Table Of ContentPulmonary Pathology
Other books in this series:
Prayson: Neuropathology
Iacobuzio-Donahue & Montgomery: Gastrointestinal and Liver Pathology
Thompson: Head and Neck Pathology
O’Malley & Pinder: Breast Pathology
Thompson: Endocrine Pathology
Zhou & Magi-Galluzzi: Genitourinary Pathology
Hsi: Hematopathology
Sidawy & Ali: Fine Needle Aspiration Cytology
Other books coming soon in this series:
Busam: Dermatopathology
Folpe & Inwards: Bone and Soft Tissue Pathology
Nucci & Oliva: Gynecologic Pathology
Tubbs & Stoler: Cell and Tissue Based Molecular Pathology
Pulmonary Pathology
A Volume in the Series
Foundations in Diagnostic Pathology
Edited by
Dani S. Zander, M.D.
Professor and Chair of Pathology
University Chair in Pathology
Department of Pathology
Penn State Milton S. Hershey Medical Center and
Penn State University College of Medicine
Hershey, Pennsylvania
Carol F. Farver, M.D.
Director, Pulmonary Pathology
Vice-Chair of Education
Division of Pathology and Laboratory Medicine
Cleveland Clinic
Cleveland, Ohio
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, Pennsylvania 19103-2899
PULMONARY PATHOLOGY
A Volume in the Series Foundations in Diagnostic Pathology ISBN: 978-0-443-06741-9
Copyright © 2008 by Churchill Livingstone, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including photocopying, recording, or any information storage
and retrieval system, without permission in writing from the publisher. Permissions may be sought
directly from Elsevier’s Rights Department: phone: ((cid:2)1) 215 239 3804 (US) or ((cid:2)44) 1865 843830
(UK); fax: ((cid:2)44) 1865 853333; e-mail: [email protected]. You may also complete your
request on-line via the Elsevier website at http://www.elsevier.com/permissions.
Notice
Knowledge and best practice in this fi eld are constantly changing. As new research and experience
broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or
appropriate. Readers are advised to check the most current information provided (i) on procedures
featured or (ii) by the manufacturer of each product to be administered, to verify the recommended
dose or formula, the method and duration of administration, and contraindications. It is the re-
sponsibility of the practitioner, relying on their own experience and knowledge of the patient, to
make diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor
the Editors assume any liability for any injury and/or damage to persons or property arising out of
or related to any use of the material contained in this book.
The Publisher
Library of Congress Cataloging-in-Publication Data
Pulmonary pathology / [edited by] Dani S. Zander, Carol F. Farver. — 1st ed.
p. ; cm. — (Foundations in diagnostic pathology)
Includes bibliographical references.
ISBN 978-0-443-06741-9
1. Lungs—Pathophysiology. 2. Lungs—Diseases—Diagnosis. I. Zander, Dani S. II. Farver, Carol F. III.
Series.
[DNLM: 1. Lung Diseases—diagnosis. 2. Lung Diseases—pathology. 3.
Pleural Diseases—diagnosis. 4. Pleural Diseases—pathology. WF 600
P98374 2008]
RC711.P832 2008
616.2’4—dc22
2007034369
Acquisitions Editor: Bill Schmitt
Developmental Editor: Nicole DiCicco
Publishing Services Manager: Joan Sinclair
Project Manager: Bryan Hayward
Design Coordinator: Karen O’Keefe
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
My thanks to my husband, Dr. Erik Zander, who has
been an unwavering source of encouragement and
goodwill, and to my children, Brianne and
Paul Zander, for their kindness and patience during
the preparation of this book.
— Dani S. Zander, MD
My thanks to my husband, Dr. Robert Needlman,
for his love, support and infi nite optimism that
carried me through this and many other projects
and to our daughter, Grace Needlman, whose true joy
of learning inspires me each and every day.
— Carol F. Farver, MD
This page intentionally left blank
Contributors
Ashley W. Allison, M.D. Megan K. Dishop, M.D.
