Table Of ContentEDITORS
J. Thomas Stocker MD
Professor of Pathology, Pediatrics and Emerging Infectious Disease
Department of Pathology
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Louis P. Dehner MD
Professor
Division of Anatomic and Molecular Pathology
Department of Pathology and Immunology
Washington University in St. Louis
Attending Surgical Pathologist
Lauren V. Ackerman Laboratory of Surgical Pathology
Barnes-Jewish and St. Louis Childrens Hospitals at the Washington University Medical Center
St. Louis, Missouri
Aliya N. Husain MD
Professor
Department of Pathology
University of Chicago
Chicago, Illinois
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Contributors
Hikmat A. Al-Ahmadie MD
Assistant Attending, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
Kevin E. Bove MD
Professor, Department of Pathology and Laboratory Medicine, University of Cincinnati, College of Medicine
Staff Pathologist, Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical
Center, Cincinnati, Ohio
David S. Brink MD
Associate Professor, Departments of Pathology and Pediatrics, St. Louis University School of Medicine
Associate Pathologist, Department of Pathology, SSM
Cardinal Glennon Children's Medical Center, St. Louis, Missouri
John J. Buchino MD
Emeritus Professor, Department of Pathology, Department of Pediatrics, University of Louisville
Emeritus Chief, Department of Pathology, Kosair
Children's Hospital, Louisville, Kentucky
J. Douglas Cameron MD
Professor of Ophthalmology, Departments of Ophthalmology and Pathology, Mayo Clinic, Rochester,
Minnesota
Ellen Chung
Assistant Professor, Department of Radiology and Radiological Sciences and Department of Pediatrics,
Uniformed Services University of the Heath Sciences
Integrated Chief, Diagnostic Radiology Service, Department of Radiology, Walter Reed National Military
Medical Center, Bethesda, Maryland
Kim A. Collins MD
Professor, Department of Pathology and Laboratory Medicine, Medical University of South Carolina,
Charleston, South Carolina
Richard M. Conran MD, PhD, JD
Professor of Pathology and Emerging Infectious Diseases, Department of Pathology, Uniformed Services
University of the Health Sciences, Bethesda, Maryland
Tracey S. Corey
Clinical Professor, Division of Forensic Pathology, University of Louisville School of Medicine Chief Medical
Examiner, Kentucky Medical Examiner Program, Commonwealth of Kentucky, Louisville, Kentucky
Robert F. Debski MD
Assistant Professor, Department of Pathology, Department of Pediatrics, University of Louisville
Chief, Department of Pathology, Kosair Children's Hospital, Louisville, Kentucky
Louis P. Dehner MD
Professor, Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology,
Washington University in St. Louis Attending Surgical Pathologist, Lauren V Ackerman Laboratory of Surgical
Pathology, Barnes-Jewish and St. Louis Children's Hospitals at the Washington University Medical Center, St.
