OXFORD HANDBOOK OF CLINICAL PATHOLOGY PDF

adminComment(0)

OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Clinical Pathology Published and forthcoming Oxford Handbooks Oxford Handbook for the Foundation. The Oxford Handbook of Clinical Pathology is an accessible and easy-to-use resource, which explains the pathology behind important and common diseases . handbook of clinical pathology oxford medical handbooks, but end up in Oxford Handbook of Clinical Pathology PDF - If you found this book helpful then.


Oxford Handbook Of Clinical Pathology Pdf

Author:MORIAH SKIVER
Language:English, German, Portuguese
Country:Morocco
Genre:Biography
Pages:458
Published (Last):20.10.2015
ISBN:363-7-33772-928-6
ePub File Size:21.72 MB
PDF File Size:10.38 MB
Distribution:Free* [*Registration needed]
Downloads:50554
Uploaded by: ROBBY

Oxford Handbook Of Clinical Pathology. Oxford Handbook of Clinical Medicine Pdf features contents. The features are: Symbols and abbreviations, Thinking. Download the Medical Book: Oxford Handbook of Clinical Pathology For Free. This Website we Provide Free Medical Books for all Students. Download the Medical Book: Oxford Handbook of Clinical Pathology For Free. Oxford Handboook of Clinical Pathology pdf Medical Surgical Nursing, Medical.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging-in-Publication Data Carton, James.

ISBN —0—19——3 alk. Handbook of clinical pathology. Oxford handbooks. Pathology, Clinical—methods—Handbooks. The handbook covers both general and systems-based pathology with each topic occupying either a single- or double-page spread.

A uniform sequence of headings is followed for each topic to allow easy access to the facts. Although aimed primarily at medical students, this handbook should also be useful for postgraduate doctors working in specialties with close links to pathology.

Feedback on errors and omissions would be much appreciated. Please post your comments via the OUP website www. Finally, thank you to all the wonderful staff at OUP: Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations.

The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Diseases whose aetiology is unknown are described as idiopathic, cryptogenic, or essential. Acute illnesses are of rapid onset. Chronic conditions usually have a gradual onset and are more likely to have a prolonged course. This is typically seen in the brain following cerebral infarction. It may be seen in many conditions, but is most commonly associated with tuberculosis.

Toes deprived of blood in critical leg ischaemia usually show dry gangrene b p. Fas or TNF-A extrinsic pathway or through cellular injury intrinsic pathway.

This can only occur if the connective tissue framework of the tissue is not disrupted and if the tissue is capable of regeneration.

Although the structural integrity is maintained, there is loss of function of the tissue that is scarred. Decay accelerating factor disrupts binding to C3b to cell surfaces and membrane co-factor protein breaks down C3b. The remainder are doomed to die by apoptosis in the germinal centre. T-lymphocytes activated by antigen-presenting cells proliferate and express genes appropriate to their actions.

In its most severe form, it can lead to anaphylactic shock b p. The word is often used synonymously with the word tumour which simply means a swelling. Although benign neoplasms usually run an innocuous course, they can be dangerous if they compress vital nearby structures or if the neoplasm secretes hormones uncontrollably.

Carcinomas showing squamous differentiation are called squamous cell carcinomas. Carcinomas showing glandular differentiation are called adenocarcinomas. HPV in cervical carcinoma. Oncogenes code for proteins with key roles in growth- stimulating cell signalling pathways. Some only grow in the absence of oxygen strict anaerobes. Some viruses also have an outer lipid membrane acquired from the host cell they formed in.

HPV in cervical carcinoma b p. Mycelia produce spores. Plasmodium, Leishmania, Toxoplasma. Giardia, Trichomonas. Aciclovir triphosphate is incorporated into viral DNA and terminates chain replication. Lymphomas are usually of diffuse large B-cell type b p. Plasmodium P. Poor prognostic signs include high levels of parasitaemia, hypoglycaemia, disseminated intravascular coagulation DIC , and renal impairment.

An infected mosquito injects sporozoites into blood which home to the liver and multiply in hepatocytes, forming merozoites. Merozoites released into blood infect red blood cells and multiply again, rupturing the red cells and infecting more red cells. Some merozoites mature into gametocytes which newly infect a mosquito, completing the life cycle.

