Muir's textbook of pathology.

581 Pages·2008·56.056 MB·English

by  Muir, Robert, Levison, David Annan

Muir’s
Textbook of
Pathology
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Muir’s
Textbook of
Pathology
Fourteenth Edition
Edited by
DAVID A LEVISON
MD FRCPath
Professor of Pathology,University of Dundee,and Honorary Consultant Pathologist,
Ninewells Hospital and Medical School,Dundee,UK
ROBIN REID
BSc(Hons) MBChB FRCPath
Consultant Pathologist,Western Infirmary,Glasgow,and Honorary Senior Lecturer in
Pathology,University of Glasgow,Glasgow,UK
ALASTAIR D BURT
BSc(Hons) MBChB MD(Hons) FRCPath FI Biol
Professor of Pathology and Dean of Clinical Medicine,Newcastle University,
Royal Victoria Infirmary,Newcastle-upon-Tyne,UK
DAVID J HARRISON
BSc(Hons) Ed MD MRCPath FRCPath FRCPEd FRCSEd
Professor of Pathology and Director of the Edinburgh Cancer Research Centre,
University of Edinburgh,Edinburgh,UK
STEWART FLEMING
MBChB BSc(Hons) MD(Hons) FRCPath
Professor of Cellular and Molecular Pathology,University of Dundee,
Ninewells Hospital,Dundee,UK
with Hodder Arnold Sponsored by AstraZeneca
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Whilst the advice and information in this
book are believed to be true and accurate at
the date of going to press,neither the authors
nor the publisher can accept any legal respon-
sibility or liability for any errors or omissions
that may be made.In particular (but without
limiting the generality of the preceding
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check drug dosages;however it is still possible
that errors have been missed.Furthermore,
dosage schedules are constantly being revised
and new side-effects recognized.For these
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First published in Great Britain 1924
Second edition 1929
Third edition 1933
Fourth edition 1936
Fifth edition 1941
Sixth edition 1951
Seventh edition 1958
Eighth edition 1964
Ninth edition 1971
Tenth edition 1976
Eleventh edition 1980
Twelfth edition 1985
Thirteenth edition 1992
Fourteenth edition 2008
ELBS edition first published 1964
ELBS edition of ninth edition 1971
ELBS edition of tenth edition 1976
ELBS edition of eleventh edition 1980
ELBS edition of twelfth edition 1984
ELBS edition of thirteenth edition 1992
BookPower edition of fourteenth edition first
published 2008
ISBN 978 0 340 81024 8
Typeset in 10/12 Berling by Charon Tec Ltd
(A Macmillan Company)
www.charontec.com
Printed and bound in India
CONTENTS
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
SECTION 1
MECHANISMS OF DISEASE: CELLULAR AND MOLECULAR
1 Applications of pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2 Normal cellular functions,disease and immunology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3 Clinical genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
4 Cell injury,inflammation and repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5 Cancer and benign tumours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
SECTION 2
SYSTEMIC PATHOLOGY
6 The cardiovascular system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
7 The respiratory system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
8 The lymphoreticular system and bone marrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
9 The gastrointestinal system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
10 The liver,gallbladder and pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
11 The nervous systems and the eye. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
12 The locomotor system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
13 The kidneys and urinary tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
14 The female reproductive system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
15 The breasts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
16 The male reproductive system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438
17 The endocrine system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
18 The skin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474
19 Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
To download electronic files of the illustrations used in this book,go to the Muir’s Textbook of Pathologyhomepage,
www.muirspathology.com.Access to the files is password protected.
Your username is:student99
Your password is:pathology
Contributors
David AnsellMA MB BChir FRCPath Philip S Hasleton MD FRCPath
Consultant Histopathologist,Department of Histopathology, Professor of Pathology, Department of Histopathology,
City Hospital,Nottingham,UK Manchester Royal Infirmary,Manchester,UK
Jonathan N Berg MB ChB MSc MD FRCP(Ed) C Simon HerringtonMA MB BS DPhil MRCP FRCPath
Senior Lecturer in Clinical Genetics,University of Dundee Professor and Consultant in Pathology,Bute Medical School,
and Honorary Consultant in Clinical Genetics, Ninewells University of St Andrews,St Andrews,UK
Hospitaland Medical School,Dundee,UK
Robert Jackson
Alastair D BurtBSc(Hons) MD(Hons) FRCPath FIBiol Department of Pathology,Royal Infirmary,Glasgow,UK
Professor of Pathology and Dean of Clinical Medicine,
Frederick D Lee
Newcastle University, Royal Victoria Infirmary,
Professor of Pathology, Department of Pathology, Royal
Newcastle-upon-Tyne,UK
Infirmary,Glasgow,UK
Francis A CareyBSc(Hons) MB BCh BAO MD FRCPath
Andrew HS LeeMRCP FRCPath
Consultant and Professor of Pathology, Department of
Consultant Histopathologist, City Hospital, Nottingham,
Pathology, Ninewells Hospital and Medical School,
UK
Dundee,UK
David A LevisonMD FRCPath FRCP(Ed)
Henry J DargieMB ChB FRCP FESC FRSE
Professor of Pathology,University of Dundee,and Honorary
Consultant Cardiologist,Honorary Professor,University of
Consultant Pathologist, Ninewells Hospital and Medical
