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Exam Preparatory Manual for Undergraduates: Pathology
Ramadas Nayak
SECTION 1: GENERAL PATHOLOGY
CHAPTER 1:
Cellular Responses to Stress and Injury
INTRODUCTION
Learning Pathology
Scientific Study of Disease
Etiology
Pathogenesis
Molecular Pathology
Functional Derangements and Clinical Manifestations
TYPES OF CELLULAR RESPONSES TO INJURY
CELLULAR ADAPTATIONS
Hypertrophy
Causes
Mechanisms of Cellular Hypertrophy
Hyperplasia
Causes
Mechanism
Atrophy
Causes
Mechanisms
Metaplasia
Causes
Types of Metaplasia
Mechanism
CELL INJURY
Causes of Cell Injury
General Principles of Cell Injury
Mechanisms of Cell Injury
Decreased Production of Adenosine Triphosphate
Mitochondrial Damage (Fig. 1.8)
Influx of Calcium and Loss of Calcium Homeostasis (Fig. 1.9)
Accumulation of Oxygen-derived Free Radicals (Oxidative Stress)
Effects of Cell Injury
Defects in Membrane Permeability and Membrane Damage
Damage to DNA and Proteins
ISCHEMIA-REPERFUSION INJURY
Mechanism of Reperfusion Injury
TYPES OF CELL INJURY
Reversible Cell Injury
Steatosis (Fatty Change)
Cholesterol Deposits
Atherosclerosis
Xanthoma
Irreversible Cell Injury
NECROSIS
Patterns/Types of Tissue Necrosis
Coagulative Necrosis
Liquefactive Necrosis (Colliquative Necrosis)
Caseous Necrosis
Fat Necrosis
Fibrinoid Necrosis
Gangrene (Gangrenous Necrosis)
Gummatous Necrosis
APOPTOSIS
Causes of Apoptosis
Physiological Situations
Pathological Conditions
Mechanisms of Apoptosis
Phases of Apoptosis
Removal of Apoptotic Cells
Diagnosis/Detection of Apoptosis
Disorders Associated with Dysregulated Apoptosis
Clinical Significance of Apoptosis in Cancers
PATHOLOGIC CALCIFICATION
Dystrophic Calcification
Causes
Metastatic Calcification
Causes
Sites
HYALINE CHANGE
Causes (Table 1.6)
Intracellular Hyaline
Extracellular Hyaline
PIGMENTS
Melanin
Alkaptonuria
Hemosiderin
Causes
Other Pigments
CELLULAR AGING
Causes
Mechanism of Cellular Aging
Decreased Cellular Replication
Accumulation of Metabolic and Genetic Damage (Fig. 1.31)
Factors that Increases Longevity
Caloric Restriction
Growth Factor Signaling
CHAPTER 2:
Acute Inflammation
INTRODUCTION
Cardinal Signs of Inflammation
Causes of (Stimuli for) Acute Inflammation
SEQUENCE OF EVENTS IN ACUTE INFLAMMATION
REACTIONS OF BLOOD VESSELS (VASCULAR CHANGES)
Changes in Vascular Flow and Caliber
Increased Vascular Permeability (Vascular Leakage)
Mechanism of Increased Vascular Permeability
LEUKOCYTIC/CELLULAR EVENTS
Leukocyte Recruitment/Extravasation
Steps in Leukocyte Recruitment/Extravasation (Fig. 2.3)
Leukocyte Activation
Phagocytosis and Clearance of the Offending Agent
Clinical Significance of Inherited Defects in Microbicidal Activity
Acquired Defects of Leukocyte Functions
CHEMICAL MEDIATORS OF INFLAMMATION
General Features of Chemical Mediators
Cell-Derived Mediators
Vasoactive Amines: Histamine and Serotonin
Arachidonic Acid Metabolites (Prostaglandins, Leukotrienes, and Lipoxins)
Platelet-activating Factor (PAF)
Reactive Oxygen Species
Nitric Oxide
Cytokines and Chemokines
Lysosomal Constituents of Leukocytes
Neuropeptides
Plasma-Derived Mediators
Complement System
Coagulation and Kinin Systems
Kinins System
Cells of Inflammation
Neutrophils
Eosinophils
Mast cells
Basophils
Lymphocytes
Plasma Cells
OUTCOMES OF ACUTE INFLAMMATION (FIG. 2.10)
MORPHOLOGICAL TYPES/PATTERNS OF ACUTE INFLAMMATION
SYSTEMIC EFFECTS OF INFLAMMATION
CHAPTER 3:
Wound Healing
INTRODUCTION
Healing
Factors Deciding the Pattern of Healing
Proliferative Capacity of the Tissue
Extent of Tissue Injury
STEM CELLS
Properties
Types
Sites of Stem Cells
CELL CYCLE AND CELL PROLIFERATION
Phases of Cell Cycle (Fig. 3.1)
Growth Factors
Signaling Mechanisms of Growth Factor Receptors
HEALING BY REPAIR, SCAR FORMATION AND FIBROSIS
Steps in Healing by Repair (Scar Formation)
Inflammation
Angiogenesis
Formation of Granulation Tissue
Scar Formation
Connective Tissue Remodeling
Role of Macrophages in Repair
CUTANEOUS WOUND HEALING
Healing by Primary Union or by First Intention
Stages in the Healing by First Intention (Figs 3.5A to D)
Healing by Secondary Union or by Second Intention
Features of Healing by Secondary Intention (Figs 3.6A to D)
Wound Strength
FACTORS THAT INFLUENCE WOUND HEALING
Local Factors
Systemic Factors
COMPLICATIONS OF WOUND HEALING
Inadequate Granulation Tissue Formation
Excessive Scar Formation
Excessive Contraction
Others
Fibrosis
CHAPTER 4:
Chronic Inflammation
INTRODUCTION
Causes of Chronic Inflammation
Morphologic Features
Chronic Inflammatory Cells and Mediators
Macrophages
Lymphocytes
Other Cells
TYPES OF CHRONIC INFLAMMATION
Granulomatous Inflammation
Types of Granulomas
GIANT CELL
GRANULOMATOUS DISEASES
LEPROSY
Classification
Variants of Leprosy
Pathogenesis
Reactions in Leprosy
Diagnosis of Leprosy
SYPHILIS
Etiology
Basic Microscopic Lesion
Stages of Syphilis (Fig. 4.8)
Primary Syphilis
Secondary Syphilis
Tertiary Syphilis
Congenital Syphilis
Transplacental Transmission
Laboratory Diagnosis
TUBERCULOSIS
OTHER INFECTIONS
Actinomycosis
Rhinosporidiosis
Microscopy (Fig. 4.10)
Molluscum Contagiosum
CHAPTER 5:
Hemodynamic Disorders, Thromboembolism and Shock
HYPEREMIA AND CONGESTION
Hyperemia
Causes
Congestion
Types and Causes
Onset
Chronic Venous Congestion of Lung
Causes
Mechanism
Consequences
Chronic Venous Congestion of Liver
Causes
Congestive Splenomegaly (CVC Spleen)
Causes
EDEMA
Types of Edema Fluid
Pathophysiologic Categories of Edema (Table 5.2)
Local/Localized Edema
Generalized Edema
Mechanism/Pathogenesis of Edema (Fig. 5.4)
Normal Fluid Balance
Mechanism of Edema
Clinical Consequences
FUNCTIONS OF NORMAL ENDOTHELIUM
Antithrombotic Properties
Antiplatelet Effects
Anticoagulant Effects
Fibrinolytic Effects
Prothrombotic Properties
Platelet Effects
Procoagulant Effects
Antifibrinolytic Effects
THROMBOSIS
Etiology
Injury to Endothelium (Changes in the Vessel Wall)
Alterations in Normal Blood Flow
Hypercoagulability
Terminology
Types of Thrombi
Site and Types
Postmortem Clots
Fate of the Thrombus (Fig. 5.8)
VENOUS THROMBOSIS (PHLEBOTHROMBOSIS)
Veins Involved
Pathogenesis of DVT (Phlebothrombosis)
Thrombophlebitis
Consequences of Thrombi
EMBOLISM
Types of Emboli
PULMONARY EMBOLISM
Site of Origin of Emboli (Fig. 5.11)
Fate of Pulmonary Embolism
Consequences (Fig. 5.11)
SYSTEMIC THROMBOEMBOLISM
Sources of Systemic Emboli (Fig. 5.12)
Consequences
Major Sites Affected by Arterial Thromboemboli ( Fig. 5.12)
FAT AND MARROW EMBOLISM
Causes
Manifestation
Pathogenesis
Consequences of Fat Embolism
Clinical Presentation
AIR EMBOLISM
Causes
Decompression Sickness
Acute Decompression Sickness
Effects
Chronic Decompression Sickness
AMNIOTIC FLUID EMBOLISM
Clinical Features
MISCELLANEOUS PULMONARY EMBOLI
INFARCTION
Causes of Infarction
Factors that Determine the Outcome of an Infarct
Classification (Table 5.8)
White/Pale Infarcts
Red/Hemorrhagic Infarcts
SHOCK
Classification
Etiology and Pathogenesis
Hypovolemic Shock
Cardiogenic Shock
Septic Shock
Stages of Shock
Changes in Septic Shock
Clinical Consequences
Prognosis
CHAPTER 6:
Diseases of the Immune System
IMMUNITY
Innate (Natural/Native) Immunity
General Features
Major Components
Functions of Innate Immune Response