Louis, Missouri
Christopher Dunham MD
Clinical Fellow, Department of Pathology and Immunology, Washington University Clinical Fellow, Department
of Pathology and Immunology, Barnes-Jewish Hospital, St. Louis, Missouri
Michael K. Fritsch MD, PhD
Associate Professor, Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison,
Wisconsin
Dorothy K. Grange MD
Professor of Pediatrics, Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington
University School of Medicine
Professor of Pediatrics, Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
John Hart MD
John Hart MD
Professor, Department of Pathology, University of Chicago, Chicago, Illinois
Anjum Hassan MD
Assistant Professor, Division of Anatomic and Molecular Pathology, Washington University School of Medicine
Assistant Director FISH Laboratory, Department of Pathology, Washington University Medical Center, Barnes
Jewish Hospital, St. Louis, Missouri
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M. John Hicks MD, DDS, MS, PhD
Professor of Pathology, Department of Pathology and Immunology, Baylor College of Medicine
Attending Pathologist, Department of Pathology, Texas Children's Hospital, Houston, Texas
D. Ashley Hill MD
Associate Professor, Department of Pathology and Pediatrics, The George Washington University
Chief, Department of Pathology, Children's National Medical Center, Washington, DC
Aliya N. Husain MD
Professor, Department of Pathology, University of Chicago, Chicago, Illinois
Jason A. Jarzembowski MD, PhD
Assistant Professor, Department of Pathology, Medical College of Wisconsin Program Director, Perinatal
Pathology, Department of Pathology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
Raj P. Kapur MD, PhD
Professor, Department of Pathology, University of Washington Staff Pathologist, Department of Laboratories,
Seattle Children's Hospital, Seattle, Washington DC
Jochen K. M. Lennerz MD, PhD
Division of Anatomic and Molecular Pathology, Department of Pathology and Immunology, Washington
University School of Medicine, St. Louis, Missouri
Haresh Mani MD
Assistant Professor, Department of Pathology, Northwestern University's Feinberg School of Medicine
Pathologist-in-Chief, Children's Memorial Hospital, Chicago, Illinois
Thomas L. McCurley MD
Associate Professor, Department of Pathology, Vanderbilt University Director, Department of Immunopathology
Laboratory, Nashville, Tennessee
Deborah E. McFadden MD
Clinical Professor, Department of Pathology and Laboratory Medicine, University of British Columbia
Head and Medical Director, Department of Pathology and Laboratory Medicine, BC Children's Hospital and BC
Women's Hospital and Health Centre, Vancouver, British Columbia
Gary W. Mierau PhD
Electron Microscopist, Department of Pathology and Laboratory Medicine, The Children's Hospital, Aurora,
Colorado
Lili Miles MD
Associate Professor, Department of Pathology and Laboratory Medicine, University of Cincinnati, College of
Medicine
Staff Pathologist, Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical
Center, Cincinnati, Ohio
Jeffrey Mueller MD
Assistant Professor, Department of Pathology, University of Chicago, Chicago, Illinois
Rish K. Pai MD, PhD
Associate Staff, Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
Kathleen Patterson MD
Associate Professor, Department of Pathology, University of Washington Associate Pathologist, Department of
Pathology, Seattle Children's Hospital, Seattle, Washington DC
Elizabeth J. Perlman MD
Pathologist-in-chief, Children's Memorial Hospital
Professor of Pathology, Northewestern University's Feinberg School of Medicine, Chicago, Illinois
Arie Perry MD
Professor of Pathology and Neurological Surgery, Director of Neuropathology and Vice Chair of Pathology,
Department of Pathology, Division of Neuropathology, University of California, San Francisco (UCSF), San
Francisco, California
Theodore J. Pysher MD
Professor of Pathology, Department of Pathology, University of Utah School of Medicine
Division Chief of Pediatric Pathology and Director of Laboratories, Primary Children's Medical Center, Salt
Lake City, Utah
Vijaya B. Reddy MD
Professor, Department of Pathology, Rush Medical College Senior Attending, Department of Pathology, Rush
University Medical Center, Chicago, Illinois
Raymond W. Redline MD
Professor, Pathology and Reproductive Biology, Case Western Reserve University School of Medicine,
Cleveland, OH Co-director, Pediatric Pathology, Pathology, University Hospitals Case Medical Center,
Cleveland, OH
Andrea M. Sheehan MD
Assistant Professor, Department of Pathology and Immunology, Department of Pediatrics, Section of
Hematology and Oncology, Baylor College of Medicine
Director of Hematology and Flow Cytometry, Department of Hematopathology, Department of Pathology, Texas
Children's Hospital, Houston, Texas
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Hiroyuki Shimada MD, PhD
Professor, Department of Pathology, University of Southern California Keck School of Medicine
Pathologist, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles,
California
Joseph R. Siebert PhD
