PathologyGrossPathologyGrossGross Pathology

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ISBN: 978-93-86217-52-3

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Ila Tyagi

Abhijit Das

Chief Editor

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fis a practical guide in museum and gross pathology for the undergraduate medical students and also a work of reference for residents.

It includes all aspects of gross pathology, beginning with the collection of the specimen in the laboratory, progressing through fixation, gross examination, grossing techniques, differential diagnosis and finally mounting of the specimens in the museum. Apart from the basics of grossing, a strategic approach to specimen processing and diagnosis through each organ system is illustrated. An important aspect of the book is numerous high resolution color photographs of the pathological specimens and schematic diagrams to illustrate the normal anatomy, grossing techniques and salient gross features which are frequently asked in the practical examinations.Photomicrographs of important specimens are also incorporated so as to give a wholesome picture of the subject, especially for the benefit of the postgaduate students/residents. This book is unique for three reasons. First, it is based on gross pathology—a very crucial aspect of histopathology. Second, it provides an accurate and quick description of surgical and autopsy specimens that is easy for students to understand. Third, it offers differential diagnosis of important specimens commonly asked in examinations.

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Ila Tyagi MBBS, DNB is Associate Professor, Department of Pathology, North Delhi Municipal Corporation Medical College (NDMCMC) and Hindu Rao Hospital (HRH), Delhi. She is recipient of Dr Ramalingaswami Award for the best paper presentation at IAPM and has to her credit many publications in indexed journals of national and international repute. She has presented papers at various national and international conferences. She has setup pathology museum at NDMCMC and made museum catalogue for undergraduates. She had a major role in organizing for the first time “MCI Basic Course Workshop in Medical Education Technologies for Medical Teachers” training programme at NDMCMC. She took up the lead in initiating clinicopathological meets in NDMC medical college. Her fields of interest are gastrointestinal and renal pathology.

Abhijit Das MBBS, MD is senior resident, Department of Pathology, NDMCMC, Delhi. He completed his postgraduation from All India Institute of Medical Sciences, New Delhi. He is coauthor of Essentials of Practical Pathology for Undergraduates, and has drawn schematic diagrams for the forthcoming Textbook of Pathology by Dr Vinay Kamal. He has published many articles both in national and international journals and been awarded for paper presentation in various conferences. His work has been appreciated by eminent faculty members across the country.

Essentials of

GrossPathology

CBS Publishers & Distributors Pvt LtdNew Delhi • Benga luru • Chenna i • Koc hi • Kolka ta • Mumba i

Hydera bad • Na gpur • Pa tna • Pune • Vijayawa da

Chief Ed itor

Ila Tyagi DNB

Assoc ia te Professor, Depa rtment o f Pa tho logyNorth Delhi Munic ipa l Corp ora tion (NDMC)

Med ic a l College a nd Hindu Rao Hosp ita l (HRH)Delhi

EditorAbhijit Das MD

Senior Resid entNDMC Med ic a l College a nd HRH, Delhi

Essentials of

GrossPathology

Ritu Arora MD

Senior Resid entNDMC Med ic a l College a nd HRH, Delhi

Assoc ia te Ed itorsNamrata Nargotra MD

Hea d , Depa rtment o f Pa tho logyNDMC Med ic a l College a nd HRH, Delhi

Srishti Gupta MD

Senior Resid entNDMC Med ic a l College a nd HRH, Delhi

Dipti Kalita MD

Consulta nt Pa tho log ist, Ba tra Hosp ita l and Med ic a lResea rc h Centre, Delhi

ISBN: 978-93-86217-52-3

Copyright © Editors and Publishers

First Edition 2017

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Disc la imer

Researc h in trea tment a nd d rug therap y is c ontinua lly in p rogressthroughout the w orld . Rec ommenda tions and c ontra ind ic a tionsin dosa ge sc hed ules req uire c onsta nt up da ting a nd c ha ng e,bo th from year to year and c ountry to c ountry. Diffe rent d rugsma y have a simila r na me in other c ountries or the same d rugsma y b e pac ked in d ifferent streng ths. It is, there fore, ad visab leto c onsult the p roduc t info rma tion shee t p rovided w ith ea c hdrug , pa rtic ula rly in the c ase of new , fore ign or ra rely used d rugsto e nsure th a t c ha ng e s ha v e no t b e e n m a d e in therec ommended d osages.

Foreword

Gross pathology, a vital part of histopathology, is absolutely necessary in the curriculum of MBBS undergraduates,pathology residents and paramedical students. There is a lacuna in the availability of books which specificallyfocus on gross features and differential diagnoses of pathological specimens commonly asked in the exams. Onehas to go through multiple books to gather all the information, which is not only a time consuming task but alsoadds to a lot of confusion due to discrepancy in different books.