Adaptive Immunity
General Features
Components
Functions of Adaptive Immune Response
CELLS OF THE IMMUNE SYSTEM
Naïve Lymphocytes
T Lymphocytes
B Lymphocytes
Dendritic Cells
Macrophages
Natural Killer Cells
Function
CYTOKINES
Classification
Cytokines of Innate Immunity
Cytokines of Adaptive Immune Responses
Colony-Stimulating Factors
HYPERSENSITIVITY REACTIONS
General Features of Hypersensitivity Disorders
Classification of Hypersensitivity Reactions (Table 6.3)
TYPE I (IMMEDIATE) HYPERSENSITIVITY REACTIONS
Characteristics
Sequence of Events (Fig. 6.2)
During Initial Exposure to Antigen (Sensitization)
During Subsequent Exposure to Antigen
Mediators of Type I Hypersensitivity Reactions (Fig. 6.3)
Eosinophils in Type I Hypersensitivity Reaction
Clinical Manifestations
Systemic Anaphylaxis
Local Reactions
Atopy
Diagnosis of Type I Hypersensitivity
Anaphylactoid Reactions
ANTIBODY-MEDIATED (TYPE II) HYPERSENSITIVITY REACTIONS
Characteristics
Mechanism of Injury
Complement Dependent Reactions
Antibody-Dependent (Complement Independent) Cellular Dysfunction
IMMUNE COMPLEX-MEDIATED (TYPE III) HYPERSENSITIVITY REACTIONS
Characteristics
Sites of Antigen-antibody Formation
Sites of Immune Complex Deposition
Cause of Tissue Damage
Systemic Immune Complex Disease—Acute Serum Sickness
Pathogenesis (Fig. 6.9)
Fate of the Lesion
Local Immune Complex Disease—Arthus Reaction
T-CELL MEDIATED (TYPE IV) HYPERSENSITIVITY REACTIONS
Cytokine Mediated Inflammation Elicited By CD4+ T-cells (Fig. 6.10)
Tuberculin Reaction (Montoux Test)
Contact Dermatitis
Direct Cell Toxicity Mediated By CD8+ T-cells
Mechanism of Cytotoxic T-cell Mediated Killing
AUTOIMMUNE DISEASES
IMMUNOLOGICAL TOLERANCE
Mechanisms of Self-tolerance
Central Tolerance (Fig. 6.14)
Peripheral Tolerance (Fig. 6.14)
MECHANISMS OF AUTOIMMUNITY (FIG. 6.15)
Genetic Factors
Environmental Factors
SYSTEMIC LUPUS ERYTHEMATOSUS
Etiology
Genetic Factors
Environmental Factors
Immunological Abnormalities
Pathogenesis of SLE (Fig. 6.16)
Autoantibodies in SLE
Types of Antibodies
Mechanisms of Tissue Injury
LE Bodies or Hematoxylin Bodies
LE Bodies
LE Cell (Fig 6.18 and refer page 344)
Clinical Features
Laboratory Findings
MAJOR HISTOCOMPATIBILITY COMPLEX MOLECULES
Classification
Class I MHC Molecules
Class II MHC Molecules
Class III MHC Molecules
HLA and Disease Association (Table 6.11)
REJECTION OF TRANSPLANTS
Mechanism of Immune Recognition and Rejection of Allograft
T-cell Mediated Graft Rejection
Antibody-mediated Graft Rejection
Classification of Rejection Reaction (Table 6.12)
Hyperacute Rejection
Acute Rejection
Chronic Rejection
Transplantation of Hematopoietic Cells
Types of Hematopoietic Stem Cell Transplant
Sources of Hematopoietic Stem Cells
Complications of Hematopoietic Stem Cell Transplantation
IMMUNODEFICIENCY SYNDROMES
Classification
Primary Immunodeficiency
X-linked Agammaglobulinemia (Bruton's Agammaglobulinemia)
DiGeorge Syndrome (Thymic Hypoplasia)
Immunodeficiency with Thrombocytopenia and Eczema (Wiskott-Aldrich Syndrome)
ACQUIRED IMMUNODEFICIENCY SYNDROME
Characteristic Features
Route of Transmission
Etiology
Properties of HIV
Structure of HIV (Fig. 6.22)
HIV Genome
Pathogenesis of HIV Infection and AIDS
Life Cycle of HIV
Progression of HIV Infection
Abnormalities of B-cell Function
Natural History of HIV Infection (Fig. 6.24)
CNS lesions in AIDS
Diagnosis of HIV Infection or AIDS
AMYLOIDOSIS
General Features
Forms of Amyloid
Physical Nature of Amyloid
Chemical Nature of Amyloid
Pathogenesis of Amyloidosis (Fig. 6.25)
Misfolding of Proteins
Categories of Proteins
Pathological Effects
Classification of Amyloidosis
Systemic (Generalized)
Hereditary or Familial Amyloidosis
Localized Amyloidosis
Clinical Features
Diagnosis
CHAPTER 7:
Neoplasia
INTRODUCTION
Salient Features of Neoplasia
CLASSIFICATION
Microscopic Components of Neoplasms
NOMENCLATURE OF NEOPLASMS
Benign Tumors
Mesenchymal Tumors
Epithelial Tumors (Fig. 7.2)
Malignant Tumors
Sarcomas
Carcinomas
Eponymously Named Tumors
Other Tumors
Mixed Tumors (Fig. 7.4)
Teratomas
Hamartomas
Choristoma
Embryonal Tumors (Blastomas)
CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS
Differentiation and Anaplasia
Differentiation
Rates of Growth
Factors Determining the Rate of Growth
Local Invasion
Benign Tumors
Malignant Tumors
CARCINOMA IN SITU
Dysplasia
Fate
METASTASIS
Significance
Morphological Appearance
Pathways of Spread
Lymphatic Spread
Hematogenous Spread
Seeding of Body Cavities and Surfaces
Direct Transplantation
INVASION–METASTATIC CASCADE (MOLECULAR EVENTS IN INVASION AND METASTASIS)
Phases
Invasion of Extracellular Matrix (Fig. 7.16)
Metastasis (Vascular Dissemination and Homing of Tumor Cells)
ENVIRONMENTAL FACTORS AND CANCER
PRECANCEROUS CONDITIONS/ PRECURSOR LESIONS
MOLECULAR BASIS OF CANCER
Fundamental Principles
GENETIC LESIONS IN CANCER
Karyotype Abnormalities in Tumors
Structural Abnormalities
Numerical Abnormalities
Minute/Subtle Changes
Epigenetic Modifications and Cancer
Noncoding RNAs and Cancer
STEPS IN NORMAL CELL PROLIFERATION
HALLMARKS OF CANCER
Increased Action of Positive Growth Regulators: Oncogenes
Growth Factor Oncoproteins
Growth Factor Receptor Oncoproteins
Signal-transducing Oncoproteins
DNA-binding Nuclear Regulatory Proteins (Transcription Factors)
Cyclins and Cyclin-dependent Kinases (CDKs)
Loss of Function of Negative Growth Regulators (Tumor Suppressor Genes)
General Characteristic Features of Tumor Suppressor Genes
Retinoblastoma Gene (RB Gene)
RB Gene and Retinoblastoma
TP53 Gene (Guardian of the Genome)
Altered Cellular Metabolism in Cancer Cells (Warburg Effect)
Loss of Normal Apoptosis Pathways
Pathways of Apoptosis (Fig. 1.25)
Methods of Evasion of Apoptosis and Associated Tumors
Loss of Replicative Senescence
Increased Angiogenesis
Effects of Neovascularization on Tumor Growth
Mechanism of Angiogenesis
Mediators of Tumor Angiogenesis
Invasion and Metastasis
Evasion of Host Immune System
Tumor Antigens
Antitumor Mechanisms
Escape of Immune Surveillance
GENOMIC INSTABILITY
ETIOLOGY OF CANCER (CARCINOGENIC AGENTS)
Chemical Carcinogenesis
Classification of Chemical Carcinogens
Mechanism of Action of Chemical Carcinogens
Multistep Hypothesis (Fig. 7.24)
Microbial Carcinogenesis
Oncogenic Rna Viruses
Oncogenic DNA Viruses
Bacteria
Fungi
Parasites
Hormones
Estrogen
Hormone-dependent Tumors
Radiation Carcinogenesis
Ultraviolet Rays
Ionizing Radiation
LABORATORY DIAGNOSIS OF CANCER
Morphological Methods
Histopathological Examination
Cytological Examination
Histochemistry and Cytochemistry
Immunohistochemistry
Electron Microscopy
Tumor Markers
Usefulness
Molecular Diagnosis
CLINICAL ASPECTS OF NEOPLASIA
Local Effects
Functional Effects
Tumor Lysis Syndrome
Cancer Cachexia (Wasting)
PARANEOPLASTIC SYNDROMES
PROGNOSIS
Prognostic Indices
TNM Staging Systems
CHAPTER 8:
Genetic Disorders
GENES
Structure of Gene (Fig. 8.1)
Regions of Gene
CLASSIFICATION OF GENETIC DISORDERS
MUTATIONS
Causes
Classification of Mutations
Structural Chromosomal Mutations
Minute/Subtle Changes
Functional Effect
MENDELIAN DISORDERS/SINGLE-GENE OR MONOGENIC DISORDERS
General Features
Autosomal Dominant Pattern of Inheritance
General Features