The chancre occurs at the point of contact and is usually genital or perianal. There may be mild regional lymph node enlargement. Serology is often negative at this stage. Many patients do not present with or recall the rash. Mexicana, usually present with a single nodule which ulcerates and heals with scarring.

Exposure of the highly thrombogenic lipid core to the blood causes an acute ischaemic event in the organ that artery is supplying Fig. Prognosis 1 Shock is a serious condition which leads to the development of multiple organ failure if not rapidly addressed.

Common sites of impaction are the popliteal artery, common femoral artery, and aortic bifurcation. The intima is placed under stress and tears, allowing blood to track into the media and dissect along it.

These enzymes are known to degrade elastin. Most are discovered incidentally on abdominal examination or imaging. Complications 3 Pulmonary thromboembolism b p. There remains, however, a risk of infective endocarditis.

This form is often not recognized until adult life. Rupture of the free wall of the infarcted ventricle causes haemopericardium with rapid cardiac tamponade and death. Thrombus forming over the akinetic myocardium can detach and give rise to systemic emboli. Bicuspid aortic valves calcify at a younger age. Myocyte disarray refers to the loss of the normal parallel arrangement of myocytes which, instead, adopt haphazard oblique organizations.

Thrombus formation over the akinetic myocardium can cause systemic emboli. The disease process usually starts in the epicardial region and works its way towards the endocardial surface.

Major systemic embolic events are also common; septic emboli can travel to multiple organs and cause abscesses. There are no normal alveoli. The recurrence risk is highest with the inverted type. Fungal hyphae can be highlighted within the material with special stains. Prognosis for sinus tumours is less favourable. The most common histological type is adenoid cystic carcinoma. There is a well-recognized association with occupational exposure, particularly in wood workers.

The lesion is covered by an intact sinonasal epithelium. Amyloid stains with Congo Red and demonstrates chromatic changes under polarized light.

Increased ventilation removes any excess carbon dioxide, but cannot compensate for the low pO2. Transfer of both oxygen and carbon dioxide is impaired so pCO2 is raised in addition to the low pO2.

There is obvious respiratory distress with hyperventilation. By contrast, the clinical picture may be surprisingly undramatic despite the low pO2 levels due to compensatory mechanisms.

Many cases prove to be idiopathic. Initially, common bacteria colonize the lungs, but eventually Pseudomonas aeruginosa often becomes the dominant organism. Dizziness and syncope are also common.

Gram-negative bacteria, e. Klebsiella, Escherichia coli, Pseudomonas. Bacterial colonies are often visible within the exudate. These are more likely with virulent organisms or in patients with coexisting heart and lung disease. The normal interstitium is thin and contains pulmonary artery capillaries. Resolution occurs within 12—18h after exposure ceases. The mitotic count is high and necrosis is often extensive. Regional lymph nodes N N0: It is thought to be due to the rupture of small delicate apical blebs of lung tissue which result from stretching of the lungs.

Rare conditions often associated with pneumothorax include pulmonary Langerhans cell histiocytosis, pulmonary lymphangioleiomyomatosis, and thoracic endometriosis. The continuous build-up of pressure and volume in the pleural space displaces mediastinal structures, causing cardiorespiratory arrest tension pneumothorax.

Patients with an underlying lung disease will usually notice a worsening in their symptoms. Cystic change may be seen. Perineural invasion is very frequently seen. Most prevalent in adult white males, but can occur in men and women of all races and in children. Encrusted golden brown iron pigment may be seen in cases caused by iron tablets.

If untreated, it can lead to severe oesophageal strictures. Regional lymph nodes N pN0: Yellow-brown iron pigment may be seen. Pyloric and intestinal type metaplasia is common. High salt intake is a strong risk factor whilst fresh fruit and vegetables are protective due to their antioxidant effects.

The surface epithelium typically shows areas of gastric metaplasia. Susceptible individuals, particularly children, are at risk of developing thrombotic microangiopathy, leading to haemolysis and acute renal failure haemolytic uraemic syndrome. CMV inclusions are found in endothelial and stromal cells. Surface erosions and ulceration may be present. Poorly formed granulomas may be seen, but these are generally uncommon. Lymphoid aggregates are present in the submucosa and muscular layers.

Poorly formed granulomas may be seen. Some tumours, particularly in the distal colon, form circumferential stenosing lesions.

