Table Of ContentDiagnostic
Electron Microscopy
A TEXT/ATLAS
Second Edition
Springer
New York
Berlin
Heidelberg
Barcelona
Hong Kong
London
Milan
Paris
Singapore
Tokyo
G. Richard Dickersin, M.D.
Associate Professor of Pathology
Harvard Medical School
Associate Professor of Pathology
Massachusetts Institute of Technology
Pathologist
Head of Diagnostic Electron Microscopy Unit
Massachusetts General Hospital
Boston, Massachusetts
Diagnostic
Electron Microscopy
A TEXT/ATLAS
Second Edition
With 894 Illustrations
G. Richard Dickersin, M.D.
Pathologist and Head, Electron Microscopy Unit
Department of Pathology
Massachusetts General Hospital
Boston, MA02114-2617
USA
and
Associate Professor of Pathology
Harvard Medical School
Boston, MA02115-6092
USA
and
Associate Professor of Pathology
Massachusetts Institute of Technology
Cambridge, MA02139
USA
Library of Congress Cataloging-in-Publication Data
Dickersin, G. Richard.
Diagnostic electron microscopy : a text/atlas / G. Richard
Dickersin. — 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 0-387-98388-0 (hardcover : alk. paper)
1. Diagnosis, Electron microscopic. 2. Tumors—Diagnosis.
I. Title.
[DNLM: 1. Microscopy, Electron—methods Atlases. 2. Neoplasms—
ultrastructure Atlases. 3. Cytodiagnosis—methods Atlases.
4. Kidney Glomerulus—ultrastructure Atlases. 5. Metabolic
Diseases—pathology Atlases. 6. Neuromuscular Diseases—pathology
Atlases. QZ 17 D549d 1999]
RB43.5.D55 1999
616.07(cid:1)58—dc21
DNLM/DLC
99-32439
Printed on acid-free paper.
©2000 by Springer-Verlag New York, Inc.
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ISBN 0-387-98388-0 Springer-Verlag New York Berlin Heidelberg SPIN 10656887
To my wife, Barbara;
my daughters,
Kay, Gail, Leslie, and Amy;
and my son, Ged.
Ten years have elapsed since the appearance of the first
edition of this book, and since then a number of ad-
vances have been made in the field of diagnostic pathol-
ogy. New and improved techniques have contributed
to our diagnostic armamentarium and to our general
understanding of various disease processes. In the field
of neoplasia, immunohistochemistry has become a rou-
tine procedure in most departments of pathology. Flow
Preface cytometry has become an efficient technique for meas-
uring ploidy, and molecular biological methods such as
DNAand RNAhybridization and polymerase chain re-
action (PCR) have made it possible to identify specific
genetic markers for various hereditary, neoplastic, and
infectious diseases. The importance of these innova-
tions in pathology is duly recognized, but, at the same
time, they have limitations, and traditional morpho-
logical studies still comprise the backbone of the
pathologist’s work. In this latter group of studies we in-
clude electron microscopy, which has continued to be
used selectively in diagnostic workups of neoplastic, re-
nal, neuromuscular, infectious, hereditary, and meta-
bolic diseases. In our own experience, electron micro-
scopy has been especially valuable in complementing
immunohistochemistry or in superseding immunohis-
tochemistry when the latter is equivocal or nonspecific.
Aside from the practical application to diagnostic
work, electron microscopy has been a valuable tool for
educating residents and staff. It reveals cells and tissues
at very high magnification, making cell surfaces and in-
teriors visible beyond the limits of light microscopy, a
seemingly important experience in the study of normal
and diseased states. The omission of this basic mor-
phological step in the training and continuing educa-
tion of pathologists would be, in our opinion, a serious
deficiency.
In this second edition, we have retained the style and
core components of the first edition but have updated
the text and bibliography, added new topics, and re-
placed and supplemented photographs appropriately.
The result has been a larger book and, we hope, one of
broader applicability.
G. Richard Dickersin, M.D.
Boston, Massachusetts
vii
It goes without saying that a book of this type cannot
be produced by one person, at least not within a prac-
tical time frame and while simultaneously carrying out
routine “service work” in a busy department of pathol-
ogy. Thus, there are a number of persons who deserve
special acknowledgment for their roles in making this
work possible. First, Cheryl Nason and Martin Selig
were at the core of the daily labor of the book. Cheryl’s
Acknowledgments mastery of the computer allowed for rough drafts,
countless additions and revisions, and literature
searches to be accomplished in a timely manner. Her
work was always outstandingly prompt and accurate,
and I am most appreciative of it. Martin was a steady,
consistent, right-hand man in the “rescoping,” photog-
raphy, and assembly of illustrations. His skills went be-
yond the purely technical ones, of which he is such a
master, and included an academic familiarity with the
particular morphology we were attempting to capture
and portray. As will be noticed, Martin is listed as a con-
tributing author of the chapter on renal glomerular dis-
ease, but he also approached a similar level of involve-
ment on several of the other chapters. I wish to
acknowledge and thank him for the high quality of his
work and for his commitment to the project.