Autosomal Recessive Pattern of Inheritance
General Features
X-linked Pattern of Inheritance
X-linked Recessive Traits
X-linked Dominant Disorders
DEVELOPMENTAL DEFECTS
LYON HYPOTHESIS
DEMONSTRATION OF SEX CHROMATIN
Buccal Smear for Barr Body (Fig. 8.6A)
Leukocytes—Nuclear Sexing (Fig. 8.6B)
CYTOGENETICS
Techniques of Cytogenetics
Karyotyping
Classification of Chromosomes in Karyotyping
Karyotype Analysis
Uses of Karyotyping
CHROMOSOMAL ABERRATIONS
Classification (Refer Box 8.1)
Numerical Chromosomal Aberrations
GENOMIC IMPRINTING
MOLECULAR GENETIC DIAGNOSIS
Diagnostic Methods and Indications for Genetic Testing
Timing of Genetic Tests
Genetic Tests
Polymerase Chain Reaction (PCR)
Molecular Analysis of Genomic Alterations
Next-Generation Sequencing
STORAGE DISEASES
General Features
Niemann-Pick Disease
Classification of Niemann-Pick Disease
Tay-Sachs Disease (GM2 Gangliosidosis: Hexosaminidase β-Subunit Deficiency)
Clinical Features
Gaucher Disease
Clinical Subtypes
Clinical Features
TRISOMY 21 (DOWN SYNDROME)
Etiology and Pathogenesis
Clinical Features
KLINEFELTER SYNDROME
Pathogenesis
Clinical Features
TURNER SYNDROME
Karyotypic Abnormalities
Clinical Features
CHAPTER 9:
Nutritional Disorders
COMMON VITAMIN DEFICIENCIES
Categories
FAT-SOLUBLE VITAMINS
Vitamin A (Retinol)
Functions
Deficiency
Pathologic Effects (Clinical Features) of Vitamin A Deficiency (Fig. 9.1)
Vitamin D
Functions
Deficiency
Skeletal Effects of Vitamin D Deficiency
Nonskeletal Effects of Vitamin D
Vitamin C (Ascorbic Acid)
Functions
Deficiency
Vitamin E
Functions
Deficiency
Vitamin K
Functions
Deficiency
WATER-SOLUBLE VITAMINS—VITAMIN B COMPLEX
Thiamine (Vitamin B1)
Functions
Deficiency
Riboflavin (Vitamin B2)
Deficiency
Niacin (Vitamin B3)
Deficiency
Pyridoxine (Vitamin B6)
Deficiency
Effects of Deficiency
Vitamin B12
Functions
Deficiency
Folic Acid
Functions
Deficiency
PROTEIN–ENERGY MALNUTRITION
Marasmus
Kwashiorkor
Cachexia
OBESITY
Types of Obesity
Etiology
1. Genetic Aspects of Human Obesity
2. Environmental Contributors to Human Obesity
Pathogenesis
1. Peripheral or Afferent System
2. Central Processing
3. Peripheral Efferent System
Pathologic Consequences of Obesity (Complications of Obesity)
EFFECTS OF TOBACCO
Constituents of Tobacco
Diseases Caused
Respiratory System
Other Systems
SECTION 2: HEMATOLOGY AND CLINICAL PATHOLOGY
CHAPTER 10:
Disorders of Red Cells
DEFINITION
Classification of Anemia
Red Cell Indices
IRON DEFICIENCY ANEMIA
Etiology (Box 10.1)
Pathogenesis of Iron Deficiency Anemia
Laboratory Findings
Peripheral Blood
Serum Iron Profile (Table 10.2)
Reticulocyte Hemoglobin
Clinical Features of IDA
Physical Findings
Causes of Microcytic Hypochromic Anemia
MEGALOBLASTIC ANEMIA
Etiology of Megaloblastic Anemia (Box 10.3)
Laboratory Findings of Megaloblastic Anemia
Peripheral Blood
Biochemical Tests for Megaloblastic Anemia
PERNICIOUS ANEMIA
Etiopathogenesis
Morphology
Alimentary System
Central Nervous System
Laboratory Findings (Fig. 10.8)
Specific Diagnostic Tests for Pernicious Anemia
Clinical Features of Megaloblastic Anemia
APLASTIC ANEMIA
Etiology
Pathogenesis (Fig. 10.9)
Clinical Features
Laboratory Findings
Peripheral Blood
No Splenomegaly
Differential Diagnosis
HEMOLYTIC ANEMIA
Definition
Classification of Hemolytic Anemias (Table 10.9)
Location of Hemolysis
Laboratory Findings in Hemolytic Anemias
Peripheral Blood
Extramedullary Hematopoiesis
Features of Increased Red Cell Destruction
Features of Increased Red Cell Production
Features of Damaged Red cells
HEREDITARY SPHEROCYTOSIS
Etiopathogenesis
Mechanism of Hemolysis in HS (Fig. 10.11)
Laboratory Findings
Peripheral Blood
Autohemolysis Test
Direct Antiglobulin (Coomb's) Test
Biochemical Findings
Osmotic Fragility Test
Clinical Features
GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY
Role of G6PD (Fig. 10.16)
Sequence of Events in G6PD Deficiency
Clinical Presentation
Laboratory Findings
Peripheral Blood
Urine
RBC Enzyme Analysis
CLASSIFICATION OF HEREDITARY DEFECTS IN HEMOGLOBIN
THALASSEMIA SYNDROME
Classification
β-Thalassemia
Molecular Pathology
β-THALASSEMIA MAJOR
Pathophysiology of β-thalassemia Major (Fig. 10.18)
Consequence of Defective or Absent β-chains
Consequences of Ineffective Erythropoiesis
Iron Overload and its Consequences
Clinical Features
Laboratory Findings
Peripheral Blood
Biochemical Findings
Special Tests
β-THALASSEMIA MINOR/TRAIT
Laboratory Findings in β-Thalassemia Minor
α-THALASSEMIA
Molecular Pathology
Clinical Syndromes
SICKLE CELL ANEMIA
Characteristic Features
Etiopathogenesis
Molecular Basis of Sickling (Fig. 10.24)
Factors Affecting Sickling (Table 10.10)
Pathogenesis of the Microvascular Occlusions
Clinical Features (Fig. 10.25)
Chronic Hemolytic Anemia
Crises
Increased Susceptibility to Infections
Chronic Organ Damage
Laboratory Findings in Sickle Cell Anemia
Peripheral Blood
Serum Findings
Diagnostic/Confirmatory Tests
SICKLE CELL TRAIT
Pathogenesis
Clinical Features
Laboratory Findings
Peripheral Blood
Diagnostic Tests
IMMUNOHEMOLYTIC ANEMIAS
Classification of Immunohemolytic Anemias (Box 10.8)
Alloimmune Hemolytic Anemia
HEMOLYTIC DISEASE OF THE NEWBORN
Rh Hemolytic Disease of the Newborn (Fig. 10.29)
Pathogenesis
Clinicopathological Features
Laboratory Findings
ABO Hemolytic Disease of the Newborn
ANTIGLOBULIN (COOMBS) TEST
Principle
Types of Antiglobulin Test (Fig. 10.30)
Direct Antiglobulin Test (Fig. 10.30)
Uses of Direct Antiglobulin Test
Indirect Antiglobulin Test (Fig. 10.30)
Uses of Indirect Antiglobulin Test
AUTOIMMUNE HEMOLYTIC ANEMIA
Warm Antibody Type
Cold Agglutinin Type
Cold Hemolysins Type (Donath-Landsteiner Antibodies)
FRAGMENTATION SYNDROME
Classification
Laboratory Findings
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
Etiology and Pathogenesis
Clinical Features
Laboratory Findings
ANEMIAS OF BLOOD LOSS
Acute Blood Loss (Hemorrhage)
Chronic Blood Loss
SIDEROBLASTIC ANEMIAS
CONTENTS OF BONE MARROW (Box 10.9)
Erythropoietin (EPO)
Parasites Causing Anemia
CHAPTER 11:
Disorders of White Cells
NORMAL DIFFERENTIAL LEUKOCYTE COUNT
QUANTITATIVE DISORDERS OF LEUKOCYTES
Leukocytosis
Leukopenia
Disorders of Neutrophils
Neutrophilia (Fig. 11.1)
Leukemoid Reaction
Neutropenia (Agranulocytosis)
Eosinophilia (Fig. 11.2)
Basophilia
Monocytosis (Box 11.5)
Lymphocytosis
Lymphocytopenia
Leukoerythroblastic Reaction/Blood Picture
QUALITATIVE DISORDERS OF LEUKOCYTES
INFECTIOUS MONONUCLEOSIS (GLANDULAR FEVER)
Pathogenesis
Clinical Features
Laboratory Finding
DEFINITION
Etiology and Pathogenesis
Classification
FAB Classification of Acute Leukemias
WHO Classification (2016) of Acute Leukemia (Box 11.11)
Differences between Myeloblast and Lymphoblast (Table 11.14)
Cytochemistry in Leukemia
Uses
Myeloperoxidase
Sudan Black B
Nonspecific Esterase
Periodic Acid-Schiff Reaction
Neutrophil Alkaline Phosphatase
ACUTE LYMPHOBLASTIC LEUKEMIA/LYMPHOMA
Molecular Pathogenesis
Classification of Acute Lymphoblastic Leukemia (Box 11.10, 11.11 and Table 11.5)
Clinical Features
Laboratory Findings
Peripheral Blood
Cytochemistry of lymphoblasts
Immunophenotyping
Biochemical Findings
CSF Examination
ACUTE MYELOGENOUS LEUKEMIA
Molecular Pathogenesis
Clinical Features
Laboratory Findings
Peripheral Blood