Fellow in Dermatopathology, Department of Dermatology, Assistant Professor, Department of Pathology, Texas
The University of Texas Medical Branch, Galveston, Texas Children’s Hospital, Baylor College of Medicine,
Houston, Texas
Sadir J. Alrawi, M.D.
Chief of Surgical Oncology, University of Florida Carol F. Farver, M.D.
at Jacksonville, Jacksonville, Florida
Director, Pulmonary Pathology; Vice-Chair of Education,
Richard L. Attanoos, M.D. Division of Pathology and Laboratory Medicine, Cleveland
Consultant Histopathologist, Department of Histopathology, Clinic, Cleveland, Ohio
Llandough Hospital, Cardiff and Vale NHS Trust, Wales,
Douglas B. Flieder, M.D.
United Kingdom
Department of Pathology, Fox Chase Cancer Center,
Marie Christine Aubry, M.D. Philadelphia, Pennsylvania
Associate Professor of Pathology, Division of Anatomic
Armando E. Fraire, M.D.
Pathology, Mayo Clinic, Laboratory Medicine and Pathology,
Professor, Department of Pathology, University of
Rochester, Minnesota
Massachusetts Medical School, Worcester, Massachusetts
Roberto J. Barrios, M.D.
Anthony A. Gal, M.D.
Professor of Pathology and Laboratory Medicine, Weill Medi-
cal College of Cornell University; Department of Pathology, Professor of Pathology, Department of Pathology and
The Methodist Hospital, Houston, Texas Laboratory Medicine, Emory University School of Medicine,
Atlanta, Georgia
Mary Beth Beasley, M.D.
Assistant Professor of Pathology, Department of Pathology, Allen R. Gibbs, M.D.
Mount Sinai School of Medicine, New York, New York Llandough Hospital, Department of Histopathology, Penarth,
Cardiff and Vale NHS Trust, United Kingdom
Jennifer Brainard, M.D.
Section Head, Cytopathology, Department of Anatomic Linda K. Green, M.D.
Pathology, Cleveland Clinic Foundation, Cleveland, Ohio Professor of Pathology, Baylor College of Medicine, and
Director of Cytology, Flow Cytometry and FISH, Michael E.
Elisabeth Brambilla, MD, Ph.D.
DeBakey Veterans Affairs Medical Center, Houston, Texas
Professor of Pathology, Département d’Anatomie et Cytolo-
gie Pathologiques, CHU Albert Michallon, INSERM U823, Ulrike Gruber-Mösenbacher, M.D.
Université J. Fourier, Grenoble, France Staff Pathologist, Institute of Pathology, Academic
Teaching Hospital, Feldkirch, Austria
Kelly J. Butnor, M.D.
Donald G. Guinee, Jr., M.D.
Assistant Professor of Pathology, Department of Pathology,
Virginia Mason Medical Center, Department of Pathology,
Fletcher Allen Health Care/University of Vermont Burlington,
Seattle, Washington
Burlington, Vermont
Abida K. Haque, M.D.
Omar R. Chughtai, M.D.
Professor of Pathology, Weill Medical School of Cornell
Director of Operations, Chughtai’s Lahore Lab, Lahore, Pakistan
University; Department of Pathology, The Methodist
Carlyne D. Cool, M.D. Hospital, Houston, Texas
Associate Clinical Professor, Department of Pathology,
Aliya N. Husain, M.D.
University of Colorado Health Sciences Center; Associate
Professor of Pathology, Department of Pathology, University
Professor, Department of Medicine, National Jewish Medical
of Chicago, Chicago, Illinois
and Research Center, Denver, Colorado
Diana N. Ionescu, M.D., FRCPC
Michael H. Covinsky, M.D., Ph.D.
Consultant Pathologist, BC Cancer Agency, Clinical Assistant
Assistant Professor of Pathology, University of Texas Health Professor, Department of Pathology, University of British
Science Center at Houston Medical School, Department of Columbia, Vancouver, British Columbia, Canada
Pathology and Laboratory Medicine, Houston, Texas
Jaishree Jagirdar, M.D.