An “unsung hero” in the evolution of this book was
a person whose skillful and reliable performance of rou-
tine technical chores kept our electron microscopy serv-
ice viable and efficient. That person is Robert Holmes.
To Rob, our emphatic expression of gratitude and ap-
preciation.
Special appreciation also goes to the authors of
Chapters 12 and 13, Shamila Mauiyyedi, Alain P. Mar-
ion, Robert B. Colvin, Umberto De Girolami, and Dou-
glas C. Anthony. Their expertise and contributions
round out this book, making it more comprehensive
and authoritative than I could possibly have hoped to
accomplish myself.
Finally, as for the first edition, I want to thank my
wife, daughters, and son for their tolerance during
weekends and vacations, when I would usually put in
a few hours on “the book.”
G. Richard Dickersin, M.D.
Boston, Massachusetts
ix
Contents
Preface vii
Acknowledgments ix
Contributors xix
CHAPTER1
Normal Cell Ultrastructure and Function 1
Cytoplasmic Organelles 1
Cytoskeleton (Cytoplasmic Matrix Structures) 4
Cytoplasmic Inclusions 4
Nuclear Organelles 4
Organization of Organelles Within the Cell 5
Cell Attachment Sites 5
CHAPTER2
Selective Embryology 7
Embryogenesis from Fertilization Through Three Weeks 7
Differentiation of the Paraxial Mesoderm 9
Differentiation of the Intermediate Mesoderm 10
Differentiation of the Lateral Mesoderm 11
Comparison of Embryonic Mesodermal Differentiation with Embryonal Rhabdomyosarcoma,
Wilms’Tumor, and Mesothelioma 11
CHAPTER3
Large Cell Neoplasms 27
Carcinoma 27
Adenocarcinoma (and Adenoma) 27
Squamous Cell Carcinoma 65
xi
XII CONTENTS
Transitional Cell (Urothelial) Carcinoma 65
Undifferentiated Carcinoma 88
Melanoma 88
Mesothelioma 88
Lymphoma 89
Histiocytic Disorders 116
Macrophagic Lesions 116
Dendritic Cell Lesions 117
Mastocytosis and Mastocytoma 124
CHAPTER4
Small Cell Neoplasms 147
Neuroendocrine Carcinoma 147
Neuroblastoma 147
Ewing’s Sarcoma 161
Primitive Neuroectodermal Tumor 161
Embryonal and Alveolar Rhabdomyosarcoma 169
Rhabdoid Tumor 169
Nephroblastoma (Wilms’Tumor) 169
Lymphoma (Small Cell) 197
Plasmacytoma 197
Desmoplastic Small Round Cell Tumor with Divergent Differentiation 197
Small Cell Osteosarcoma 197
Mesenchymal Chondrosarcoma 209
CHAPTER5
Leukemias 217
Myelocytic Leukemia 217
Monocytic and Myelomonocytic Leukemia 227
Lymphocytic Leukemia 227
Erythrocytic Leukemia 227
Megakaryocytic Leukemia 234
Hairy Cell Leukemia (Leukemic Reticuloendotheliosis) 234
CHAPTER6
Spindle Cell Neoplasms and Their Epithelioid Variants 247
Fibrous Neoplasms 247
Malignant Fibrous Histiocytoma 264
CONTENTS XIII
Cartilaginous Neoplasms 278
Osteoblastoma and Osteosarcoma 278
Synovial Sarcoma 295
Adipose Neoplasms 295
Smooth Muscle Neoplasms 320
Skeletal Muscle Neoplasms 320
Vascular Neoplasms 341
Hemangiopericytoma 341
Schwannoma and Malignant Schwannoma 359
Granular Cell Tumor 359
Neurofibroma 369
Sarcomatoid (Spindle Cell) Carcinoma 369
Sarcomatous Thymoma, Melanoma, and Mesothelioma 369
CHAPTER7
Gonadal and Related Neoplasms 391
Surface Epithelial–Stromal Tumors of the Ovary 391
Serous Tumors 391
Mucinous Tumors 406
Endometrioid Tumors 406
Clear Cell Tumors 418
Transitional Cell Tumors (Brenner and Non-Brenner Types) 424
Squamous Cell Tumors (Epidermoid Cyst and Squamous Cell Carcinoma) 424
Mixed Epithelial Tumors 424
Undifferentiated Carcinoma 424
Sex Cord–Stromal Tumors 424
Granulosa Cell Tumor 424
Thecoma 439
Fibroma 439
Signet-Ring Stromal and Related Tumors 439
Sertoli–Stromal Cell Tumors (Androblastomas) 439
Sex Cord Tumors with Annular Tubules 451
Gynandroblastoma 451
Sex Cord–Stromal Tumors Unclassified 451
Steroid (Lipid) Cell Tumors 451
Germ Cell Tumors 451
Dysgerminoma (Seminoma) 451
Yolk Sac Tumor (Endodermal Sinus Tumor) 462
Embryonal Carcinoma 462
Choriocarcinoma and Placental Site Tumor (and Normal Placenta) 462
Teratoma (Immature and Mature; Monodermal) 462
Gonadoblastoma 478