Cytochemistry of Myeloblasts (Figs 11.10 and 11.11)
Immunophenotyping
Cytogenetics
MYELOID SARCOMA
INTRODUCTION
Classification
Clinical Features
Laboratory Findings
Bone Marrow Trephine Biopsy
INTRODUCTION
WHO Classification of MPN
Pathogenesis
POLYCYTHEMIA OR ERYTHROCYTOSIS
POLYCYTHEMIA VERA
Molecular Pathogenesis (Figs 11.16 and 11.17)
Clinical Features
Phases
Laboratory Findings
Peripheral Blood (Fig. 11.18)
Bone Marrow Biopsy
Other Findings
ESSENTIAL THROMBOCYTHEMIA
Etiology
Clinical Features
Laboratory Findings
PRIMARY MYELOFIBROSIS
Molecular Pathogenesis
Clinical Features
Laboratory Findings
Bone Marrow Biopsy
CHRONIC MYELOGENOUS LEUKEMIA
Definition
Etiology and Pathogenesis
Molecular Pathogenesis
Philadelphia (Ph) Chromosome (Fig. 11.19)
BCR-ABL1 Fusion Gene (Fig. 11.20)
Clinical Features
Natural History of Chronic Myeloid Leukemia
Chronic/Stable/Indolent Phase (CP)
Accelerated Phase (AP)
Blast Phase/Crisis (BP)
CHRONIC LYMPHOCYTIC LEUKEMIA
Definition
Etiology and Pathogenesis
Cytogenetic Abnormalities
Clinical Features
Laboratory Findings
Peripheral Blood
Immunophenotype
Lymph Node
HAIRY CELL LEUKEMIA
Definition
Laboratory Findings
Peripheral Blood
Bone Marrow Trephine Biopsy
Spleen
Immunophenotype and Molecular Characteristics
Clinical Features
DEFINITION
Characteristics of Plasma Cell Neoplasms
Classification of Plasma Cell Neoplasms (Box 11.15)
PLASMA CELL MYELOMA (MULTIPLE MYELOMA)
Definition
Etiology
Risk Factors
Laboratory Findings
Peripheral Blood
Serum Findings
Electrophoretic Studies on Serum and Urine (Figs 11.29 and 11.30)
Morphology of Organs Involved
Clinical Manifestations (Fig. 11.32)
Clinical Variants of Plasma Cell Myeloma
Asymptomatic (Smoldering) Plasma Cell Myeloma
Nonsecretory Myeloma
PLASMACYTOMA
IMMUNOGLOBULIN DEPOSITION DISEASE
Primary Amyloidosis
MONOCLONAL GAMMOPATHY OF UNCERTAIN SIGNIFICANCE (MGUS)
CLASSIFICATION OF LYMPHOID NEOPLASMS (BOX 11.16)
FOLLICULAR LYMPHOMA
Morphology
Gross
Microscopy
Clinical Features
DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL)
Microscopy
Immunophenotype
Cytogenetics and Molecular Profile
Clinical Features
BURKITT LYMPHOMA
Clinical Variants
Microscopy
Immunophenotype
Cytogenetic and Molecular Genetic Features (Fig. 11.37)
Translocations of c-MYCgene
MATURE T-CELL AND NK CELL NEOPLASMS
Peripheral T Cell Lymphoma (PTCL), NOS
Microscopy
Immunophenotype
Mycosis Fungoides
Microscopy
Sézary Syndrome
DEFINITION
CLASSIFICATION (BOX 11.17)
Cell of Origin and Immunophenotype
MORPHOLOGY OF NEOPLASTIC CELLS
CLASSICAL HODGKIN LYMPHOMA
Nodular Sclerosis Classical Hodgkin Lymphoma
Microscopy of NSCHL (Fig. 11.40)
Immunophenotype
Mixed Cellularity Classical Hodgkin Lymphoma (MCCHL)
Microscopy of MCCHL (Fig. 11.41)
Lymphocyte-rich Classical Hodgkin Lymphoma (LRCHL)
Microscopy of LRCHL (Fig. 11.42)
Lymphocyte-depleted Classical Hodgkin Lymphoma (LDCHL)
Microscopy of LDCHL (Fig. 11.43)
NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA (NLPHL)
Microscopy of NLPHL (Fig. 11.44)
ETIOLOGY AND PATHOGENESIS OF HODGKIN LYMPHOMA
Pathogenesis (Fig. 11.45)
LABORATORY FINDINGS
Spread
STAGING OF HODGKIN LYMPHOMA (TABLE 11.9)
DIFFERENCES BETWEEN HODGKIN LYMPHOMA AND NON-HODGKIN LYMPHOMA
INTRODUCTION
MORPHOLOGY
LABORATORY FINDINGS
CHAPTER 12:
Disorders of Hemostasis
NORMAL HEMOSTASIS
Primary Hemostatic Plug
Secondary Hemostatic Plug
Terminology used in Bleeding Disorders
CLASSIFICATION OF HEMOSTATIC DISORDERS (Box 12.1)
BLEEDING DISORDERS CAUSED BY VESSEL WALL ABNORMALITIES
BLEEDING DISORDERS DUE TO ABNORMALITIES OF PLATELET
Classification of Platelet Disorders (Box 12.3)
THROMBOCYTOPENIA
Clinical Features of Thrombocytopenia
Severity of Bleeding
Causes of Thrombocytopenia (Box 12.4)
IMMUNE THROMBOCYTOPENIC PURPURA
Types of Immune Thrombocytopenic Purpura (ITP)
Acute Immune Thrombocytopenic Purpura
Chronic Immune Thrombocytopenic Purpura
Laboratory Findings
Peripheral Blood
THROMBOCYTOSIS
QUALITATIVE PLATELET DISORDERS
INTRODUCTION
CLASSIFICATION OF COAGULATION DISORDERS (Box 12.7)
Hereditary Coagulation Disorders
Factor VIII–vWF Complex
HEMOPHILIA
HEMOPHILIA A (FACTOR VIII DEFICIENCY)
Mode of Inheritance (Fig. 12.4)
Molecular Genetics
Clinical Features
Laboratory Findings
Complications
Due to Hemophilia
Due to Therapy
HEMOPHILIA B (CHRISTMAS DISEASE, FACTOR IX DEFICIENCY)
Laboratory Findings
VON WILLEBRAND DISEASE (VWD)
Categories
Clinical Features
Laboratory Findings
ACQUIRED COAGULATION DISORDERS
Coagulation Factor Abnormalities
DISSEMINATED INTRAVASCULAR COAGULATION
Etiology
Pathogenesis (Fig. 12.5)
Thrombi/Clot Formation
Hemorrhagic Diathesis
Clinical Features
Laboratory Findings in DIC
Screening Assays
Confirmatory Tests
HYPERCOAGULABLE STATE (THROMBOPHILIA)
Inherited Hypercoagulable States
Clinical Presentation
Deficiency of Antithrombotic Factors
Antithrombin (AT) III Deficiency
Protein C and S Deficiency
Increased Prothrombotic Factors
Activated Protein C (APC) Resistance (Factor V Leiden)
ACQUIRED HYPERCOAGULABLE STATES
Antiphospholipid Antibody Syndrome (APLA/APS)
Types
Clinical Features
Laboratory Tests
CHAPTER 13:
Clinical Pathology
ANTICOAGULANTS
Double Oxalate
Type of Blood Sample
Collection of Blood
Complications Encountered During Blood Collection
HEMOGLOBIN ESTIMATION
COMPLETE BLOOD COUNTS (HEMOGRAM) (TABLE 13.4)
Various Parameters Obtained In Automated Cell Counters (Table 13.5)
PERIPHERAL BLOOD SMEAR EXAMINATION
Importance of Peripheral Smear Examination
Stains for Blood Smear
Romanowsky Stains
Hemoparasites
RETICULOCYTE COUNT
Methods of Reticulocyte Count
HEMATOCRIT (HCT)
Uses of Wintrobe Tube and Hematocrit
ERYTHROCYTE SEDIMENTATION RATE
Factors Affecting ESR (Box 13.1)
Stages of ESR
Methods
Westergren Method
Causes of Increased ESR (Table 13.8)
LE CELL TEST
BONE MARROW EXAMINATION
Bone Marrow Aspiration
Sites for Bone Marrow Aspirate
Dry Tap
Bone Marrow Trephine Biopsy
Sites of Trephine Biopsy
Indications for Trephine Biopsy (Box 13.4)
OSMOTIC FRAGILITY TEST
Principle
Interpretation
Use
LABORATORY EVALUATION OF HEMOSTATIC DISORDERS
Tests for Platelet Component
Platelet Count
Platelet Aggregation
Clot Retraction Test
Tests for Platelet and Vascular Component
Capillary Fragility Test (Hess Test/Tourniquet Test)
Bleeding Time
Tests for Coagulation Component
Coagulation or Clotting Time (Lee–White Method)
Quick's One Stage Prothrombin Time
Activated Partial Thromboplastin Time (Partial Thromboplastin Time)
URINE ANALYSIS
Methods of Collection
Preservation of Urine
Examination of Urine
Physical Examination
Volume
Color (Table 13.12)
Specific Gravity
Chemical Examination
Proteinuria
Test for Protein in Urine (Box 13.3)
Reducing Substances in Urine
Ketone Bodies
Bilirubin (Bile Pigment)
Urobilinogen
Bile Salts
Tests for Blood in Urine
Microscopic Examination
Organized Deposit
Unorganized Sediments
BODY FLUIDS
Specimen Collection
Examination of Body Fluids
Physical Examination
Chemical Examination
Microscopic Examination
Microbiological Examination
CEREBROSPINAL FLUID EXAMINATION
Sites
Method of Collection
Indications for Lumbar Puncture (Box 13.14)
Contraindications for Lumbar Puncture (Box 13.15)
Complications of Lumbar Puncture (Box 13.16)
Examination of CSF
Physical Examination
Microscopic Examination