Gail H. Deutsch, M.D. Professor of Pathology and Director of Anatomic Pathology,
Assistant Professor of Pathology, Pathology and Laboratory University of Texas Health Science Center at San Antonio,
Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pathology, San Antonio, Texas
Cincinnati, Ohio
vii
viii Contributors
Keith M. Kerr, BSc, MB ChB, FRCPath, FRCPEd Gary W. Procop, M.D., M.S.
Consultant Pathologist, Department of Pathology, Aberdeen Chairman, Department of Clinical Pathology; Director,
Royal Infi rmary, Professor of Pulmonary Pathology, Aberdeen Molecular Microbiology, Mycology, and Parasitology,
University School of Medicine, Foresterhill, Aberdeen, Cleveland Clinic Pathology and Laboratory Medicine
Scotland, United Kingdom Institute, Cleveland, Ohio
Andras Khoor, M.D. Semyon A. Risin, M.D., Ph.D.
Chair, Department of Laboratory Medicine and Pathology, Professor, Department of Pathology and Laboratory Medi-
Mayo Clinic, Jacksonville, Florida cine, University of Texas Health Science Center–Houston
Medical School; Director of Clinical Immunology, Memorial
Claire Langston, M.D.
Herrmann Hospital, Houston, Texas
Professor, Department of Pathology, Baylor College of
Anna E. Sienko, M.D., FRCP(C)
Medicine, Texas Children’s Hospital, Houston, Texas
Department of Pathology, The Methodist Hospital, Houston,
Sylvie Lantuejoul, M.D., Ph.D. Texas
Professor of Pathology, Département d’Anatomie et Cytologie Thomas A. Sporn, M.D.
Pathologiques, CHU Albert Michallon, INSERM U823, Assistant Professor of Pathology, Duke University
Université J. Fourier, Grenoble, France Medical Center, Department of Pathology, Durham,
North Carolina
Kevin O. Leslie, M.D.
Consultant and Vice Chair for Anatomic Pathology Services, Dongfeng Tan, M.D.
Department of Laboratory Medicine and Pathology, Mayo Associate Professor, Department of Pathology, MD Anderson
Clinic Arizona, Scottsdale, Arizona; Professor of Pathology, Cancer Center, Houston, Texas
Mayo Clinic College of Medicine, Rochester, Minnesota
William D. Travis, M.D.
Cynthia M. Magro, M.D. Attending Thoracic Pathologist, Department of Pathology,
Professor of Pathology and Laboratory Medicine and Director of Memorial Sloan Kettering Cancer Center; Professor of
Dermatopathology, Weill Medical College of Cornell University, Pathology, Weill Medical College of Cornell University,
New York Presbyterian Hospital–Cornell Campus, Department New York, New York
of Pathology and Laboratory Medicine, New York, New York
David H. Walker, M.D.
Andre L. Moreira, M.D., Ph.D. The Carmage and Martha Walls Distinguished University
Assistant Attending, Department of Pathology, Memorial Chair in Tropical Diseases, Professor and Chairman, Depart-
Sloan Kettering Cancer Center, New York. New York ment of Pathology, Executive Director, Center for Biodefense
and Emerging Infectious Disease, University of Texas Medi-
Bruno Murer, M.D.
cal Branch at Galveston, Galveston, Texas
Ospedale dell’ Angelo, AULSS 12 Veneziana, Veneziana,
Anatomic Pathology Department, Mestre-Venice, Italy Joanne L. Wright, M.D., FRCP
University of British Columbia, Department of Pathology,
Ronald C. Neafi e, M.D.
Vancouver, British Columbia, Canada
Chief, Parasitic Disease Pathology Branch, Department of
Environmental and Infectious Disease Sciences, Armed Sherif R. Zaki, M.D., Ph.D.
Forces Institute of Pathology, Washington, D.C.