This book entitled Essentials of Gross Pathology authored by Dr Ila Tyagi, Dr Namrata Nargotra, Dr Dipti Kalita,Dr Abhijit Das, Dr Srishti Gupta and Dr Ritu Arora is a unique publication. It is no exaggeration when I say thatthis book is an “all-in-one” practical gross pathology book as it covers all aspects of histopathology specimens forundergraduate’s practical examination. It is a one stop source of in-depth and detailed information on the subjectwritten in a very lucid, concise and bullet point form. I am sure this book will be of immense benefit to one and allworking in this field.

It is my privilege and honor to be invited to contribute the foreword for this comprehensive practical book ongross pathology. I can imagine the hard work put in by the authors preparing this book. I congratulate all of themand specially Dr. Ila Tyagi for initiating such a venture, leading the team, her untiring efforts and her valuablecontributions to the subject. I wish all the authors the very best in their future endeavors!

Lastly, I thank CBS Publishing House Ltd., New Delhi, for having readily agreed to publish the book. I knowthey are second to none in the publication of a series of medical books of value.

Puja SakhujaPro fessor a nd Head

Dep a rtment o f Pa tho logyGovind Ba lla bh Pant Institute o f

Postgrad ua te Med ic a l Educ a tion a nd Resea rc h,New Delhi-110002

Preface

Gross pathology refers to macroscopic manifestation of diseases in organs, tissues and body cavities. Grossing isthe first step in surgical pathology and extremely important for correct interpretation and diagnosis. Thoughseveral good books on pathology are available for students’ consumption, there is a paucity of books on grosspathology.

This book serves as a practical guide for the undergraduate museum in all the aspects of gross pathology, i.e.reception of the specimen, fixation, gross examination and dissection, and differential diagnosis and techniquesof mounting of the specimens. It includes basic introduction to grossing techniques, a discussion of typical specimentypes and a strategic approach to the specimen along with schematic pictures illustrating the same progressingthrough each organ system.

The chapters have been organized in the following fashion. Each chapter begins with a brief review of thenormal anatomy of an organ followed by its grossing techniques. We then discuss the salient gross features ofimportant specimens that frequently occur in undergraduate examinations. The chapter ends with a discussionon differential diagnosis focusing predominantly on gross pathology. There are numerous gross pictures andschematic diagrams to illustrate the normal anatomy, grossing techniques and pathology.

This book is unique for three reasons. Firstly, it is based on gross pathology—a very crucial aspect ofhistopathology. Secondly, it provides an accurate and quick description of surgical and autopsy specimens that iseasy to digest for students. Lastly, it offers differential diagnosis of important specimens commonly asked inexaminations.

This book has been compiled after extensive research of current examination trends based on our discussionsand continuous interactions with students and faculty alike. In our constant endeavor to keep this book currentwith examination trends, all suggestions for further improvement are welcomed.

We sincerely hope that this book will be of immense help to undergraduate students in their practicals andviva voce examinations.

Editors

Ila Tyagi DNB (Institute o f Pa tho log y, ICMR Delhi)

Assoc ia te Professor, Depa rtment o f Pa tho logyNorth Delhi Munic ipa l Corp ora tion (NDMC) Med ic a lCollege and Hind u Rao Hosp ita l, Delhi

Namrata Nargotra MD (AFMC Pune)

Hea d , Depa rtment o f Pa tho logyNDMC Med ic a l College a nd HRH, Delhi

Srishti Gupta MD (Army ho sp ita l, R&R Delhi)

Senior Resid entNDMC Med ic a l College a nd HRH, Delhi

Ritu Arora MD (GMC Amritsa r)

Senior Resid entNDMC Med ic a l College a nd HRH, Delhi

Abhijit Das MD (AIIMS Delhi)

Senior Resid entNDMC Med ic a l College a nd HRH, Delhi

Dipti Kalita MD (AMC Dib ruga rh)

Consulta nt Pa tho log ist, Ba tra Hosp ita l and Med ic a lResea rc h Centre, Delhi

Contributors List

We extend our sincere thanks to a number of people without whom this book would not have become a reality.We take this opportunity to thank Mr PK Gupta (Commissioner, MCD) and Mr Pankaj Kumar Singh (Additional,Commissioner, MCD) who are the backbone of the newly formed NDMC Medical College.

