Table Of ContentPathology for Surgeons in Training
An A–Z Revision Text
Third Edition
Dugald L.Gardner,MD FRCP FRCPed FRCPath FRCSEd
Honorary Fellow,Department of Pathology,University of Edinburgh;
Emeritus Conservator,the Royal College of Surgeons of Edinburgh,
Emeritus Professor of Histopathology,University of Manchester
and
David E.F.Tweedle ChM FRCS FRCSEd
Consultant Surgeon,University Hospital of
South Manchester and the Christie Hospital,Manchester,
Examiner,the Royal College of Surgeons of Edinburgh
A member of the Hodder Headline Group
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CONTENTS
Foreword vii
Preface viii
Acknowledgements ix
A 1
B 30
C 73
D 116
E 123
F 128
G 136
H 145
I 164
J 189
K 195
L 202
M 225
N 238
O 250
P 262
Q 284
R 284
S 287
T 315
U 334
V 343
W 354
X 362
Y 362
Z 363
v
Contents
Appendix tables 365
Brief biographies 369
Further reading 378
Index 379
vi
FOREWORD
The third edition of Pathology for Surgeons in Trainingindicates that the unusual format of this book has found a
real niche in the ever expanding surgical literature available to young surgeons.That it is specifically directed to
this group of doctors is important because they are faced with a wide range of pressures in their professional lives
and yet have to find the time and the stimulus to acquire knowledge rapidly.This format with its focus specifi-
cally on the knowledge required for surgical examinations set by the Royal Colleges,provides a most useful
learning and reference foundation.The previous editions of this book enjoyed considerable success and there is
no doubt the new and revised addition which has been brought thoroughly up to date but has maintained the
original style,will be equally well received.
Pathology is the foundation stone of surgical knowledge for clinical application.All subjects are extensively
cross-referenced but also include where appropriate historical notes and suggestions for further reading which
are most useful.The student is provided with the base knowledge and the opportunity to extend this as interest
or necessity dictates.The very fact that the volume does not need to be read from cover to cover but acts much
more as an anthology of Pathology only adds to its usefulness.The text is clear,well laid out and the knowledge
contained is accurate.
I commend Pathology for Surgeons in Training not only to young surgeons but to established teachers,trainers
and examiners as a certain way to ensure that they also keep their knowledge base up to date.Passing examina-
tions is a means to an end but this revision text should not be considered simply as an examination crammer.It
serves a much wider,more useful and longer lasting function.
Professor J G Temple
President,Royal College
of Surgeons of Edinburgh
vii
PREFACE
Candidates preparing for the examinations for the diplomas of MRCS or AFRCS often feel a need for a
compact guide allowing quick and highly selective revision of Pathology.The present volume is intended to
meet this requirement.The subjects chosen include not only classical Surgical Pathology but a substantial
component of Microbiology,Haematology,Immunology,Clinical Chemistry and Blood Transfusion
as well as brief notes on such issues as Audit,Computers,Imaging and Telepathology.
This is not a textbook nor should it be read from cover-to-cover.The book has been prepared as an A to Z
guide to the knowledge demanded by College examiners. It is planned so that postgraduate students can
approach their chosen topics easily.To meet these aims,the contents,based on the syllabuses issued by the four
surgical Colleges of Great Britain and Eire,are assembled for rapid,selective reference.
There is extensive Cross-referencingso that a candidate,wishing to revise Ischaemia,for example, is advised
also to read Anoxia,Gangrene and Necrosis while an examinee,seeking rapid help with Cancer of the Colon,is
referred to Carcinogenesis,Cancer Genetics and Tumours.For the same reasons,there is a comprehensive Index,
arranged so that the major topics are clearly distinguished from those that have been given only incidental men-
tion.
A difficulty that all recent surgical texts face is how to deal with the advances taking place in Molecular
Biology,Immunology and Geneticsand other subjects dominated by highly specialised techniques,a prob-
lem compounded by the jargon used by experts in these subjects.Here,we have compromised.All surgeons in
training require to know that a susceptibility to colon and breast cancer,retinoblastoma and Wilms’tumour,
chronic myelocytic leukaemia and xeroderma pigmentosa,may be inherited.They may be interested in the fre-
quency of the heritable defects,the mode of inheritance and the chromosomal abnormalities that underlie some
cancers.They cannot be expected to know the exact location and designation of the mutant gene loci associated
with these tumours or even the number and location of any chromosomal defect.
The text includes 56 Tables. Further summary Tables of normal haematological and chemical values are
appended.There are 58 explanatoryDiagrams selected to illuminate points of importance and difficulty.The
relevance of Historyto contemporary surgical practice may be denied but the authors believe that short com-
ments on the founding fathers of Surgery and related subjects,add interest and assist candidates to place exami-
nation topics in context.Brief biographies of pioneers whose names are quoted in the text are therefore retained.
No modern work can fail to take proper account of the impact made by the Internet.Consequently,a short
note is included indicating how additional information can be obtained from Websites.
D.L.Gardner
D.E.F.Tweedle
January 2002
viii
ACKNOWLEDGEMENTS
We owe a particular debt to Mr P.K.Datta FRCSEd,Consultant Surgeon,Caithness General Hospital,whose
long experience as an Examiner for the Royal College of Surgeons of Edinburgh has proved invaluable in
designing this Edition,and to Dr.Stephanie J.Dancer FRCPath,Department of Laboratory Medicine,Vale of
Leven District General Hospital,whose advice and guidance in this,as in the previous Edition,has enabled us to
deal with the complex problems of Clinical Microbiology.
Our colleagues,Professor T.J.Anderson FRCPath.,Western General Hospital,Edinburgh (Breast cancer);Mr
A. Bleetman FRCSEd., Birmingham Heartlands Hospital (Accident and Emergency Surgery); Dr Jan
Cullingworth, Ph.D. University of Edinburgh (Carcinogenesis); Mr. I D Gardner FRCS., Derbyshire Royal
Infirmary (Surgery); Dr T Hewson PhD, University of Edinburgh (Immunology); Dr S. J. Howell MRCP,
Christie Hospital,Manchester (Cancer studies);Dr.A.S.Krajewski FRCPath,Northampton General Hospital
(Immunology);Dr A.M.Lessells,FRCPath,Western General Hospital,Edinburgh (Biopsy diagnosis);Dr D.F.
Martin FRCP, University Hospital of South Manchester (Imaging); Mr. R. K. Tandon FRCSEd, Royal
Wolverhampton Hospital (Orthopaedics); Professor W. A.Wallace, FRCSEd., Department of Orthopaedic
Surgery,University of Nottingham (Internet),have given unstintingly of their time and energy in ensuring the
accuracy of the text.
We acknowledge the expert advice of the Departments of Haematology and of Clinical Biochemistry
(Dr S.W.Walker) of the Royal Infirmary, Edinburgh, and the guidance of the staff of the Scottish Blood
Transfusion Service.We express our thanks to Mr I.Lennox,MMAA,formerly of the Department of Medical
Illustration of the University of Edinburgh, who prepared the drawings with his customary skill and
understanding,and to Mrs S.Jones M A of the Royal College of Surgeons of Edinburgh whose critical help with
the manuscript has proved indispensable.
ix
