monica B. Lemos
xi
Contents
1 Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Monica B. Lemos and Patricia Chevez-Barrios
2 Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Monica B. Lemos and Nour Sneige
3 Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Monica B. Lemos and Alberto Ayala
4 Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Monica B. Lemos and Mary Schwartz
5 Hepatobiliary and Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Monica B. Lemos and Mary Schwartz
6 Genitourinary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Monica B. Lemos and Steven Shen
7 Female Reproductive Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Monica B. Lemos, Donna Coffey, and Michael Deavers
8 Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Monica B. Lemos and Roberto Barrios
9 Bone and Soft Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Monica B. Lemos and Michael Deavers
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
xiii