The vast majority of cases are seen in the sigmoid colon. Only a thin coating of longitudinal muscle separates the diverticulum from the pericolic fat. Clues to a viral aetiology may be present, however, e.

Three patterns of disease are recognized: Jaundice may occur if there is marked loss of liver function. Background steatosis and hepatitis may not be present.

The macrophages may coalesce into clusters and form granulomas. Usually, the entire biliary tree is affected, but occasionally, only small interlobular bile ducts are affected small duct primary sclerosing cholangitis [PSC].

Laboratory Handbook of Dermatophytes A Clinical Guide and Laboratory Handbook of PDF

Biliary stasis also promotes infection and stone formation. Advanced disease causes a cirrhotic liver with bile staining. Fibrotic biliary strictures may be apparent in the major bile ducts. There is a biliary pattern of cirrhosis with large irregular jigsaw-like nodules of hepatocytes. If the biopsy is taken from an area unaffected by the primary disease, but distal to a large duct stricture, the liver shows features of duct obstruction i.

Large vessels are often present within the lesion, but portal tracts are absent. Most lesions have a characteristic central scar. Large thick-walled vessels are very often present and a helpful diagnostic clue. Inspissated bile may be present within the ductules.

Bile is not present in the ductules. Bile production may be seen by the tumour. As this duct drains into the duodenum via the smaller minor papilla, there is a tendency to stasis of pancreatic secretions and susceptibility to pancreatitis. The endocrine tissue is typically spared until late in the disease. Large ducts are dilated and contain inspissated secretions. Patients often have raised serum IgG4 levels.

This variant is thought to be autoimmune in nature. Treatment is supportive only and most patients will have other alcohol-related pathology. Tumours may be functioning or non-functioning, depending on whether a syndrome of inappropriate hormone secretion is present. Uncertain behaviour: The epithelial cells may show a range of atypia from low to high grade.

Invasive carcinoma can arise within this lesion. The cysts do not communicate with the pancreatic ductal system. The epithelial component may show a range of atypia from low to high grade. Invasive carcinomas can arise within these lesions. Histologically, the small cysts are lined by cuboidal cells with a round nucleus and clear cytoplasm due to the accumulation of glycogen. The cells tend to be poorly cohesive and fall apart, creating pseudopapillary and cystic areas. Nevertheless, these features on a renal biopsy support a diagnosis of hypertensive nephropathy provided the clinical picture is compatible.

Biopsy is usually reserved for atypical cases where an alternative diagnosis may be possible. Careful exclusion of other known causes of segmental glomerulosclerosis is, therefore, essential before making a diagnosis of FSGS as this labels the patient with a disease expected to rapidly progress to end-stage renal failure.

In these cases, the immune complexes probably form elsewhere and circulate to the kidneys where they are deposited within the glomeruli. The peak incidence is in adults from 20—40y. Distinction between the two is usually possible, based on the clinical picture and the pattern of scarring.

Distinction is usually possible, based on the clinical picture and pattern of scarring. The presence of fetal cartilage is a characteristic feature. The precise clinical picture will depend on whether the obstruction is acute or chronic, involves the upper or lower urinary tract, and whether it is unilateral or bilateral. Most patients have absorptive hypercalciuria in which too much calcium is absorbed from the gut. Others have renal hypercalciuria in which calcium absorption from the proximal tubule is impaired.

Only a minority have hypercalciuria due to hypercalcaemia which is usually due to primary hyperparathyroidism. The ammonia alkalinizes the urine and promotes precipitation of magnesium ammonium phosphate salts. However, most patients do not have hyperuricaemia nor increased urinary excretion of uric acid. It is thought that these patients have a tendency to make slightly acidic urine which is prone to forming uric acid stones.

They may be asymptomatic or picked up following investigation of haematuria or recurrent UTIs. Common points of impaction are the pelviureteric junction, the pelvic brim, and the vesicoureteric junction. Complications 2 Complete obstruction of the urinary tract requires urgent intervention to remove the stone. Large tumours are nevertheless often excised. These are more likely to be multiple and bilateral. Entrapped tubules may be found at the edge of the lesion. The vasculature within the tumour is thick-walled.

Grade 1 has the best prognosis and grade 4 the worst. Extensive vascular invasion is usually evident. This group is not formally subdivided into low and high grade, though most show high-grade nuclear atypia.

