Table Of ContentTHIRD EDITION
Robbins and Cotran
Atlas of Pathology
Edward C. Klatt, MD
Professor of Pathology
Biomedical Education Program Director
Department of Biomedical Sciences
Mercer University School of Medicine
Savannah, Georgia
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
ROBBINS AND COTRAN ATLAS OF PATHOLOGY,
THIRD EDITION ISBN: 978-1-4557-4876-1
International Edition ISBN 978-0-323-2-8080-8
Copyright © 2015, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
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Library of Congress Cataloging-in-Publication Data
Klatt, Edward C., 1951- , author.
Robbins and Cotran atlas of pathology / Edward C. Klatt. – Third edition.
p. ; cm.
Atlas of pathology
Includes index.
ISBN 978-1-4557-4876-1 (pbk. : alk. paper) – ISBN 978-0-323-28080-8 (E-ISBN)
I. Title. II. Title: Atlas of pathology.
[DNLM: 1. Pathology–Atlases. QZ 17]
RB33
616.07022’2–dc23
2014031172
Executive Content Strategist: William Schmitt
Content Development Specialist: Laura Schmidt
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Mary Pohlman
Design Direction: Ashley Miner
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Preface
This third edition of the atlas accompanying the Robbins series. In addition, there are examples of normal organs and
series of texts has been updated with the addition of over 400 tissues for review and orientation.
new images that increase the depth and breadth for coverage Each figure is accompanied by a brief description that pro-
of subject areas in pathology, enhancing its usefulness to the vides the key points illustrated by the figure. For initial and
entire series. This atlas remains organized into chapters that more complete study, the learner is directed to the Robbins texts.
closely follow the section on Diseases of Organ Systems in the The labels and descriptions provided for the figures will guide
ninth edition of the “big” Robbins and Cotran Pathologic Basis the learner in a discovery process while perusing these figures.
of Disease. The atlas is designed to complement the Pathologic Though concise, the figure descriptions cumulatively yield a
Basis of Disease, Basic Pathology, and Robbins’ Pocket Companion considerable volume of reading, but that reading is highly com-
texts by providing even more examples of disease processes. partmentalized to aid review and reflection. Correlations with
The atlas reflects the knowledge base of the Robbins series findings from clinical history, physical examination, and clini-
primarily in a visual format, and because most students are cal laboratory testing are included in many of the descriptions.
“visual learners” they will readily take advantage of this study The atlas author pursues an integrative approach to medical
aid. The gross, microscopic, and radiologic images used for the education, combining elements of basic science, clinical, and
figures as presented in this atlas are designed to reinforce one behavioral subjects into learning materials that promote a flow-
another, as well as those present in other works in the Robbins ering of knowledge to benefit those in need of health care.
v
Acknowledgments
The author is indebted to the stalwart figures who have funda- a migration, so too medical educators build on the work of
mentally contributed to the development of the entire Robbins colleagues over many generations.
series, starting with the founding author Dr. Stanley Robbins, Persons associated with the publisher, Elsevier, require
continuing with Dr. Ramzi Cotran, and ongoing with Dr. Vinay special thanks including the Content Development Specialist,
Kumar. These lead authors have set the standard of excellence Laura Schmidt, and Senior Project Manager, Mary Pohlman.
that characterizes this series. In addition, there have been and Of course, none of this work would be possible without the
continue to be numerous contributing authors who have made support and vision provided by Mr. William Schmitt, Execu-
the Robbins series into the valuable tool it remains for medi- tive Content Strategist for Medical Textbooks.
cal education. Just as no single monarch butterfly completes Edward C. Klatt, MD
vii
To all who strive for improving the health of everyone.