Our special thanks to Mr Mayank Sharma (former Additional Commissioner, MCD), who played a major rolein the formation of this medical college. We also thank our Medical Superintendent—Dr KL Khurana forencouraging us and providing us with necessary support at all times.

We thank and acknowledge the Dean of our college, Dr Rani Kumar, for her constant encouragement andsupport. She inspired us to write this book on gross pathology and has been the guiding light in our endeavor.

We are greatly indebted to our teacher, mentor and guide Prof Rajbala Yadav. With her vast experience in thefield of pathology, she has provided her expert insight to this work. We also thank the other faculty members ofour department Dr. Sompal Singh, Dr Manupriya Nain, Dr Jyotsna Nigam and Dr Ruchi Rathore for their support.

Our special thanks and acknowledgement to Dr Dinesh Negi, CMO Administration, NDMC Medical Collegefor his constant encouragement and invaluable ideas which have enthused us to strive to do better.

This acknowledgement wouldn’t be complete without thanking faculty members of other colleges who helpedus immensely at all times of need and have been a source of constructive suggestions.

For her constant support and encouragement we would like to thank Dr Leela Pant, Medical Suprintendent,Kasturba Hospital (former Head, Department of Pathology, Hindu Rao Hospital)

Our special thanks to Dr Vinay Kamal, Director Professor Pathology, MAMC for his constant encourgement,guidance and constructive suggestions.

We are greatly indebted to Dr Puja Sakhuja, Head of the Department, Pathology, GB Pant Institute ofPostgraduate Medical Education and Research (GIPMER), New Delhi for readily helping us and graciouslyproviding us with gross photographs of gastrointestinal and neuropathology specimens. We also thank otherfaculty members of GIPMER, Prof KR Saran, Prof Vinita Batra and Dr Kaushik Majumdar for their support.

We wholeheartedly thank Dr Sunita Saxena, Director and Dr Usha Agarwal, Additional Director, NationalInstitute of Pathology (NIOP) for helping us.

We are greatly indebted to Dr Surider Paul HOD, Government Medical College, Amritsar for supporting us.Constant inspiration and support from Dr Nidhi Verma, Dr Prerna Arora, Dr Meeta Singh (MAMC), Dr Monika

Matlani, Dr Meetu Agarwal (Safdarjung Hospital), Dr Fouzia Siraj, Dr Harpreet Walia (NIOP) and Dr KavitaGaur (GIPMER) kept us going through the course of this book.

We acknowledge and thank and our residents Dr Gaurav Jain, Dr. Mansi Chandana, Dr.Garima, Dr.Ruchi, DrMeenal, Dr Alek, Dr Meenakshi, Dr Ranjeet and Dr Varun, Dr Shakti, Dr Pinkey, Dr Anshu, Dr Malini, Dr Swapna,Dr Amul and Dr Shilpi for their help and support.

We wholeheartedly thank CBS Publishers and Distributors specially Mr YN Arjuna (Senior Vice-PresidentPublishing, Editorial and Publicity) for his immense support, encouragement and invaluable guidance for this project andhis team Ms Ritu Chawla (AGM Production), Neeraj Prasad (Graphic artist) with his untiring efforts on drawings,Ms Jyoti Kaur (DTP Operator) for excellent formatting, Mr Kshirod Sahoo (Proof-reader) for his excellent workand Mr Sunil Dutt for helping us come out with this book.

We sincerely thank the backbone of support-our technical staff Mrs Shakti Kalani, Mr Sukhvinder, Mr Ravi,Mr Aman and Mr Nitish who helped us in setting up the Pathology Museum and mounting.

No work is complete without the unending support, patience, constant encouragement of a loving familymember. So we thank our family members (Dr Anand Tyagi, Gen. Sarin, Dr Rajeev Bhagat, Dr Kunjahari Medhi,Mrs Kankana Roy Das and Mr Tarun Aggrawal) for being there with us at times of need.

Above all we thank Almighty for the divine blessings without which no work can ever reach completion.

Editors

Acknowledgments

Foreword by Puja Sakhuja v

Prefac e vii

Contributors list ix

1. Fixa tion 1

2. Museum Preparation Techniques 4

3. General Approach to Grossing of Surgical Spec imen 8

4. Heart 11

5. Lymph Node and Spleen 21

6. Respiratory System 31

7. Head and Neck 54

8. Gastrointestinal Trac t 76

9. Liver, Panc reas and Gallb ladder 103

10.Urinary Trac t 121

11.Male Genital Trac t 151

12.Female Genital Trac t 172

13.Breast 211

14.Bones and Joints 220

15.Soft Tissues 249

16.Central Nervous System 266

17.Eye and the Orbit 279

Index 283

Contents