Biochemical Evaluation
SEMEN ANALYSIS
Collection of the Sample
Examination of Semen
Physical Examination
Microscopic Examination
Tests for Antibody Coating of Spermatozoa
SPUTUM EXAMINATION
Indications for Sputum Examination
Sputum Collection
Examination of Sputum
Physical Examination
Microscopic Examination
BLOOD GROUP SYSTEM
ABO Blood Group System
ABO Antigens
ABO Antibodies
H Genes and H Antigens
Bombay Blood Group
ABO Grouping Technique
Rh Blood Group System
Rh (D) System
Rh (D) Typing Techniques
Importance of Blood Group
TRANSFUSION MEDICINE
Blood Transfusion
Donor Selection
Collection of Blood
Predonation Check-Up
Compatibility Testing (Pretransfusion Testing)
Cross-matching
Importance of Cross-matching
Types
Blood Components
Platelet Concentrate
Fresh Frozen Plasma (FFP)
Transfusion Reactions
LIVER FUNCTION TESTS
Liver Biopsy
Indications for Liver Biopsy
Contraindications
Complications
RENAL FUNCTION TESTS
THYROID FUNCTION TESTS
SECTION 3: SYSTEMIC PATHOLOGY
CHAPTER 14:
Vascular Disorders
ARTERIOSCLEROSIS
ATHEROSCLEROSIS
Risk Factors for Atherosclerosis
Modifiable Risk Factors in Ischemic Heart Disease (IHD)
Nonmodifiable/Constitutional Risk Factors
Additional Risk Factors
Pathogenesis of Atherosclerosis
Response-to-Injury Hypothesis (Figs 14.1A to E)
Clinicopathologic Manifestations of Atherosclerosis
ANEURYSMS AND DISSECTION
Classification
Pathogenesis of Aneurysms
Predisposition Factors
Abdominal Aortic Aneurysm
Causes
Morphology of Atherosclerotic Aneurysm
Clinical Features and Complications
Thoracic Aortic Aneurysms
Syphilitic Aneurysm
Aortic Dissection
Etiology
Pathogenesis
Classification (Fig. 14.6)
Complications due to Rupture
Classical Symptoms
Cause of Death
HYPERTENSIVE VASCULAR DISEASE
Causes of Hypertension (Box 14.1)
Regulation of Normal Blood Pressure
Factors Determining Blood Pressure
Pathogenesis of Hypertension
Mechanisms of Essential Hypertension
Consequences of Hypertension
Pathogenesis of Secondary Hypertension
Morphology of Vascular Changes in Hypertension
VASCULITIS
General Characteristics
Classification
Pathogenesis of Vasculitis
Noninfectious Vasculitis
Giant Cell (Temporal) Arteritis
Clinical Features
Polyarteritis Nodosa
Clinical Features
Wegener's Granulomatosis
Pathological Hallmarks
VASCULAR TUMORS
Hemangioma
Capillary Hemangioma
Cavernous Hemangioma
CHAPTER 15:
Heart Disorders
ISCHEMIC HEART DISEASE
Etiology and Pathogenesis of IHD
Decreased/Impaired Coronary Blood Flow
Increased Myocardial Demand
ANGINA PECTORIS
Variants of Angina Pectoris
Stable Angina
Prinzmetal Variant Angina
Unstable or Crescendo Angina
MYOCARDIAL INFARCTION
Risk Factors
Etiology
Coronary Atherosclerosis
Nonatheromatous Causes
Pathogenesis of MI
Consequence of Myocardial Ischemia
Classification of Myocardial Infarct
Reperfusion and its Effects on MI
Complication of Reperfusion
Diagnosis of Myocardial Infraction
Clinical Symptoms
Electrocardiographic Changes
Laboratory Findings
Complications of Myocardial Infarction
Chronic Ischemic Heart Disease
Sudden Cardiac Death
INFECTIVE ENDOCARDITIS
Classification
Etiology
Causative Organism
Predisposing Factors
Pathogenesis
Complications of Infective Endocarditis
Cardiac Complications
Extracardiac Complications
Clinical Features
Diagnostic Criteria for Infective Endocarditis (Box 15.2)
RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE
Incidence
Valves Affected
Etiology and Pathogenesis (Fig. 15.18)
Complications of Chronic Rheumatic Heart Disease
Clinical Features
Laboratory Findings
Course
CONGENITAL HEART DISEASE
Incidence
Etiology and Pathogenesis
Clinical Features
Classification (Box 15.3)
Left-to-right Shunt
Right-to-left Shunt
Obstructive Congenital Heart Disease
LEFT-TO-RIGHT SHUNTS
Atrial Septal Defect
Clinical Features
Ventricular Septal Defect
Classification
Clinical Features
Patent Ductus Arteriosus
Normal Function of Ductus Arteriosus
Patent (Persistent) Ductus Arteriosus (PDA)
Clinical Features
Patent Foramen Ovale
Normal Function of Foramen Ovale
Consequences of a Patent Foramen Ovale
RIGHT-TO-LEFT SHUNTS
Tetralogy of Fallot
Clinical Features
Transposition of the Great Arteries (TGA)
OBSTRUCTIVE CONGENITAL ANOMALIES
Coarctation of the Aorta (Aortic Coarctation)
Types
Clinical Features
CARDIOMYOPATHY
Definition
Etiology
Classification
CARDIAC MYXOMA
CHAPTER 16:
Lung Disorders
OBSTRUCTIVE LUNG DISEASES
Emphysema
Types of Emphysema/Classification (Fig. 16.1)
Etiology and Pathogenesis (Fig. 16.2)
Clinical Course
Other Forms of Emphysema
CHRONIC BRONCHITIS
Etiology
Pathogenesis
Role of Inflammation
Role of Infection
Clinical Features
Complications
ASTHMA
Characteristics
Classification (Box 16.1)
Common Types of Asthma
Atopic Asthma
Non-atopic Asthma
Drug-induced Asthma
Occupational Asthma
Etiology
Endogenous Risk Factors
Environmental Risk Factors: Asthma Triggers
Hygiene Hypothesis
Pathogenesis of Atopic Asthma (Fig. 16.6)
Major Etiological Factors in Atopic Asthma
Steps in Pathogenesis
Clinical Course
Diagnosis
BRONCHIECTASIS
Etiology
Nonobstructive (Postinflammatory) Bronchiectasis
Obstructive Bronchiectasis
Pathogenesis
Clinical Course
PULMONARY INFECTIONS
Causes
PNEUMONIA
Etiology
Factors Favoring Development of Pneumonia
Portal of Entry
Classification of Pneumonia (Box 16.2)
COMMUNITY-ACQUIRED ACUTE PNEUMONIAS
Causative Microorganisms (Table 16.1)
Predisposing Conditions
Pathogenesis
Classification of Bacterial Pneumonia
LOBAR PNEUMONIA
Complications of Pneumonia
Clinical Feature
Pneumocystis Pneumonia
Morphologic Features
Community: Acquired Viral Pneumonia
Etiology
Pathogenesis
Clinical Course
HOSPITAL-ACQUIRED PNEUMONIA
Etiology
LUNG ABSCESS
Etiology and Pathogenesis
Causative Organisms
Mechanism
Clinical Course
Complications
TUBERCULOSIS
Characteristics of Mycobacteria
Epidemiology
Infection Versus Disease
Mode of Transmission
Inhalation
Ingestion
Inoculation
Tuberculin (Mantoux) Test
Pathogenesis
Mechanism of Granuloma Formation in Tuberculosis (Fig. 16.17)
Primary Tuberculosis
Secondary Tuberculosis
Fate of Secondary Tuberculosis (Fig. 16.22)
Clinical Features
Diagnosis: Pulmonary Disease
SARCOIDOSIS
Etiology
Pathogenesis
Systemic Immunological Abnormalities
Lung
Lymph Nodes
Clinical Features
Prognosis
ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROME (DIFFUSE ALVEOLAR DAMAGE)
Etiology
Pathogenesis
Clinical Course
ATELECTASIS (COLLAPSE)
Significance
PNEUMOCONIOSES
Pathogenesis
Coal Workers’ Pneumoconiosis
Pathogenesis
Clinical Course
Silicosis
Pathogenesis
Clinical Course
Asbestosis and Asbestos—Related Diseases
Asbestos Use and Exposure
Asbestos Types
Pathogenesis
Pleural Plaques
Lung Cancer and Mesothelioma
Clinical Features
LUNG CARCINOMAS
Etiology and Pathogenesis
Tobacco Smoking
Industrial Hazards
Others
Molecular Genetics
Squamous Cell Carcinoma
Small Cell Carcinoma
Adenocarcinoma
Activation of Oncogenes
Classification (Box 16.5)
Squamous Cell Carcinomas
Adenocarcinoma
Neuroendocrine Tumors
Clinical Features
Secondary Changes due to Tumor
Spread of Tumor (Fig. 16.34 and Table 16.6)
Local Spread
Lymphatic Spread
Hematogenous Spread
Clinical Course
Investigations
Paraneoplastic Syndromes
Other Systemic Manifestations
METASTATIC TUMORS
Sources of Metastases to Lung
PLEURAL TUMOR
