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Immunohistology of Infectious Disease

Introduction During the last two decades, the approach to histopathologic diagnosis has been dramatically transformed by immunohistochemistry, specifically in the diagnosis and classification of tumors and, more recently, in the diagnosis of infectious diseases in tissue samples. Pathologists play an important role in recognizing infectious agents in tissue samples from patients, providing a rapid morphologic diagnosis, and facilitating clinical decisions in patient management, particularly when fresh…

Quality Assurance in Immunohistochemistry in the Age of Precision Medicine

Introduction Quality assurance (QA) in immunohistochemistry (IHC) in the era of precision medicine means that IHC assays are set up to be fit-for-purpose. , Although it is without question that precision medicine depends on accurate diagnosis and classification of various diseases, the surge in the development and clinical testing for predictive biomarkers has gained much attention and is becoming an important resource-intensive area of practice for…

Techniques of Immunohistochemistry: Principles, Pitfalls, and Standardization

Overview Immunohistochemistry (IHC), or immunocytochemistry (ICC), is a laboratory technique used to detect specific antigens (i.e., proteins) in tissues or cells based on antigen-antibody recognition; it seeks to exploit the specificity provided by the binding of an antibody with its target antigen at the light-microscopy level. IHC has a long history that dates back more than 70 years when Coons first developed an immunofluorescence technique to…

Application of Modern Techniques

The practice of surgical pathology has relied traditionally on evaluation of the gross and microscopic features of tissue specimens, integrated with the clinical history and other laboratory data, to reach a definitive diagnosis, assign prognosis, and assist the clinician and ultimately the patient to select the most appropriate form of therapy. Histologic examination of tissue specimens has, for many decades, occupied the central role in the…

Tumors of the Ear

Reactive and neoplastic lesions of the ear are infrequent but may pose diagnostic difficulties for the pathologist. The inner ear is composed of a specific form of inert bone, a virtually nonmitotic sensory area, and nerves. Its tumors are mainly those of Schwann cell lineage, the only relatively labile cells in that region. The middle ear is lined by a simple flat epithelium, but its ability…

Tumors of the Eye and Ocular Adnexa

Surgical pathologists are often challenged when evaluating neoplastic lesions of the eye and ocular adnexa. Most pathologists are accustomed to focusing their attention on the diagnosis and prognostic features that guide therapy. The diagnosis of neoplasms of the eye and adnexa adds an additional dimension: The pathologist must provide information that also helps the surgeon to preserve vision, a therapeutic goal that may assume equal importance…

Tumors of the Autonomic Nervous System, Including Paraganglia

Extraadrenal Paraganglia Extraadrenal paraganglia have a centripetal and roughly symmetric distribution on either side of the midline, extending from the middle ear region and base of the skull to the pelvic floor. The sympathoadrenal neuroendocrine system is an integrated complex composed of the sympathetic nervous system, with postganglionic neurons mediating effector responses via the neurotransmitter norepinephrine, and the adrenal medullae, which synthesize and secrete the hormones…

Tumors of the Peripheral Nervous System

Introduction Traditionally, chapters similar to this one are entitled either “Tumors of the Peripheral Nervous System” or “Peripheral Nerve Sheath Tumors.” Such designations have been dropped in the present text so as to avoid any implications of histogenesis, which have progressively become less tenable, and to allow more logical inclusion of those tumors showing neuroectodermal differentiation, which arise at soft tissue locations without evidence or likelihood…

Tumors of the Central Nervous System

Introduction The 2016 World Health Organizaiton (WHO) classification of tumors of the central nervous system (CNS) introduced a very significant paradigm in which diagnostic reports integrate histologic features with molecular parameters to designate tumor groups, instead of simply listing associated molecular markers. The justification for this so-called integrated diagnosis, rather than merely noting an association, is a better understanding of the effects that specific molecular alterations…

Tumors of the Osteoarticular System

Epidemiology and Predisposing Factors While benign bone tumors are relatively common, primary malignant tumors of bone are rare and occur far less frequently than osseous metastases. Approximately 3200 patients are diagnosed with primary bone sarcoma in the United States per year compared with approximately 222,000 new cases of lung cancer and 255,000 new cases of breast cancer. The overall annual incidence rate for primary bone sarcomas…

Tumors of Soft Tissue

Introduction Tumors arising in soft tissue, although clinically often nondistinctive, form a varied and complex group that may show a wide range of differentiation. To an extent perhaps shared only by hematolymphoid disorders, the morphology of soft tissue lesions frequently belies their true biologic potential: examples of pseudomalignancy and even pseudobenignity abound. For this reason alone, in the absence of a firm histologic diagnosis it is…