viii
Contributors
Arthur J. Belanger, MHS, PA(ASCP) Walter H. Henricks, MD
Autopsy Service Manager Staff Pathologist and
Yale University School of Medicine Director of Laboratory Information Services
New Haven, Connecticut The Cleveland Clinic Foundation
Cleveland, Ohio
John Blackmon, MD
Associate Professor of Pathology Lauren C. Hughey, MD
Florida State University College of Medicine Associate Professor of Dermatology
Tallahassee, Florida University of Alabama at Birmingham
Birmingham, Alabama
Professor David Y. Cohen
Director of Pathology Carl R. Kjeldsberg, MD
Herzliyah Medical Center Professor of Pathology and Medicine
Herzliyah-on-Sea, Israel University of Utah School of Medicine
Chief Executive Officer and Chairman
Richard M. Conran, MD, PhD, JD ARUP Laboratories
Professor of Pathology Salt Lake City, Utah
Uniformed Services University of the Health Sciences
Bethesda, Maryland Nick Mamalis, MD
Professor of Ophthalmology and Visual Sciences
Todd Cameron Grey, MD John A. Moran Eye Center
Chief Medical Examiner, State of Utah University of Utah
Associate Professor of Pathology Salt Lake City, Utah
University of Utah
Salt Lake City, Utah Professor John Nicholls
Clinical Professor
Ilan Hammel, DSc Department of Pathology
Professor and Chairman The University of Hong Kong
Department of Pathology Pok Fu Lam, Hong Kong, SAR
Sackler Faculty of Medicine
Tel Aviv University Sherrie L. Perkins, MD, PhD
Tel Aviv, Israel Professor of Pathology
University of Utah School of Medicine
M. Elizabeth H. Hammond, MD Director of Hematopathology Laboratory
Professor of Pathology and ARUP Laboratories
Adjunct Professor of Internal Medicine Salt Lake City, Utah
University of Utah School of Medicine
Salt Lake City, Utah Mary Ann Sens, MD, PhD
Professor and Chair of Pathology
Sate Hamza, MD University of North Dakota School of Medicine
Assistant Professor and Health Sciences
University of Manitoba Grand Forks, North Dakota
Winnipeg, Manitoba, Canada
ix
x Contributors
Shane Silver, MD, FRCPC Amy Theos, MD
Dermatologist Associate Professor of Dermatology
203 Edmonton Street University of Alabama Medical Center
Winnipeg, Manitoba Birmingham, Alabama
Hiroyuki Takahashi, MD, PhD Omid Zargari, MD
Associate Professor Consultant Dermatologist
Department of Pathology Pars Clinic
The Jikei University School of Medicine Rasht, Iran
Tokyo, Japan
C H A P T E R
1
Blood Vessels
1
2 CHAPTER 1 Blood Vessels
Figure 1-1 Normal artery, microscopic
This is a muscular artery in longitudinal section
showing a thin intima ( ) on top of the internal
elastic lamina. Below this is the thick media
( ), with layers of circular smooth muscle and
interspersed elastic fibers to withstand the arterial
pressure load and dampen the pressure wave
from left ventricular contraction. The media is
bounded by the external elastic lamina ( ). Out-
side the media is the adventitia ( ), which merges
with surrounding supporting connective tissue.
Figure 1-2 Normal artery and vein,
microscopic
Seen here in cross-section is a normal artery ( )
with a thick, smooth muscle wall alongside a
normal vein ( ) with a thin, smooth muscle wall,
running in connective tissue in a fascial plane
between muscle bundles of the lower leg. The
larger arteries and veins are often grouped, along
with a nerve, into a neurovascular bundle to sup-
ply a body region. More distal areas of regional
blood flow and the blood pressure are regulated
by alternating vasoconstriction and dilation of
small muscular arteries and arterioles.
Figure 1-3 Normal arteriole and venule,
microscopic
A normal arteriole ( ) is alongside a normal venule
( ) and a small peripheral nerve ( ), all in cross-
section, grouped into a loose neurovascular
bundle. The major point of blood pressure regula-
tion is at the arteriolar level. Exchange of solutes
and gases with diffusion into tissues occurs at
the capillary level. The diminished vascular pres-
sure of the venules, along with the intravascular
oncotic pressure exerted by plasma proteins,
brings interstitial fluids back into the venules. Not
seen here are the normally inconspicuous lym-
phatic channels that scavenge what little residual
fluid is exuded from capillaries and not recovered
into the venous system, preventing edema.