Malignant Mesothelioma
Etiology
Clinical Course
Spread
CHAPTER 17:
Oral Cavity and Salivary Gland Disorders
PRECANCEROUS LESIONS OF ORAL CAVITY
Leukoplakia and Erythroplakia
Leukoplakia
Erythroplakia
Features of Leukoplakia and Erythroplakia
Age and Gender
Hairy Leukoplakia
SQUAMOUS CELL CARCINOMA
Etiology
Risk Factors
Role of Oncogenic HPV Virus Infection
Inherited Genomic Instability
Pathogenesis
Spread
Verrucous Carcinoma
SALIVARY GLAND NEOPLASMS
Incidence
Classification of Salivary Glands Tumors (Table 17.1)
Clinical Presentation
PLEOMORPHIC ADENOMA
Site
Etiology
Clinical Features
Carcinoma Ex Pleomorphic Adenoma
WARTHIN TUMOR
MUCOEPIDERMOID CARCINOMA
Incidence
Etiology
CHAPTER 18:
Gastrointestinal Tract Disorders
ESOPHAGUS
Lacerations: Mallory-Weiss Tears
Barrett Esophagus
ESOPHAGEAL CANCER
Squamous Cell Carcinoma
Etiology
Spread
Adenocarcinoma
Etiology
Pathogenesis
STOMACH
Definitions
Classification of Gastritis (Box 18.1)
ACUTE GASTRITIS
Etiology
Pathogenesis
Clinical Features
Mucosal Disease Related To Stress
Types
Pathogenesis
Clinical Features
CHRONIC GASTRITIS
H. pylori Gastritis
Pathogenesis
Mechanism of Action
Microscopy
Demonstration of H. pylori
Diagnostic Tests for H. pylori
PEPTIC ULCER DISEASE
Normal Process in the Stomach
Damaging Forces
Defensive Forces
Pathogenesis of PUD/Acute or Chronic Gastritis
Direct Mucosal Injury/Increased Damage
Impaired Defense
Clinical Features
Complications of Gastric Ulcers
ZOLLINGER-ELLISON SYNDROME (ZES)
GASTRIC ADENOCARCINOMA
Epidemiology
Etiology and Pathogenesis
Risk Factors (Box 18.3)
Pathogenesis
Spread of Carcinoma Stomach
Clinical Features
GASTROINTESTINAL STROMAL TUMOR
Epidemiology
Pathogenesis
Clinical Features
Prognosis
MECKEL DIVERTICULUM
Complications
TYPHOID FEVER
Etiology
Pathogenesis (Fig. 18.14)
Clinical Features
Complications
Laboratory Diagnosis
Isolation of Bacilli
Other Tests
INTESTINAL TUBERCULOSIS
Primary Intestinal Tuberculosis
Mode of Infection
Secondary Intestinal Tuberculosis
Mode of Infection
Hyperplastic Cecal Tuberculosis
SHIGELLOSIS-BACILLARY DYSENTERY
Etiology
Pathogenesis
Clinical Features
Complications
AMEBIASIS
Etiology
Pathogenesis
Clinical Features
Amebic Liver Abscess (Fig. 18.21)
CARCINOID TUMOR
Sites of Carcinoid Tumors
Clinical Features
Carcinoid Syndrome (Fig. 18.23)
INFLAMMATORY BOWEL DISEASE
Epidemiology
Etiology and Pathogenesis
Genetic Factors
Environmental Factors
Host Factors
Psychosocial Factors
Hypothesis for Pathogenesis of IBD
CROHN DISEASE
Clinical Features
Intestinal Manifestations
Extraintestinal Manifestations
Laboratory Findings
Complications
ULCERATIVE COLITIS
Clinical Features
Intestinal Manifestations
Extraintestinal Manifestations
Complications
INTUSSUSCEPTION
Causes
POLYPS OF COLON
Classification of Polyps (Box 18.5)
Non-neoplastic Polyps
Inflammatory Polyps
Hamartomatous Polyps
Hyperplastic Polyps
Neoplastic Polyps
Classification of Neoplastic Polyps
Sessile Serrated Adenomas
Intramucosal Carcinoma
Polyposis Syndromes
Familial Adenomatous Polyposis
Hereditary Non-polyposis Colorectal Cancer (HNPCC)/Lynch Syndrome
COLORECTAL CANCER: ADENOCARCINOMA
Etiology
Dietary Factors
Protective Effect of Aspirin or Other NSAIDS
Adenoma-carcinoma Sequence
Hereditary Non-polyposis Colorectal Cancer (HNPCC)
Risk Factors
Pathogenesis
Genetic Pathways
Epigenetic Abnormalities (refer page 182-183)
Clinical Features
Methods of Investigation of Colon Cancer
Staging and Prognosis
Spread
ACUTE APPENDICITIS
Pathogenesis
Clinical Features
CHAPTER 19:
Hepatobiliary Disorders
BILIRUBIN METABOLISM AND BILE FORMATION (FIG. 19.1)
Bilirubin Production
Source of Bilirubin
Bilirubin Formation
Transport of Bilirubin/Bilirubin Binding
Hepatic Processing of Bilirubin
Intestinal Phase of Bilirubin Metabolism
Renal Excretion of Bilirubin
JAUNDICE
Mechanism of Jaundice
Classification of Jaundice
HEREDITARY HYPERBILIRUBINEMIAS (TABLE 19.2)
Crigler–Najjar Syndrome
Crigler–Najjar Syndrome Type I
Crigler–Najjar Syndrome Type II
Gilbert Syndrome
Dubin–Johnson Syndrome
Etiology
Clinical Features
Rotor Syndrome
VIRAL HEPATITIS
Cause
Hepatitis A Virus
Mode of Transmission
Outcome of HAV Infection
Laboratory and Serological Findings for HAV Hepatitis
Diagnosis (Fig. 19.2)
Prophylaxis
Hepatitis B Virus (HBV)
Structure of HBV
Genome of HBV
Mode of Transmission
Sequelae/Outcome of HBV Infection (Fig. 19.4)
Sequence of Serological Markers for HBV Hepatitis
Prevention
Hepatitis C Virus
Sequelae/Outcome of HCV Infection
Hepatitis D Virus
Patterns of HDV Hepatitis
Outcome of HDV Infection
Serological Markers of HDV
Hepatitis E Virus
Outcome of HEV Infection
Diagnosis of HEV
Clinical Features
Acute Asymptomatic Acute Infection with Recovery
Acute Hepatitis
Fulminant Hepatitis
Carrier State in HBV
Factors Determining Carrier State
Types of Carriers
Morphology
Morphology of Acute and Chronic Hepatitis
Acute Hepatitis
CHRONIC HEPATITIS
Fulminant Hepatic Failure
Causes
Pathogenesis
ALCOHOLIC LIVER DISEASE
Metabolism of Ethanol (Fig. 19.12)
Formation of Acetaldehyde
Formation of Acetic Acid
Etiology of Alcoholic Liver Disease
Risk Factors
Pathogenesis of Alcoholic Liver Disease
Mechanisms of Liver Injury by Ethanol (Fig. 19.13)
Mechanisms of Fibrosis/Cirrhosis (Fig. 19.14)
Mechanisms of Steatosis in Chronic Alcoholism (refer Fig. 1.13)
Alcoholic Cirrhosis
Clinical Features
Hepatic Steatosis (Fatty Liver)
Alcoholic Hepatitis
Alcoholic Cirrhosis
Laboratory Diagnosis of Alcoholic Liver Disease
CIRRHOSIS
Morphological Characteristics
Fibrosis
Regenerating Nodules
Loss of Architecture
Classification
Morphological Classification (Fig. 19.19)
Etiological Classification
Pathogenesis
Clinical Features
PORTAL HYPERTENSION
Causes of Portal Hypertension
Pathogenesis of Portal Hypertension in Cirrhosis
Consequences of Portal Hypertension
Ascites
Portosystemic Shunts/Varices and Variceal Hemorrhage
Splenomegaly and Hypersplenism
Endocrine Complications are Associated with Cirrhosis
In Men
In Women
HEMOCHROMATOSIS
Classification of Iron Overload
Pathogenesis
Mechanism of Tissue Damage
Organ/Tissues Involved
Morphology of Liver
Clinical Features
WILSON'S DISEASE
Etiology
Organs Involved
Clinical Features
Biochemical Findings
BILIARY CIRRHOSIS
Classification
Secondary Biliary Cirrhosis
Etiology
Primary Biliary Cirrhosis (PBC)
Etiology and Pathogenesis
Laboratory Findings
Clinical Features
LIVER ABSCESSES
General Features
Etiology
Clinical Features
Amebic Liver Abscess
MALIGNANT TUMORS OF LIVER
Hepatoblastoma
Hepatocellular Carcinoma (HCC)
Etiopathogenesis
Molecular Basis of HCC
Precursor lesions of HCC
Spread
Fibrolamellar HCC
Clinical Features of HCC
Laboratory Findings—Serum Marker
Cause of Death
CHOLANGIOCARCINOMA (CCA)
Risk Factors
Classification
METASTATIC TUMORS
Clinical Features
ACUTE CHOLECYSTITIS
Types
Pathogenesis
Acute Calculous Cholecystitis
Acute Acalculous Cholecystitis
Complications
Clinical Features
CHRONIC CHOLECYSTITIS
CHOLELITHIASIS (GALLSTONES)
Classification of Gallstones
Depending on the Chemical Composition
Depending on the Location
Risk Factors for Cholesterol Stones (Box 19.6)
Pathogenesis of Cholesterol Stones (Fig. 19.30)
Cholesterol Supersaturation
Gallbladder Hypomotility