Professor of Pathology, Adjunct Professor of Pediatrics, Departments of Pathology, Pediatrics, University of
Washington Director of Autopsy Services, Department of Laboratories, Seattle Children's Hospital, Seattle,
Washington
J. Thomas Stocker MD
Professor of Pathology, Pediatrics and Emerging Infectious Disease, Department of Pathology, Uniformed
Services University of the Health Sciences, Bethesda, Maryland
Mariko Suchi MD, PhD
Assistant Professor, Department of Pathology, Medical College of Wisconsin Department of Pathology and
Laboratory Medicine, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
Jerome B. Taxy MD
Professor, Department of Pathology, University of Chicago, Chicago, Illinois
Carole A. Vogler MD
Professor and Chair, Department of Pathology, Saint Louis University School of Medicine Pathologist,
Department of Pediatric Pathology, SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri
Christopher R. Weber MD, PhD
Instructor, Department of Pathology, The University of Chicago, Chicago, Illinois
Rebecca Wilcox MD
Assistant Professor, School of Medicine, The University of Vermont Assistant Professor, Department of
Pathology, Fletcher Allen Hospital, Burlington, Vermont
Mary M. Zutter MD
Professor of Pathology and Cancer Biology, Department of Pathology, Vanderbilt University Director of
Hematopathology, Scientific Director, HTAP Shared Resource, Department of Pathology, Vanderbilt University
Medical Center, Nashville, Tennessee
Dedication
To my children and grandchildren—Louis, Jr., Carl, Christopher, Elizabeth, Rebecca, Rachael, Jennifer, and
Charlie.
Louis P. Dehner
To my mother, Khadija Omar, who has inspired me throughout my life and in memory of my father, Zahid Omar,
who saw only the beginnings of his children's lives.
Aliya N. Husain
To my wife, Pat, the Center of my life, at 44 years together and counting: to our children; Rick, his wife Cathy
and sons Jack and Joseph; David, his wife Carol and daughter Sydney; and Meg. How full they make our lives!
J. Thomas Stocker
Preface
There is no other way to put it, a book, especially one that is now in its third edition, has long since become an
enduring burden. Almost 10 years have elapsed since the last edition and no decade passes without advances
being made and old “truths” being dismissed as folly. We have attempted to capture within the front and back
covers of this book a reasonable approximation of the latest truths as they relate to our understanding of those
unique disorders of maldevelopmental, infectious, and neoplastic nature that are found predominantly in children
and in the period of 9 months preceding childhood.
The codex of pediatric pathology is still largely based upon morphologic features that are apparent in their gross
manifestations as in the case of congenital heart disease and skeletal dysplasias or on visualizing microscopic
features. Immunohistochemistry has become as routine today as the trichrome and Gomori methenamine-silver
stains. However, we have now moved into the era of application of molecular diagnostic methodologies that have
admitted us into an unseen world in a sense. The pace of discoveries has created a world where yesterday
becomes a part of the deep past as we catapult through today. In the microcosm of pediatric pathology, the
current endeavor is our attempt to capture what is reasonably stable as the foundation of morphologic pediatric
pathology. In the yesterdays, we may have speculated about the pathogenesis or puzzled over the morphologic
findings, but today, we have the ability to test those speculations and begin the process of diagnostic discovery
and investigation. As we have all experienced, this process is oftentimes one door leading to another. An attempt
has been made in this edition to not only lay out the foundation of pediatric pathology but also convey the idea
that another door awaits to be opened. It is to our younger colleagues in pediatric pathology that we address this
latter challenge.
For the majority of the chapters, about 200 of the most important references are in the printed book; the rest are
available as eReferences as indicated in the text. Similarly, some additional photomicrographs are available as
eFigures.
We have gathered a distinguished group of contributors to this tome whose collective efforts are every bit as
worthy as the three names that appear on the front cover. It is very difficult to find individuals as knowledgeable
as they are who choose to devote their precious time to the arduous task of writing a chapter that conforms to
the goals of this volume as discussed in the preceding paragraph. These authors met and exceeded those
aspirations. Some authors questioned whether the third edition would ever become a reality with legitimate
cause since we all recognize the prolonged gestation of this enterprise. One of us (LPD) had to be coaxed and
even harangued into the yoke but here we are through the monumental efforts of another one of us (ANH). We
are grateful to our authors who are also our colleagues, both past and present. Your patience and perseverance
are appreciated well beyond this acknowledgment.