The presence of lymphovascular invasion is an adverse prognostic factor. Regional lymph nodes N pN1: Common basal cell markers used for this purpose include p63 and high molecular weight keratins. In practice, patterns 1 and 2 are virtually never diagnosed and so almost all prostate cancers have a Gleason score between 6 and A higher score is associated with poorer tumour differentiation and worse outcome.

Oxford Handbook of Clinical Pathology PDF

The tumours may grow in solid sheets or form glandular structures. There is often extensive haemorrhage and necrosis.

Patients tend to present with a more purulent discharge and dysuria. Seen mostly in sexually active young men. Circumcision is associated with a reduction in risk.

Neutrophils are present within the parakeratosis. Erosive disease may occur, which can lead to scarring. The overlying epidermis shows basal cell damage and may be thickened or atrophic.

There may be areas of atrophy and haemorrhage. Itching, burning, and dyspareunia are common symptoms. The epithelium covering the papillae is double-layered, with inner tall columnar cells and outer small myoepithelial cells. Stage IB: Stage II: Stage III: Stage IV: A thick white discharge is common. Dyspareunia and dysuria may also occur. Stellate and multinucleate stromal cells are typically seen within the core near the epithelial surface.

Tumour may be seen projecting through the vaginal opening. Some tumour cells have brightly eosinophilic cytoplasm; cytoplasmic cross-striations may be visible.

The lower incidence is largely attributable to the success of cervical screening programmes. Loss of function of these proteins results in uncontrolled proliferation of the infected cells.

Residual CIN may be seen adjacent to small tumours. Residual CGIN may be seen adjacent to small tumours. Women with two tests reported as mild dyskaryosis must then be referred for colposcopy.

Almost all cases occur within the pelvis, most commonly the ovaries, uterosacral ligaments, pelvic peritoneum, pouch of Douglas, and sigmoid colon. Endometriosis is also recognized at sites outside of the pelvis such as surgical scars and the lungs, but this is rarer. Credence to this theory is lent by experimental induction of endometriosis in animals by placing endometrial tissue in the peritoneal cavity. Given that the peritoneum and female genital tract arise from the same embryological cells coelomic epithelium , this seems plausible and would account for endometriotic deposits in areas in which implantation is unlikely.

Gram-negative bacteria, e. Klebsiella, Escherichia coli, Pseudomonas. Bacterial colonies are often visible within the exudate. These are more likely with virulent organisms or in patients with coexisting heart and lung disease. The normal interstitium is thin and contains pulmonary artery capillaries. Resolution occurs within 12—18h after exposure ceases. The mitotic count is high and necrosis is often extensive. Regional lymph nodes N N0: It is thought to be due to the rupture of small delicate apical blebs of lung tissue which result from stretching of the lungs.

Rare conditions often associated with pneumothorax include pulmonary Langerhans cell histiocytosis, pulmonary lymphangioleiomyomatosis, and thoracic endometriosis. The continuous build-up of pressure and volume in the pleural space displaces mediastinal structures, causing cardiorespiratory arrest tension pneumothorax. Patients with an underlying lung disease will usually notice a worsening in their symptoms. Cystic change may be seen.

Description

Perineural invasion is very frequently seen. Most prevalent in adult white males, but can occur in men and women of all races and in children. Encrusted golden brown iron pigment may be seen in cases caused by iron tablets. If untreated, it can lead to severe oesophageal strictures. Regional lymph nodes N pN0: Yellow-brown iron pigment may be seen.

Pyloric and intestinal type metaplasia is common. High salt intake is a strong risk factor whilst fresh fruit and vegetables are protective due to their antioxidant effects. The surface epithelium typically shows areas of gastric metaplasia. Susceptible individuals, particularly children, are at risk of developing thrombotic microangiopathy, leading to haemolysis and acute renal failure haemolytic uraemic syndrome.

CMV inclusions are found in endothelial and stromal cells. Surface erosions and ulceration may be present. Poorly formed granulomas may be seen, but these are generally uncommon. Lymphoid aggregates are present in the submucosa and muscular layers. Poorly formed granulomas may be seen. Some tumours, particularly in the distal colon, form circumferential stenosing lesions. The vast majority of cases are seen in the sigmoid colon. Only a thin coating of longitudinal muscle separates the diverticulum from the pericolic fat.

Clues to a viral aetiology may be present, however, e. Three patterns of disease are recognized: Jaundice may occur if there is marked loss of liver function. Background steatosis and hepatitis may not be present.