Nucleation and Precipitation of Cholesterol Monohydrate Crystals
Growth to Stone-sized Aggregates
Pathogenesis of Pigment Stones
Black Pigment Stones
Brown Pigment Stones (Fig. 19.31)
Clinical Features
Complications
In the Gallbladder
In the Bile Ducts
In the Intestine
CARCINOMA OF THE GALLBLADDER
Etiology
Risk Factor
Molecular Genetics
Spread
Clinical Features
CHAPTER 20:
Pancreatic Disorders
ACUTE PANCREATITIS
Etiology
Pathogenesis (Fig. 20.3)
Clinical Features
Laboratory Findings
Complications of Acute Pancreatitis (Table 20.1)
CHRONIC PANCREATITIS
Etiology
Pathogenesis (Fig. 20.4)
Obstruction Theory
Necrosis-fibrosis Theory
Toxic-metabolic Theory
Oxidative Stress Theory
Profibrogenic Chemokines
Clinical Features
PSEUDOCYST OF PANCREAS (FIG. 20.5)
Complications
PANCREATIC CARCINOMA
Precursors to Pancreatic Cancer (Pancreatic Intraepithelial Neoplasias)
Molecular Carcinogenesis (Fig. 20.6)
Etiology, and Pathogenesis
Spread
Clinical Features
Laboratory Findings
DIABETES MELLITUS
Diagnosis (Table 20.2)
Classification
TYPE 1 DIABETES
Cause
Pathogenesis of Type 1 Diabetes Mellitus (Fig. 20.8)
Mechanisms of β-Cell Destruction
TYPE 2 DIABETES
Pathogenesis of Type 2 Diabetes Mellitus (Fig. 20.9)
Metabolic Defects in Type 2 Diabetes
PATHOGENESIS OF THE COMPLICATIONS OF DIABETES
Hyperglycemia
Organ Damage by Hyperglycemia
Effects Hyperglycemia
Clinical Features of Diabetes (Fig. 20.11)
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Complications (Fig. 20.12)
CHAPTER 21:
Kidney and Urinary Tract Disorders
INTRODUCTION
Glomerulus (Figs 21.2 to 21.4)
Clinical Manifestations of Renal Diseases (Table 21.1)
GLOMERULAR DISEASES
Clinical Manifestations
Histological Alterations
Increased Cellularity (Hypercellularity)
Basement Membrane Thickening
Hyalinosis and Sclerosis
PATHOGENESIS OF GLOMERULAR INJURY (Fig. 21.5)
ANTIBODY-MEDIATED INJURY
In Situ Antibodies
In Situ Antibodies against Fixed Antigen (Fig. 21.5)
In Situ Antibodies against Planted Antigens (Fig. 21.5)
Circulating Immune Complex Glomerulonephritis
NEPHRITIC SYNDROME
Acute Proliferative Glomerulonephritis
POSTSTREPTOCOCCAL (POSTINFECTIOUS) GLOMERULONEPHRITIS
Etiology and Pathogenesis
Evidences to Support Immunological Basis
Mechanism of Damage
Clinical Course
Laboratory Findings
Prognosis
Nonstreptococcal Acute Glomerulonephritis (Postinfectious Glomerulonephritis)
RAPIDLY PROGRESSIVE (CRESCENTIC) GLOMERULONEPHRITIS
Classification
Type I (Anti-GBM Antibody)
Type II (Immune Complex)
Type III (Pauci-immune)
Pathogenesis
GOODPASTURE SYNDROME
Pathogenesis
Clinical Course
NEPHROTIC SYNDROME
Pathophysiology (Fig. 21.13)
Major Complications of Nephrotic Syndrome
Causes of Nephrotic Syndrome (Table 21.2)
MEMBRANOUS NEPHROPATHY (MEMBRANOUS GLOMERULOPATHY)
Etiology
Pathogenesis
Mechanism of Glomerular Injury
Clinical Features
MINIMAL-CHANGE DISEASE
Etiology and Pathogenesis
Mechanism of Proteinuria
Clinical Features
FOCAL SEGMENTAL GLOMERULOSCLEROSIS
Classification
Pathogenesis
Clinical Course
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS
Etiology
Pathogenesis of MPGN
Clinical Features
DENSE DEPOSIT DISEASE
Pathogenesis
Clinical Features
DIFFERENCES BETWEEN NEPHRITIC AND NEPHROTIC SYNDROME (TABLE 21.3)
CHRONIC GLOMERULONEPHRITIS
Clinical Course
GLOMERULAR LESIONS ASSOCIATED WITH SYSTEMIC DISEASES
Lupus Nephritis
DIABETIC NEPHROPATHY
Pathogenesis
Diabetic Nephropathy—Renal Changes in Diabetes
Amyloidosis
PYELONEPHRITIS AND URINARY TRACT INFECTION
Classification of Urinary Tract Infections
PYELONEPHRITIS
Classification of Pyelonephritis
Acute Pyelonephritis
Etiology and Pathogenesis (Fig. 21.25)
Complications
Clinical Features
Urinary Findings
Chronic Pyelonephritis and Reflux Nephropathy
Xanthogranulomatous Pyelonephritis
Clinical Features
BENIGN NEPHROSCLEROSIS
Causes
Pathogenesis
Clinical Features
MALIGNANT HYPERTENSION AND ACCELERATED NEPHROSCLEROSIS
Pathogenesis
Clinical Features
HORSESHOE KIDNEYS
CYSTIC DISEASES OF THE KIDNEY
Classification of Renal Cystic Disease (Box 21.6)
Genetics and Pathogenesis
Clinical Features
Autosomal Recessive (Childhood) Polycystic Kidney Disease
Etiology
Features of ARPKD
ACUTE KIDNEY INJURY
Causes of Acute Kidney Injury (Box 21.7)
Pathogenesis (Fig. 21.33)
1. Injury to the Tubular Epithelial Cells
2. Disturbances in Blood Flow
Clinical Course
1. Initiation Phase
2. Maintenance Phase
3. Recovery Phase
URINARY TRACT OBSTRUCTION (OBSTRUCTIVE UROPATHY)
Hydronephrosis
Causes (Fig. 21.37)
Pathogenesis
Clinical Features
Urolithiasis (Renal Calculi, Stones)
Etiology
Pathogenesis of Renal Stones
General Features of Renal Stones
Types of Renal Stones (Box 21.8)
1. Calcium Stones (Oxalate Calculus/Calcium Oxalate)
2. Struvite Stones or (Triple stones/Magnesium, Ammonium, Phosphate Stones)
3. Uric Acid and Urate Stones
4. Cystine Stones
Clinical Features of Renal Stones
Complications of Renal Stones
MALIGNANT TUMORS OF THE KIDNEY
Renal Cell Carcinoma (Adenocarcinoma of the Kidney, Hypernephroma, Grawitz Tumor)
Etiology
Types
Classification of Renal Cell Carcinoma (Fig. 21.40)
Clinical Features
Spread
Wilms Tumor (Nephroblastoma)
Pathogenesis and Genetics
Clinical Features
Spread
Prognosis
UROTHELIAL TUMORS
Precursor Lesions
Epidemiology
Pathogenesis
Clinical Course of Bladder Cancer
CHAPTER 22:
Male Genital Tract Disorders
CARCINOMA IN SITU (CIS)
Bowen Disease
Bowenoid Papulosis
INVASIVE CARCINOMA
Etiology
Clinical Features
BENIGN PROSTATIC HYPERPLASIA OR NODULAR HYPERPLASIA
Etiology and Pathogenesis (Fig. 22.3)
Role of Androgen
Clinical Features
Complications (Fig. 22.6)
ADENOCARCINOMA OF PROSTATE
Etiology and Pathogenesis
Factors Involved in Carcinoma of Prostate
Somatic Mutation in Prostate Cancer
Prostatic Intraepithelial Neoplasia (PIN)
Spread
Grading and Staging
Gleason Grading
Staging of Prostatic Cancer
Clinical Course
Tumor Markers
Prostate-specific Antigen (PSA)
Prostatic Acid Phosphatase (PAP)
TESTICULAR TUMORS
Classification (Box 22.1)
GERM CELL TUMORS
Etiology and Pathogenesis
Classification
Intratubular Germ Cell Neoplasia (ITGCN)
SEMINOMA
Classification
Classical Seminoma
Spread
Prognosis of Seminoma
Anaplastic Seminoma
Spermatocytic Seminoma
Prognosis
NONSEMINOMATOUS GERM CELL TUMORS
Embryonal Carcinoma
Teratoma
Prognosis of Teratoma
Mixed Tumors
Clinical Features
Spread of Testicular Tumors
Tumor Markers (Table 22.2)
CHAPTER 23:
Female Genital Tract Disorders
WHO (2014) CLASSIFICATION OF TUMORS OF UTERINE CERVIX (Box 23.1)
CERVICAL INTRAEPITHELIAL NEOPLASIA (SQUAMOUS INTRAEPITHELIAL LESIONS)
Etiology and Pathogenesis of CIN and Carcinoma of Cervix
Human Papillomavirus Infection
Environmental Factors
Classification of Cervical Precancers (Fig. 23.2)
Carcinoma In Situ (CIS) System
Cervical Intraepithelial Neoplasia Classification
Squamous Intraepithelial Lesion
INVASIVE CARCINOMA OF CERVIX
Etiology and Pathogenesis (Refer Pages 203-204 and 658–660)
Spread of Carcinoma Cervix
Clinical Features
Cervical Cancer Screening
Cytologic Screening by Pap Smear Examination
Histologic Diagnosis and Removal of Precancerous Lesions
Cervical Cancer Prevention
MENSTRUAL CYCLE
ENDOMETRIOSIS
Pathogenesis
Clinical Features
Consequences
ADENOMYOSIS
Etiology and Pathogenesis
Clinical Features