Chief, Infectious Diseases Pathology Branch DVRD,
Christopher D. Paddock, M.D., M.P.H.T.M NCZVED Centers for Disease Control and Prevention,
Atlanta, Georgia
Staff Pathologist/Research Medical Offi cer, Infectious Disease
Pathology Branch, Centers for Disease Control and Prevention, Dani S. Zander, M.D.
Atlanta, Georgia
Professor and Chair of Pathology, University Chair in Pathol-
Helmut H. Popper, M.D. ogy, Department of Pathology, Penn State Milton S. Hershey
Medical Center and Penn State University College of Medi-
Professor of Pathology, Laboratories for Molecular Cytogenetics,
cine, Hershey, Pennsylvania
Environmental, and Respiratory Tract Pathology, Institute of
Pathology, Medical University of Graz, Graz, Austria
Foreword
The study and practice of anatomic pathology is both thology, including authors who have not only contrib-
exciting and overwhelming. Surgical pathology, with all uted to the literature in this fi eld, but, more importantly,
of the subspecialties it encompasses, and cytopathology have been practicing pulmonary pathology for many
have become increasingly complex and sophisticated, years, acquiring invaluable diagnostic experience. As
and it is not possible for any individual to master the with all of the other editions in the Foundations in Diag-
skills and knowledge required to perform all of these nostic Pathology series, the information presented in this
tasks at the highest level. Simply being able to make a book is organized into headings, covering the essential
correct diagnosis is challenging enough, but the standard clinical and pathologic features of each entity. There are
of care has far surpassed merely providing a diagnosis. a large number of practical tables and high-quality photo-
Pathologists are now asked to provide large amounts of micrographs, which similarly capture the essence of the
ancillary information, both diagnostic and prognostic, topics being discussed, with bullet points to allow a quick
often on small amounts of tissue, a task that can be summary of the information. Where applicable, the
daunting even to the most experienced pathologist. authors thoroughly integrate ancillary diagnostic techni-
Although large general surgical pathology textbooks ques, including immunohistochemistry, immunofl uores-
are useful resources, they by necessity could not possi- cence, electron microscopy, and molecular diagnostics.
bly cover many of the aspects that pathologists needs to This edition is organized into 40 chapters encom-
know and include in their reports. As such, the concept passing the full spectrum of pulmonary pathology. The
behind Foundations in Pathology was born. This series fi rst three chapter focus on normal pulmonary anatomy
is designed to cover the major areas of surgical and cy- and tissue artifacts, the uses (and abuse) of the lung
topathology, and each edition is focused on one major biopsy, and a pattern-based approach to the diagnosis of
topic. The goal of every book in this series is to provide pulmonary diseases. The remaining chapters examine
the essential information that any pathologist, whether congenital/pediatric, vascular, infectious, idiopathic,
general or subspecialized, in training or in practice, and neoplastic conditions. Separate chapters are also
would fi nd useful in the evaluation of virtually any type provided to include fi broinfl ammatory and neoplastic
of specimen encountered. diseases of the pleura.
Dr. Dani Zander, Professor and Chair of Pathology at I wish to extend my heartfelt appreciation to
Penn State Milton S. Hershey Medical Center, and my Drs. Zander and Farver, who took on this project de-
valued colleague at the Cleveland Clinic, Dr. Carol Farver, spite innumerable other clinical and administrative re-
both outstanding and renowned pulmonary pathologists, sponsibilities. Their organizational and editorial skills
have edited what I believe to be an outstanding state-of- have truly made this edition outstanding. I would also
the-art book covering the essential aspects of pulmonary like to extend my appreciation to the many authors
pathology. Although there are other outstanding and who have also taken the time from their busy lives to
comprehensive pulmonary pathology textbooks available, provide their knowledge and expertise. It is my sincer-
I know of no other book that so effectively gets to the est hope that you fi nd this volume of Foundations in
core of what practicing surgical pathologists want and Diagnostic Pathology to be a valuable addition to your
need to know about this challenging topic. The list of library and, more importantly, to your everyday prac-
contributors is a virtual Who’s Who of pulmonary pa- tice of pulmonary pathology.
JOHN R. GOLDBLUM, M.D.
ix
