In light of these successes, and in view of the fact that hospital pathology continues to grow rapidly in scope and complexity, we decided to prepare a second edition of our book. Several features are new to this edition. These include inevitable additions to, and revisions of, the prior text because of advances in our understanding of the pertinent disease processes. Corresponding references have been added, and they are current through mid-2010. Moreover, many illustrative photomicrographs have been changed. In an effort to improve the visual presentation of the topics discussed. Finally, self-assessment questions tied to all the chapters in the current book have been compiled and are available online. It is hoped that these questions will be useful to pathologists in their maintenance of certification and as a reflection of their mastery of the information in the book.
As before, we begin with the general patterns of disease and then add key morphologic findings that assist the reader in focusing on appropriate sections of the book where similar findings are discussed. This approach is facilitated by a structural overlay that limits the patterns. We have found that six general patterns occur, and these are best appreciated at scanning magnification with the microscope. We could begin at an even lower “magnification” using the high-resolution computed tomogram (CT), and this is what our radiology colleagues commonly do as they assemble a differential diagnosis based on observed findings in this medium (see Chapter 3). In practice, the CT images may not be readily available to the pathologist at the time the biopsy is interpreted; so for our six pathology patterns, we begin with a tissue section mounted on a glass slide.
An overview of the six patterns is presented, and each pattern is then illustrated in the pages that follow. Most of the patterns were devised to navigate the “diffuse lung diseases” commonly referred to as interstitial lung diseases or ILD. Given the tumefactive nature of neoplasms, these are heavily represented in Pattern 5 (Nodules), but some non-neoplastic diseases, such as sarcoidosis, nodular infections, Wegener's granulomatosis, and certain neumoconioses, may also manifest as a nodular pattern. Rarely, neoplasms can present as diffuse “interstitial” lung disease clinically and radiologically.
A basic knowledge of the two-dimensional structure of the lung is essential for accurately assessing patterns of disease. We assume that the reader is familiar with basic lung anatomy by the time a diagnostic problem is being evaluated in the patient care setting, but a brief review is always helpful (see Chapter 1).
Once the overriding or dominant pattern is recognized, the diagnostician assesses the cellular composition and any other distinctive findings that accompany the pattern. In the case of a tumor forming a nodular mass, the presence of prominent spindled cells, or large granular cells, or clear cells provides a direction for creating a differential diagnosis. Within each pattern, we have attempted to use such qualifying elements to direct the reader to the appropriate chapter for further study, reasonably confident that the answer will lie within. For the unusual finding not identified in the list for a given pattern, the reader is directed to the appendix, where we have assembled a “visual encyclopedia” of distinctive findings and artifacts.
Naturally, overlap occurs between patterns, and this too can be a useful guide to the correct diagnosis. For example, some infections are both nodular and have airspace filling (e.g., botyromycosis, aspiration pneumonia), whereas others are characterized by acute lung injury and diffuse airspace filling (e.g., pneumoccocal pneumonia, pneumocystis pneumonia.) In fact, some diffuse inflammatory conditions in the lung may manifest five of the six patterns, in different areas of the same biopsy (e.g., rheumatoid lung). Nevertheless, as more and more information is accrued from the biopsy, the differential diagnosis becomes more limited. In some cases, it may be necessary to include several possibilities in the final diagnosis, especially for the non-neoplastic diseases, where the effect of ancillary data not available at the time of diagnosis may be very large.
Once again, we are grateful to all of the authors who generously and diligently updated their chapters in the second edition of PPPDA. In addition, many thanks are due to our colleagues at the Mayo Clinic and the University of Virginia for their strong support of this project. Finally, this work could not have reached fruition without the valuable help of our editor, William Schmitt of Elsevier, and the editorial and production expertise of Peggy Gordon and Clay Cansler.
Kevin O. Leslie and Mark R. Wick
Key Features
- Accurately identify all major neoplastic and non-neoplastic diseases of the lungs with this comprehensive, "one-stop" resource whose last edition was named "Medical Textbook of the Year" by the Royal Society of Medicine/Society of Authors in 2005.
- Easily grasp important concepts thanks to a consistent presentation of key information on each disease and disorder: etiology, pathogenesis, clinical features, pathologic features, and differential diagnosis.
- Apply practical advice and tips from world-recognized experts, including many time-saving diagnostic clues for interpreting difficult specimens.
- Improve the accuracy and completeness of your pathology reports with relevant clinical background information and ancillary radiographs, summary tables, charts, and graphs to simplify reference and to facilitate "at-a-glance" comparison between entities.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
- Images: Browse a Library of all book images. Easily select, organize, and download your images into a presentation.
- Self-Assessment Questions: Quiz yourself, in Study or Assessment mode, with these review questions.
New to this edition
- Use pattern recognition to interpret complex diagnostic puzzles with assistance from key morphologic patterns for a full range of common and rare conditions.
- Get answers fast! A unique "visual index" directs you to the exact chapters and specific pages you need for in-depth diagnostic guidance.
- Stay current with a new chapter on pulmonary CT patterns written by two world-renowned thoracic radiologists; the latest lung cancer staging scheme in reference to therapy with biological agents; new concepts in bronchioloalveolar carcinoma diagnosis; an expanded discussion of neoplasms of the lung and pleura, with inclusion of recently-described entities; and many other timely updates.
- Access the fully searchable text anywhere, anytime at expertconsult.com, along with references, downloadable images, and self-assessment modules at the end of each chapter.
- Pattern-Based Approach to Diagnosis
- Chapter 1 - Lung Anatomy
- Chapter 2 - Optimal Processing of Diagnostic Lung Specimens
- Chapter 3 - Computed Tomography of Diffuse Lung Diseases and Solitary Pulmonary Nodules
- Chapter 4 - Developmental and Pediatric Lung Disease
- Chapter 5 - Acute Lung Injury
- Chapter 6 - Lung Infections
- Chapter 7 - Chronic Diffuse Lung Diseases
- Chapter 8 - Non-Neoplastic Pathology of the Large and Small Airways
- Chapter 9 - Pneumoconioses
- Chapter 10 - Pulmonary Vasculitis and Pulmonary Hemorrhage
- Chapter 11 - Pulmonary Hypertension
- Chapter 12 - Pathology of Lung Transplantation
- Chapter 13 - Neuroendocrine Lesions of the Lung
- Chapter 14 - Sarcomas and Sarcomatoid Neoplasms of the Lungs and Pleural Surfaces
- Chapter 15 - Hematolymphoid Disorders
- Chapter 16 - Non-Neuroendocrine Carcinomas (Excluding “Sarcomatoid” Carcinoma) and Salivary Gland Analog Carcinomas in the Lung
- Chapter 17 - Metastatic Tumors in the Lung: A Practical Approach to Diagnosis
- Chapter 18 - Pseudoneoplastic Lesions of the Lungs and Pleural Surfaces
- Chapter 19 - Benign and Borderline Tumors of the Lungs and Pleura
- Chapter 20 - Malignant and Borderline Mesothelial Tumors of the Pleura
- Miscellaneous Distinctive Histopathologic Findings
Book Details
- Hardcover: 864 pages
- Publisher: Saunders; 2 edition (May 18, 2011)
- Language: English
- ISBN-10: 1416057706
- ISBN-13: 978-1416057703
- Product Dimensions: 11.1 x 8.8 x 1.6 inches