The macrophages may coalesce into clusters and form granulomas. Usually, the entire biliary tree is affected, but occasionally, only small interlobular bile ducts are affected small duct primary sclerosing cholangitis [PSC]. Biliary stasis also promotes infection and stone formation.

Advanced disease causes a cirrhotic liver with bile staining. Fibrotic biliary strictures may be apparent in the major bile ducts. There is a biliary pattern of cirrhosis with large irregular jigsaw-like nodules of hepatocytes. If the biopsy is taken from an area unaffected by the primary disease, but distal to a large duct stricture, the liver shows features of duct obstruction i.

Large vessels are often present within the lesion, but portal tracts are absent. Most lesions have a characteristic central scar. Large thick-walled vessels are very often present and a helpful diagnostic clue. Inspissated bile may be present within the ductules. Bile is not present in the ductules. Bile production may be seen by the tumour. As this duct drains into the duodenum via the smaller minor papilla, there is a tendency to stasis of pancreatic secretions and susceptibility to pancreatitis.

The endocrine tissue is typically spared until late in the disease. Large ducts are dilated and contain inspissated secretions.

Patients often have raised serum IgG4 levels.

This variant is thought to be autoimmune in nature. Treatment is supportive only and most patients will have other alcohol-related pathology. Tumours may be functioning or non-functioning, depending on whether a syndrome of inappropriate hormone secretion is present. Uncertain behaviour: The epithelial cells may show a range of atypia from low to high grade. Invasive carcinoma can arise within this lesion.

The cysts do not communicate with the pancreatic ductal system. The epithelial component may show a range of atypia from low to high grade. Invasive carcinomas can arise within these lesions.

Histologically, the small cysts are lined by cuboidal cells with a round nucleus and clear cytoplasm due to the accumulation of glycogen. The cells tend to be poorly cohesive and fall apart, creating pseudopapillary and cystic areas.

Nevertheless, these features on a renal biopsy support a diagnosis of hypertensive nephropathy provided the clinical picture is compatible. Biopsy is usually reserved for atypical cases where an alternative diagnosis may be possible. Careful exclusion of other known causes of segmental glomerulosclerosis is, therefore, essential before making a diagnosis of FSGS as this labels the patient with a disease expected to rapidly progress to end-stage renal failure.

In these cases, the immune complexes probably form elsewhere and circulate to the kidneys where they are deposited within the glomeruli.

The peak incidence is in adults from 20—40y. Distinction between the two is usually possible, based on the clinical picture and the pattern of scarring. Distinction is usually possible, based on the clinical picture and pattern of scarring. The presence of fetal cartilage is a characteristic feature.

The precise clinical picture will depend on whether the obstruction is acute or chronic, involves the upper or lower urinary tract, and whether it is unilateral or bilateral. Most patients have absorptive hypercalciuria in which too much calcium is absorbed from the gut. Others have renal hypercalciuria in which calcium absorption from the proximal tubule is impaired.

Only a minority have hypercalciuria due to hypercalcaemia which is usually due to primary hyperparathyroidism. The ammonia alkalinizes the urine and promotes precipitation of magnesium ammonium phosphate salts.

However, most patients do not have hyperuricaemia nor increased urinary excretion of uric acid. It is thought that these patients have a tendency to make slightly acidic urine which is prone to forming uric acid stones. They may be asymptomatic or picked up following investigation of haematuria or recurrent UTIs. Common points of impaction are the pelviureteric junction, the pelvic brim, and the vesicoureteric junction.

Complications 2 Complete obstruction of the urinary tract requires urgent intervention to remove the stone. Large tumours are nevertheless often excised. These are more likely to be multiple and bilateral. Entrapped tubules may be found at the edge of the lesion. The vasculature within the tumour is thick-walled. Grade 1 has the best prognosis and grade 4 the worst. Extensive vascular invasion is usually evident.

This group is not formally subdivided into low and high grade, though most show high-grade nuclear atypia. The presence of lymphovascular invasion is an adverse prognostic factor. Regional lymph nodes N pN1: Common basal cell markers used for this purpose include p63 and high molecular weight keratins. In practice, patterns 1 and 2 are virtually never diagnosed and so almost all prostate cancers have a Gleason score between 6 and A higher score is associated with poorer tumour differentiation and worse outcome.