Glasgow,Glasgow,UK
School,Dundee,UK
Ian O Ellis BMedSci BM BS MRCPath
George BM Lindop BSc(Hons) MBChB FRCP(Glas)
Professor of Cancer Pathology and Honorary Consultant
FRCPath
Pathologist, Faculty of Medicine and Health Sciences,
Senior Consultant Pathologist, Sheikh Khalifa Hospital,
Department of Histopathology, City Hospital Campus,
Abu Dhabi,UAE
Nottingham University Hospitals NHS Trust Nottingham,
UK Sebastian B LucasFRCP FRCPath
Christopher W Elston MD FRCPath Professor, Department of Histopathology, King’s College
Professor of Tumour Pathology and Consultant London School of Medicine,St Thomas’ Hospital,London,
Histopathologist (Retired),City Hospital,Nottingham,UK UK
Alan T Evans BMedBiol(Hons) MD(Hons) FRCPath The late D Gordon MacDonald
Consultant Dermatopathologist,Department of Pathology, Professor,Department of Oral Pathology,Glasgow Dental
NinewellsHospital and Medical School,Dundee,UK Hospital,Glasgow,UK
Stewart FlemingMBChB BSc(Hons) MD(Hons) FRCPath Anne Marie McNicol BSc MD MRCP(UK) FRCP
Professor of Cellular and Molecular Pathology, University Glas FRCPath
of Dundee,Ninewells Hospital,Dundee,UK Reader, University Department of Pathology, Glasgow
Royal Infirmary University NHS Trust,Glasgow,UK
Alan K FoulisBSc MD MRCPath FRCP(Ed)
Department of Pathology,Royal Infirmary,Glasgow,UK Allan R McPhadenBSc(Hons) MBChB,MD,MRCPath
Department of Pathology, Glasgow Royal Infirmary,
David I GrahamMBBch PhD FRCPath FRCP(G) FRS(Ed)
Glasgow,UK
Emeritus Professor of Neuropathology, University
Department of Neuropathology, Institute of Neurological Sarju Mehta BSc(Hons) MBBS MRCP(UK)
Sciences,Southern General Hospital NHS Trust,Glasgow,UK Consultant in Clinical Genetics, Department of Clinical
Genetics,Addenbrooke’s Hospital,Cambridge,UK
David J Harrison BSc(Hons) Ed MD FRCPath FRCP(Ed)
FRCS(Ed) Wolter J Mooi MD PhD
Professor of Pathology and Director of the Edinburgh Cancer Professor of Pathology, Department of Pathology, Vrye
Research Centre,University of Edinburgh,Edinburgh,UK Universiteit Medical Centre,Amsterdam,the Netherlands
Contributors
viii
Ian AR MoreBSc PhD MD FRCP FRCPath Fiona Roberts BSc MBChB MD FRCPath
Department of Pathology, Western Infirmary, Glasgow, Consultant Ophthalmic Pathologist, Department of
UK Pathology, University of Glasgow, Western Infirmary,
Glasgow,UK
James AR NicollBSc MD FRCPath
Professor of Neuropathology, Division of Clinical R Stuart C RodgerMB FRCP
Neurosciences, University of Southampton and Honorary Consultant Nephrologist, Honorary Clinical Senior
Consultant Neuropathologist, Southampton University Lecturer in Medicine, Renal Unit, University of Glasgow,
Hospitals NHS Trust,Southampton,UK Western Infirmary,Glasgow,UK
Sarah E Pinder MBChB,FRCPath Paul Van der ValkMD PhD
Department of Histopathology, Addenbrooke’s Hospital, Professor of Pathology, Department of Pathology, Vrye
Cambridge,UK Universiteit Medical Centre,Amsterdam,the Netherlands
Robin ReidBSc(Hons) MBChB FRCPath
Consultant Pathologist, Western Infirmary, Glasgow, and
Honorary Senior Lecturer in Pathology, University of
Glasgow,Glasgow,UK
Prevailing a head
ix
preface
This is the Fourteenth Edition of Muir’s Textbook of to appreciate that undergraduate education is just the
Pathology,building upon the work of previous editions.It is beginning – a window on the exciting and challenging
different in a number of ways from previous editions,but world of disease.We have also included in most chapters,
we think it is similar enough to retain the traditional values several case histories which illustrate and add to the infor-
of its predecessors.We trust we have produced a text that mation provided in the main text,in an attempt to empha-
will be useful both to undergraduate medical students and size the fundamental relevance of pathology to clinical
to postgraduates who are interested in having a better medicine. By adopting this format of special study topics
understanding of disease upon which to base either their and case studies integrated into, but clearly distinguished
clinical practice or their research,or both. from,the core text,we are adopting the approach taken to
This edition differs in the balance between general and medical education in many medical schools. We strongly
systematic pathology from most earlier editions, with the support the move in the UK to more integrated teaching of
general section being relatively shorter.This is deliberate;it the disciplines in medicine.We,not unexpectedly,believe
is not meant to suggest that we think an understanding of that the best doctors are knowledgeable about disease
the basic sciences is any less important to clinical practice processes, and we hope that this belief is reflected in the
than it used to be – quite the contrary.What we have tried level at which we have pitched the text.
to do is to focus on the most clinically relevant basic science It will be noted for this edition of the book that for the
and we have included some of that in the systematic chap- first time ever the majority of the editors are not based in
ters where its relevance is hopefully easier to appreciate. Glasgow. However,three of us are Glasgow graduates,and
We have also introduced into almost every chapter one we all acknowledge our debt to, and the inspiration we
or two special study topics where the information provided have drawn from,our predecessors in Glasgow Pathology.
is rather more than most medical educators would include We are honoured to have had the opportunity to edit this
in the core curriculum of a medical undergraduate course. latest edition of ‘Muir’ and hope that we have done justice
This is intended to interest and stimulate the best students to the task.
David A Levison
Robin Reid
Alastair D Burt
David J Harrison
Stewart Fleming
2008