Tumors of the Skin

The nomenclature of cutaneous tumors, as in other areas of pathology, is in constant evolution. Some of the newly created terms to replace older conditions are hardly an improvement to the previous, more popular ones. Some names are so deeply ingrained that, despite their obvious inaccuracies, the replacement terms are very slowly adopted: The cases of mycosis fungoides and pyogenic granuloma by cutaneous T-cell lymphoma and…

Tumors of the Hematopoietic System

The identification of genes associated with recurrent chromosomal abnormalities has revolutionized diagnostic surgical pathology. This is especially true for the hematopoietic diseases, loosely defined as hematolymphoid disorders that most commonly involve the bone marrow, spleen, and peripheral blood. These chromosomal aberrations result in altered cellular programs that, in concert with additional genetic or epigenetic changes, lead to characteristic tumor morphology and, perhaps more importantly, a particular…

Tumors of the Lymphoreticular System, Including Spleen and Thymus

Lymph Node Scott B. Lovitch John K.C. Chan Chapter Outline Lymph Node and Organized Lymphoid Tissues, 1412 Diagnosis of Lymphomas, 1415 Hodgkin Lymphoma, 1428 Non-Hodgkin Lymphomas, 1444 Precursor Lymphoblastic Lymphoma, 1450 Mature B-Cell Lymphomas, 1453 Peripheral T-Cell and Putative NK-Cell Neoplasms, 1498 Lymphoproliferative Disorders Associated With Immunodeficiency, 1527 Tumors of Histiocytes and Dendritic Cells, 1529 Leukemia and Related Conditions, 1538 Metastatic Tumor in Lymph Node, 1539 Nonhematolymphoid Tumors…

Tumors of the Endocrine Pancreas

Terminology and Classification Tumors of the endocrine pancreas are called pancreatic neuroendocrine neoplasms (PanNENs). PanNEN, like the neuroendocrine neoplasms (NENs) of the gastrointestinal tract, are stratified into two major groups ( Table 20.1 ), the well-differentiated NENs called pancreatic neuroendocrine tumors (PanNETs) and the poorly differentiated NENs called pancreatic neuroendocrine carcinomas (PanNECs). The PanNETs are further separated by their proliferative activity into either G1 NET (Ki67…

Tumors of the Adrenal Gland

The Normal Adrenal Gland The adrenal gland is a bipartite endocrine gland composed of cortex and medulla, each of which has different embryogenesis, structure, and function. The adrenal cortex arises from cells associated with the coelomic epithelium, which are of mesodermal origin. The cortex plays a vital role in the regulation of water and electrolyte balance, mainly by the secretion of mineralocorticoids and, through the action…

Tumors of the Thyroid and Parathyroid Glands

The Thyroid Gland John K.C. Chan Chapter Outline The Normal Thyroid Gland, 1244 Thyroid Tumors: An Overview, 1244 Diagnosis of Thyroid Tumors, 1247 Tumors of Follicular or Metaplastic Epithelium, 1249 Tumors Showing C-Cell Differentiation, 1292 Tumors Showing Both Follicular and C-Cell Differentiation, 1300 Thymic and Related Branchial Pouch Tumors of the Thyroid, 1301 Tumors of Hematolymphoid Cells, 1304 Mesenchymal Tumors and Other Tumors, 1307 Unusual and Uncommon…

Tumors of the Pituitary Gland

Introduction Tumors of the pituitary gland and sellar region represent approximately 15% of all brain tumors, and the most common primary brain tumor by histologic type in person age 15 to 39 years. Numerous types of tumors may involve the sellar region, reflecting its complex anatomy. Table 17.1 lists the most frequent tumors arising in the sellar and parasellar regions. The most common tumors are, by…

Tumors of the Breast

Classification of Breast Disease For the most part, consistency now exists in the terminology, definitions, and systems used for pathologic and clinical classification of breast disease. The World Health Organization (WHO), Royal College of Pathologists, College of American Pathologists (CAP), and European Commission have produced guidelines on reporting breast disease. These propose virtually identical systems of classification of benign conditions that pathologists are encouraged to adopt.…

Tumors of the Peritoneum

In this chapter, peritoneal lesions are reviewed under the following headings: tumorlike lesions, mesothelial neoplasms, miscellaneous primary tumors, metastatic tumors, and lesions derived from the so-called secondary Müllerian system. Disorders of the retroperitoneum, except those of peritoneal origin, are not included. Tumor-like Lesions Mesothelial Hyperplasia Mesothelial hyperplasia is a common response to acute and chronic inflammation and chronic effusions ( Figs. 15.1, 15.2, 15.3, and 15.4…