J. Thomas Stocker MD
Louis P. Dehner MD
Aliya N. Husain MD
Preface to the First Edition
Several years ago, the editors of this volume were lamenting the fact that a third edition of Kissane's Pathology
of Infancy and Childhood was unlikely because John Kissane had committed himself to another formidable
publishing enterprise. Our British colleagues in pediatric pathology have authored two fine references (Keeling's
Fetal and Neonatal Pathology and Berry's Paediatric Pathology), but it was our opinion that a comprehensive
volume on all major aspects of the pathologic anatomy of chlldhood disorders ranging from chromosomal
syndromes and neoplasms to forensic pathology was needed. At this juncture in our deliberations, we were
confronted with the daunting nature of the potential task at hand given the required range of expertise necessary
to cover all of these areas. Our attention turned to the reservoir of such abilities that exists in an organization of
which we are privileged to be members, the Society for Pediatric Pathology, formerly known as the Pediatric
Pathology Club. Many of the contributors to this volume are friends and colleagues whom we met through the
Society for Pediatric Pathology.
It was Albert Einstein who acknowledged the fact that we all stand on the shoulders of giants, and certainly
pediatric pathology has evolved to its present state through the seminal contributions of the “first” generation of
North American pediatric pathologists. Some of these include Maude Abbott, Dorothy Andersen, James B. Arey,
J. Bruce Beckwith, Jay Bernstein, William A. Blanc, Robert P. Bolande, John Craig, John R. Esterly, Sidney
Farber, George Fetterman, Enid Gilbert-Barness, M. Daria Haust, John M. Kissane, Benjamin
H. Landing, A. James McAdams, Harry B. Neustein, William A. Newton, Ella Oppenheimer, Eugene V. Perrin,
Edith Potter, Harvey S. Rosenberg, Marie Valdes-Dapena, Gordon Vawter, and F.W. Wigglesworth, to mention
only a few. Virtually all of us in the second and now third generation of pediatric pathologists can call one of
these extraordinary individuals our mentor.
Because we the editors are also the co-authors of several chapters in this textbook, we appreciate firsthand the
many hours that our contributors have invested in the completion of their manuscripts. The time, experience, and
patience necessary to compile information into the concise prose required by a textbook of this type are greatly
appreciated. This textbook belongs to all of these authors collectively, despite the connotations of the cover and
title page.
We also thank our colleagues and friends at our respective institutions for their understanding and support
during the prolonged gestation and difficult delivery of this textbook. At the Armed Forces Institute of Pathology,
these include Robert McMeekin, MD, Robert F. Karnei, MD, Vernon Armbrustmacher, MD, Nancy Roberts,
Luther Duckett, Lisa Penalver, and Venetia Valiga. At the University of Minnesota, Ellis S. Benson, MD, Dale
Snover, MD, and Diane Perez, and at the Washington University Medical Center, Emil Unanue, MD, Mark R.
Wick, MD; Eleanor Grob, and Patricia Dixon are recognized for their special support.
J. Thomas Stocker MD
Louis P. Dehner MD
Acknowledgments
Dr. Stocker would like to acknowledge the authors of prior editions who are no longer with us: Drs. Laurence E.
Becker and Patricia A. O'Shea.
Dr. Dehner would like to acknowledge Jeannie Doerr, Margaret Chesney, and Walter Clermont whose tireless
efforts and encouragement brought him back from the lip of the abyss.
Dr. Husain would like to acknowledge the strong support and advice given by Drs. Thomas Krausz and Vinay
Kumar and the excellent secretarial service provided by Dorothy Peoples and Margaret Rietman.