The tumours may grow in solid sheets or form glandular structures. There is often extensive haemorrhage and necrosis. Patients tend to present with a more purulent discharge and dysuria. Seen mostly in sexually active young men. Circumcision is associated with a reduction in risk.

Neutrophils are present within the parakeratosis. Erosive disease may occur, which can lead to scarring. The overlying epidermis shows basal cell damage and may be thickened or atrophic.

There may be areas of atrophy and haemorrhage. Itching, burning, and dyspareunia are common symptoms.

The epithelium covering the papillae is double-layered, with inner tall columnar cells and outer small myoepithelial cells. Stage IB: Stage II: Stage III: Stage IV: A thick white discharge is common.

Dyspareunia and dysuria may also occur. Stellate and multinucleate stromal cells are typically seen within the core near the epithelial surface.

Related titles

Tumour may be seen projecting through the vaginal opening. Some tumour cells have brightly eosinophilic cytoplasm; cytoplasmic cross-striations may be visible. The lower incidence is largely attributable to the success of cervical screening programmes.

Loss of function of these proteins results in uncontrolled proliferation of the infected cells. Residual CIN may be seen adjacent to small tumours. Residual CGIN may be seen adjacent to small tumours. Women with two tests reported as mild dyskaryosis must then be referred for colposcopy.

Almost all cases occur within the pelvis, most commonly the ovaries, uterosacral ligaments, pelvic peritoneum, pouch of Douglas, and sigmoid colon. Endometriosis is also recognized at sites outside of the pelvis such as surgical scars and the lungs, but this is rarer. Credence to this theory is lent by experimental induction of endometriosis in animals by placing endometrial tissue in the peritoneal cavity.

Given that the peritoneum and female genital tract arise from the same embryological cells coelomic epithelium , this seems plausible and would account for endometriotic deposits in areas in which implantation is unlikely. This would account for cases arising in locations where implantation and metaplasia are improbable such as the lung. There is little evidence to support tubal distortion as a cause in most women. There is often abundant surrounding haemorrhage.

Loss of function of PTEN is typical. Loss of function of TP53 gene is typical. Both are high-grade malignancies with extensive spread at presentation.

These include cellular leiomyoma, highly cellular leiomyoma, mitotically active leiomyoma, and atypical leiomyoma. Although uncommon, it represents the most com- mon uterine sarcoma.

Histologically, leiomyosarcomas are smooth muscle tumours which demonstrate a number of atypical features such as diffuse cytological atypia, tumour cell necrosis, and high mitotic activity. Leiomyosarcomas are aggressive malignancies with a tendency to local recurrence and metastasis, particularly to the liver and lungs.

Nuclear grooves may be seen. Some cysts may also contain luteinized cells. Nuclear grooves are not present. The lining is composed of fully luteinized granulosa and theca cells. They are predominantly of clinical importance as large cysts may raise concern for a cystic neoplasm. The most serious complication is torsion or rupture, leading to an acute abdomen. Hair, cartilage, bone, and teeth may be visible.

They are often small and discovered incidentally. Large tumour may cause abdominal pain and ascites. The vast majority of borderline epithelial tumours are serous in type borderline serous tumours. Macroscopically, they are large, usually mul- tilocular, cystic tumours that are frequently bilateral. The cysts often show many papillary excrescences growing from the surface.

Histologically, the tumours are composed of complex branching papillae covered by prolif- erating columnar epithelial cells demonstrating low-grade nuclear atypia. Histologically, these implants are divided into non-invasive and invasive types. Most are of the non-invasive type and these patients tend to have a favourable prognosis. Invasive implants are generally associated with an adverse prognosis, but are much rarer.

Some workers speculate that these tumours arise from paraovarian Mullerian epithelium through a sequence of benign cystadenoma l borderline neoplasm l invasive carcinoma. Some workers speculate that these tumours may, in fact, arise in other pelvic organs e.

Psammoma bodies may be present. Areas of squamous differentiation are common. Both organisms are sexually transmitted bacteria. Nearly all occur in the Fallopian tubes, usually in the ampullary region. Other sites include the ovaries and abdominal cavity, but these are rare. Two types are recognized: They arise from fertilization of an anucleate ovum by a haploid sperm which then duplicates its genetic material.

