Cellular Pathology Cook Pdf Download
Elida Obrian
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Pathological classifications in current use for the assessment of glomerular disease have been typically opinion-based and built on the expert assumptions of renal pathologists about lesions historically thought to be relevant to prognosis. Here we develop a unique approach for the pathological classification of a glomerular disease, IgA nephropathy, in which renal pathologists first undertook extensive iterative work to define pathologic variables with acceptable inter-observer reproducibility. Where groups of such features closely correlated, variables were further selected on the basis of least susceptibility to sampling error and ease of scoring in routine practice. This process identified six pathologic variables that could then be used to interrogate prognostic significance independent of the clinical data in IgA nephropathy (described in the accompanying article). These variables were (1) mesangial cellularity score; percentage of glomeruli showing (2) segmental sclerosis, (3) endocapillary hypercellularity, or (4) cellular/fibrocellular crescents; (5) percentage of interstitial fibrosis/tubular atrophy; and finally (6) arteriosclerosis score. Results for interobserver reproducibility of individual pathological features are likely applicable to other glomerulonephritides, but it is not known if the correlations between variables depend on the specific type of glomerular pathobiology. Variables identified in this study withstood rigorous pathology review and statistical testing and we recommend that they become a necessary part of pathology reports for IgA nephropathy. Our methodology, translating a strong evidence-based dataset into a working format, is a model for developing classifications of other types of renal disease.
The rewriting of this third edition was a chance to bring this student-oriented text up to date and firmly into the 21st century. For the rewriting, the writing team has increased to two authors. The collaboration and friendly critiques between the authors have been both beneficial and pleasurable.
The new text has been substantially changed, with a new chapter on the background pathological disorders, since investigation of these disorders constitutes the main task in biomedical histology laboratories. The separate chapter on autoradiography in the second edition is now incorporated into a fresh chapter on molecular biology to emphasize the development of DNA investigation as an important method in the diagnosis of disease.
The coverage of cytological methods has been expanded to update the coverage of liquid-based cytology, which has become the standard method, and also to expand the coverage of the use of cytology in different organ systems. This has resulted in the splitting of cytology into two chapters, the first covering gynaecological cytology and the second dealing with the other applications.
The chapter on microscopy has expanded coverage of confocal microscopy and the use of digital techniques in interpreting images. There has also been a significant update for the chapter on management, with more emphasis given to safety and quality control.
The changes in the text are now supported by a greater use of colour images and this helps readers to better visualize the topics covered in the text. Thanks are due to Behad Shambayati and Libby Soar for help with obtaining cytology images.
It is nice to have the opportunity to produce a second edition of this book. Some things have changed but the popular structure of the book remains the same. Some of the changes are additions of new material, particularly in chapters 10, 12 and 17, whilst others are removal of older outdated material such as the references to stripping film in autoradiography where this particular product is, sadly, no longer produced. Chapter 10 on immunology techniques includes a range of newer techniques that have become popular since the first edition. Chapter 12 now introduces the changes to cytology screening in the UK where the use of fluid-based systems is replacing the traditional direct smearing and includes details of the Bethesda 2001 system for classifying cellular abnormalities. Some of the changes in chapter 17 relate to changes in legal requirements for safety in the laboratory. In the first edition safety was mentioned at many points in passing but there was no consideration of safety as a single topic. In this edition the individual references to safety remain embedded in the individual chapters but there is now a section purely on the organization and legal aspects of safety. Also changed in chapter 17 is a revised section mentioning the Human Tissue Act and introducing inter-laboratory quality control.
Other changes have occurred because of a change in publisher. The layout of the chapters has been improved and the learning objectives expanded. The contents list has been expanded significantly to help readers to navigate through the book more easily. The most important change is the inclusion of colour photographs in the book to help readers gain a better understanding of the subject in practice. So my thanks go to Jonathan Ray of Scion Publishing Ltd for encouraging the inclusion of the many colour photographs and also for his help in producing a new and better edition. My thanks also go to the copy-editor, Jane Hoyle, who checked my drafts and corrected my errors.
I am fortunate to be revising this edition at all. I began revising the material in the autumn of 2005 but then had a cycling accident at the end of November 2005. This fractured my skull and resulted in a subdural haematoma. The clot was removed at Southampton Neurological Centre and I was in Intensive Care on life support. Fortunately, I have recovered completely and so was able to complete the revisions in January 2006. I would like to thank the staff at Southampton Neurological Centre for their care and support. I would also like to thank Judy, my wife, and my children, Malcolm and Elaine, for their support and encouragement during my convalescence.
Ever since the microscope was invented somewhere around the beginning of the 17th century it has been used to magnify human cells and tissues. The great difficulty with the application of the microscope is that the tissues themselves are really quite featureless and uninteresting unless they are first prepared in some way to enhance the detail. This book is an attempt to explain the methods used in examining cells and to try to give a theoretical outline of the basis of the techniques.
I will begin with the words used to describe the topic itself. There are many words that have been used to describe the subject over the years and they all have some merit. The parent subject is anatomy (from the Greek meaning cutting up: ana = up and tome = to cut), which is the study of the organs and their shape, arrangement and structure. Anatomy is an ancient discipline. Ever since humans first started butchering animals, people must have realized that the body is made of different organs and that all of these organs have varying structures. Over many centuries, the study of anatomy catalogued and described the visible structure of the human body and laid the foundations of physiology by trying to explain the functions of each organ and how the organs interacted with each other (see Box 1.1 for comments).
With the development of the microscope, the organs could be seen in finer detail and the discipline of microscopic anatomy was born. This is now normally called histology, the study of tissues and their structure. The term histology usually means the study of normal tissues, whilst the study of diseases in tissues is more correctly called histopathology, but fashions in science change and the more common term now is cellular pathology. This is a good name for the science since the basic structure of the human body is the cell and the basis of most human disease is also at the cellular level.
Tissues consist of cells and the study of the structure of cells is cytology, which can be used diagnostically. The prefix cyto can usually replace the prefix histo with the inference that the emphasis is on subcellular detail rather than on multicellular structures. Thus, we can have cytochemistry, immunocytochemistry, cytopathology and so on. In many cases the terms are simply interchangeable. Although this book is entitled Cellular Pathology, it is not limited to the diagnosis of disease and can be used equally as an introduction to normal histological techniques and/or research applications. There is no dividing line between the preparation of normal tissues and diseased tissues; the methods are the same, just the application is different.
Histology does not exist in isolation but constantly interacts with other disciplines such as biochemistry and physiology. Many of the histochemical techniques used today are modifications of methods used originally in biochemistry. Biochemistry in turn depends on the information provided by histology to identify the sites where the biochemical events are occurring. The scientific disciplines are complementary. The main advantage of histology is its ability to localize materials and metabolic processes within the tissues and even within individual organelles in the cell. The main disadvantage of histology is the requirement that the materials being examined cannot be allowed to move and must be kept in their original site (in situ). The advantage and disadvantage are the same: the very thing that makes histology so useful also imposes its own problems. This is why histology needs the other disciplines and the other disciplines need histology. They are not competitors but allies in the scientific investigation of disease.
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