WHO (2014) Classification of Tumors of Uterine Corpus (Box 23.3)
ENDOMETRIAL HYPERPLASIA
Etiology
Classification
Old Classification
World Health Organization (WHO) 2014 Classification
CARCINOMA OF THE ENDOMETRIUM
Molecular Pathogenesis
Type I Carcinomas (Endometrioid Cancers)
Type II Serous Carcinomas
Clinical Features of Endometrial Carcinoma
Malignant Mixed Müllerian Tumors (MMMTs)
LEIOMYOMAS
Molecular Changes
Clinical Features
OVARIAN TUMORS
WHO Classification of Ovarian Neoplasms
TUMORS OF SURFACE (MÜLLERIAN) EPITHELIUM
Classification
Histological Types
Biological Behavior
Pattern of Growth and Amount of Fibrous Stroma
Serous Tumors
Age Group
Molecular Pathogenesis
Spread of Ovarian Serous Carcinoma
Mucinous Tumors
Incidence
Molecular Pathogenesis
Spread of Mucinous Carcinoma
Endometrioid Tumors
Pathogenesis
Brenner Tumor
Clinical Presentation of Surface Epithelial Tumors
Biochemical Markers of Surface Epithelial Tumors
GERM CELL TUMORS
Teratomas
Origin
Sites
Classification
Mature (Benign) Teratomas
Immature Malignant Teratomas
Monodermal Teratomas and Somatic type Tumors Arising from a Dermoid Cyst
Dysgerminoma
Spread
Endodermal Sinus (Yolk Sac) Tumor
Nongestational Choriocarcinoma
Other Germ Cell Tumors
SEX CORD-STROMAL TUMORS
Granulosa-Theca Cell Tumors
Clinical Features
Fibromas, Thecomas, and Fibrothecomas
Clinical Features
METASTATIC TUMORS
Source of Primary Tumor
Krukenberg Tumors
GESTATIONAL TROPHOBLASTIC DISEASE
Classification (Box 23.5)
Hydatidiform Mole
Risk Factors
Types
Clinical Features
Invasive Mole
Choriocarcinoma
Types
Clinical Features
CHAPTER 24:
Breast Disorders
FEMALE BREAST
MICROSCOPY
BENIGN EPITHELIAL LESIONS
Nonproliferative Breast Changes (Fibrocystic Changes)
Proliferative Breast Disease without Atypia
Proliferative Breast Disease with Atypia
Clinical Significance of Benign Epithelial Changes (refer Box 24.1)
CARCINOMA OF THE BREAST
Etiology
Risk Factors (Fig. 24.3)
Pathogenesis (Fig. 24.4)
Familial/Hereditary Breast Cancer
Sporadic Breast Cancer
Molecular Carcinogenesis
Classification of Breast Carcinoma
Histological Classification (Box 24.2)
PRECURSOR LESIONS/NONINVASIVE CARCINOMA
Classification
Ductal Carcinoma in Situ (DCIS; Intraductal Carcinoma)
Lobular Carcinoma in Situ (LCIS)
Molecular Changes
INVASIVE (INFILTRATING) CARCINOMA
Classification of Invasive Carcinoma
Morphological Classification (refer Box 24.2)
Molecular Classification
Common Features
Invasive (Infiltrating) Carcinoma, No Special Type (NST); Invasive Ductal Carcinoma
Special Histologic Types of Invasive Carcinoma
Medullary Carcinoma
Mucinous (Colloid) Carcinoma
Tubular Carcinoma
Invasive Lobular Carcinoma
Clinical Patterns
Inflammatory Carcinoma
PAGET DISEASE OF THE NIPPLE
Clinical Presentation
SPREAD OF BREAST CARCINOMA
PROGNOSTIC AND PREDICTIVE FACTORS (TABLE 24.3)
Prognostic Factors Related to Extent of Carcinoma
Prognostic Factors Related to the Underlying Biology of the Cancer
STROMAL/FIBROEPITHELIAL TUMORS
Fibroadenoma
Phyllodes Tumor
Recurrence
MALE BREAST
Gynecomastia
Etiology and Pathogenesis
Clinical Features
CHAPTER 25:
Endocrine Disorders
THYROIDITIS
Hashimoto Thyroiditis
Etiology
Pathogenesis (Fig. 25.1)
Clinical Course
Subacute (Granulomatous) Thyroiditis
Etiology and Pathogenesis
Clinical Course
Riedel Thyroiditis
THYROTOXICOSIS
Causes of Thyrotoxicosis (Box 25.2)
Thyrotoxicosis Associated with Hyperthyroidism
Thyrotoxicosis not Associated with Hyperthyroidism
Clinical Manifestations of Hyperthyroidism
Diagnosis of Hyperthyroidism
GRAVES’ DISEASE
Triad of Clinical Findings
Etiology
Genetic Factor
Pathogenesis (Fig. 25.4)
Autoantibodies in Graves’ Disease
Infiltrative Ophthalmopathy
Clinical Features
Laboratory Findings in Graves’ Disease
DIFFUSE AND MULTINODULAR GOITERS
Diffuse Nontoxic (Simple) Goiter
Etiology
Clinical Course
Laboratory Findings
Multinodular Goiter
Evolution of Multinodular Goiter
Clinical Course
NEOPLASMS OF THE THYROID
Follicular Adenomas
Pathogenesis
Clinical Features
Investigations
CARCINOMAS
Major Subtypes
Pathogenesis of Thyroid Carcinomas
Origin
A. Genetic Factors (Fig. 25.11)
B. Environmental Factors
Papillary Carcinoma
Clinical Course
Follicular Carcinoma
Etiology
Anaplastic (Undifferentiated) Carcinoma
Spread
Clinical Course
Medullary Carcinoma
Types
Clinical Course
NEUROBLASTIC TUMORS
Neuroblastoma
Spread of Tumor
Clinical Course
Laboratory Finding
Prognostic Factors
Pheochromocytoma
Rule of 10s
Etiology
Spread
Clinical Course
CHAPTER 26:
Skin Disorders
MELANOCYTIC NEVUS (PIGMENTED NEVUS, MOLE)
Clinical Presentation
MELANOMA
Etiology and Pathogenesis
Predisposing Factors
Clinical Features
Prognostic Factors (Table 26.1)
Sentinel Lymph Node Biopsy
PREMALIGNANT AND MALIGNANT EPIDERMAL TUMORS
Actinic Keratosis
Squamous Cell Carcinoma
Etiology and Pathogenesis
Basal Cell Carcinoma
Etiology and Pathogenesis
Clinical Presentation
CHAPTER 27:
Bone and Joint Disorders
HEALING OF A FRACTURE
Phases of Fracture Healing (Fig. 27.1)
Inflammatory Phase
Reparative Phase
Remodeling Phase
Major Causes of Delayed Fracture Healing (Table 27.1)
Complications of Healing
INFECTIONS—OSTEOMYELITIS
Classification
Pyogenic Osteomyelitis
Etiology
Portal of Entry of Organism
Pathogenesis and Morphology (Fig. 27.2)
Complications
Clinical Course
Tuberculous Osteomyelitis
Clinical Course
Complications
BONE TUMORS
Classification of Bone Tumors (Table 27.2)
Osteochondroma
Clinical Features
Osteosarcoma
Pathogenesis
Classification
Surface Osteosarcoma
Clinical Course
Radiological Appearance
Spread
Giant-cell Tumor
Radiological Appearance
Clinical Course
Spread
Chondrosarcoma
Classification
Radiological Appearance
Clinical Features
Ewing Sarcoma/Primitive Neuroectodermal Tumor
Categories
Etiology and Pathogenesis
Radiographic Appearance
Clinical Features
Spread
OSTEOARTHRITIS
Types
Pathogenesis and Morphology (Fig. 27.11)
Chondrocyte Injury
Changes in the Articular Cartilage
Changes in the Subchondral Bone
Clinical Features
RHEUMATOID ARTHRITIS
Etiology
Pathogenesis (Fig. 27.12)
Clinical Course
Laboratory Findings
GOUT AND GOUTY ARTHRITIS
Classification (Box 27.1)
Etiology
Pathogenesis
Acute Arthritis
Chronic Arthritis
Clinical Course
CHAPTER 28:
Central Nervous System Disorders
CEREBROVASCULAR DISEASES
Pathogenic Mechanism
Effects of Cerebrovascular Diseases
Classification of Infarcts
Clinical Features
INTRACRANIAL HEMORRHAGE
Epidural Hemorrhage
Subdural Hemorrhage
Subarachnoid Hemorrhage and Ruptured Saccular Aneurysms
Causes
Saccular Aneurysms
Pathogenesis
Clinical Features
Intracerebral (Intraparenchymal) Hemorrhage (Fig. 28.2)
MENINGITIS
Causes
Acute Pyogenic (Bacterial/Purulent) Meningitis
Etiology
Complications of Bacterial Meningitis
Clinical Features
Acute Aseptic (Viral) Meningitis
CSF Findings
Chronic Meningitis
Types
Tuberculous Meningitis
Tuberculoma
Neurosyphilis
TUMORS OF CNS
GLIOMAS
Astrocytoma
Diffusely Infiltrating Astrocytomas
Molecular Genetics
Pilocytic Astrocytoma (Grade I/IV)
Oligodendroglioma (WHO Grade II/IV)
Molecular Genetics
Ependymoma
Sites
Embryonal Tumors
Medulloblastoma
Molecular Genetics
MENINGIOMAS
Molecular Genetics
Clinical Features
METASTATIC TUMORS
Bibliography
Appendices
INDEX
TOC
Index
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