They arise from fertilization of an ovum by two sperms. Usually, there is no clinical suspicion of molar pregnancy, the diagnosis being made following histopathological examination of the evacuated products of conception. The villi have a myxoid stroma containing collapsed empty blood vessels and karyorrhectic debris. There is abnormal non- polar trophoblastic hyperplasia and sheets of pleomorphic extravillous trophoblast may be present.

A prominent implantation site reaction is often seen, but with the absence of the normal trophoblast plugging of decidual blood vessels. Abnormal non-polar trophoblastic hyperplasia is present, though this is usually focal and less marked than in complete moles. The implantation site is usually unremarkable with normal trophoblast plugging of decidual blood vessels.

About half develop from a preceding hydatidiform mole with the remainder following a nor- mal pregnancy or non-molar miscarriage. Histologically, choriocarcinomas are composed of a mixture of cytotrophoblast and syncytiotrophoblast, typically forming bilaminar structures. Choriocarcinomas have a great propensity for vascular invasion, leading to early dissemination to multiple distant sites. Fortunately, gestational choriocarcinomas respond extremely well to chemotherapy and the prognosis for most women is very good.

Villous blood vessels are often small and inconspicuous. Maternal decidual arteries show failure of physiological conversion by trophoblast.

Fibrin microthrombi may be seen within glomerular capillary loops in more severe cases. Prognosis 2 Delivery is the only cure for pre-eclampsia. The danger to the fetus from premature delivery must be weighed against the risks to the mother. The disease behaves very unpredictably and can progress very rapidly so patients must be closely monitored for signs of deterioration.

The discharge may be clear, creamy, or bloodstained. The terminal duct lobular unit is compressed into slit-like channels. The stroma shows variation in cellularity and composition of the extracellular matrix. All phyllodes tumours have the potential for local recurrence and are usually treated by wide local excision.

In practice, most do not recur, even following simple enucleation. Phyllodes tumours can develop the capacity to metastasize, but this is very rare. Papillomas can develop anywhere in the ductal system, but show a predilection for either small terminal ductules peripheral papillomas or the large lactiferous ducts central papillomas.

This is thought to be the earliest morphological precursor to low-grade ductal carcinoma in situ. The relative risk is quoted as between 7—12 times that expected in women without lobular neoplasia. Necrosis in the centre of the duct is unusual. Central necrosis may be present. Central necrosis is common.

Prognosis depends on the persistence of any neoplastic cells after treatment. Recurrence is more likely with extensive disease, high nuclear grade, and the presence of comedo necrosis. Genetically, they have simple diploid or near diploid karyotypes and as a hallmark, show deletion of 16q and gains of 1q. Genetically, they have complex karyotypes with many unbalanced chromosomal aberrations. Frequent changes include loss of 1p, 8p, and 17p and gains of 1q and 8q.

Background bare bipolar nuclei are absent. They often occur in young women and are linked to BRCA mutations. Immunohistochemically, they are characterized by the expression of basal-type keratins, e.

These tumours appear to have a propensity to visceral metastasis, notably to the lungs and brain. This usually implies the biopsy missed the area of interest.

Oxford Handbook of Clinical and Laboratory Investigations Provan

This category mainly consists of lesions which may be benign in the core, but are known to show heterogeneity or to have an increased risk albeit low of an adjacent malignancy. The periductal stromal is often cellular and oedematous.

Autoantibodies against beta cells and insulin may also be relevant. Lack of insulin causes the breakdown of protein in muscle and of triglyceride in fat, providing substrates for gluconeogenesis in the liver. This, together with glucose formed from glycogen in the liver, causes hyperglycaemia. Cataract Retinopathy Ischaemic heart disease Diabetic nephropathy Acute pyelonephritis Peripheral vascular disease Peripheral neuropathy Fig.

This is fortu- nate as the highly cellular aspirates can easily be mistaken for a neoplastic process by the unwary. This can only be done histologically. Four major types are recognized:Child and Adolescent Psychiatry. Many patients do not present with or recall the rash. The vast majority of cases are seen in the sigmoid colon. Cerebral oedema within and around the infarct often causes midline shift. It typically arises in young to middle- aged adults aged 30— Some patients may be asymptomatic.

A palpable mass may be present. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Giardia, Trichomonas. Providing clear and user-friendly guidance on all aspects of history taking, physical examination, common practical procedures, data interpretation and communication skills, it gives realistic advice on coping with common situations.