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Diagnostic Electron Microscopy a TEXT/ATLAS Diagnostic Electron Microscopy A TEXT/ATLAS Second Edition Springer New York Berlin Heidelberg Barcelona Hong Kong London Milan Paris Singapore Tokyo G. Richard Dickersin, M.D. Associate Professor of Pathology Harvard Medical School Associate Professor of Pathology Massachusetts Institute of Technology Pathologist Head of Diagnostic Electron Microscopy Unit Massachusetts General Hospital Boston, Massachusetts Diagnostic Electron Microscopy A TEXT/ATLAS Second Edition With 894 Illustrations G. Richard Dickersin, M.D. Pathologist and Head, Electron Microscopy Unit Department of Pathology Massachusetts General Hospital Boston, MA 02114-2617 USA and Associate Professor of Pathology Harvard Medical School Boston, MA 02115-6092 USA and Associate Professor of Pathology Massachusetts Institute of Technology Cambridge, MA 02139 USA Library of Congress Cataloging-in-Publication Data Dickersin, G. Richard. Diagnostic electron microscopy : a text/atlas / G. Richard Dickersin. — 2nd ed. p. cm. Includes bibliographical references and index. ISBN 0-387-98388-0 (hardcover : alk. paper) 1. Diagnosis, Electron microscopic. 2. Tumors—Diagnosis. I. Title. [DNLM: 1. Microscopy, Electron—methods Atlases. 2. Neoplasms— ultrastructure Atlases. 3. Cytodiagnosis—methods Atlases. 4. Kidney Glomerulus—ultrastructure Atlases. 5. Metabolic Diseases—pathology Atlases. 6. Neuromuscular Diseases—pathology Atlases. QZ 17 D549d 1999] RB43.5.D55 1999 616.07Ј58—dc21 DNLM/DLC 99-32439 Printed on acid-free paper. ©2000 by Springer-Verlag New York, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the for- mer are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with re- spect to the material contained herein. Production coordinated by Impressions Book and Journal Services, Inc., managed by Terry Kornak, and manufacturing supervised by Jacqui Ashri. Typeset by Impressions Book and Journal Services, Inc., Madison, WI. Printed and bound by Maple-Vail Book Manufacturing Group, York, PA. Printed in the United States of America. 987654321 ISBN 0-387-98388-0 Springer-Verlag New York Berlin Heidelberg SPIN 10656887 To my wife, Barbara; my daughters, Kay, Gail, Leslie, and Amy; and my son, Ged. Ten years have elapsed since the appearance of the first edition of this book, and since then a number of ad- vances have been made in the field of diagnostic pathol- ogy. New and improved techniques have contributed to our diagnostic armamentarium and to our general understanding of various disease processes. In the field of neoplasia, immunohistochemistry has become a rou- tine procedure in most departments of pathology. Flow cytometry has become an efficient technique for meas- Preface uring ploidy, and molecular biological methods such as DNA and RNA hybridization and polymerase chain re- action (PCR) have made it possible to identify specific genetic markers for various hereditary, neoplastic, and infectious diseases. The importance of these innova- tions in pathology is duly recognized, but, at the same time, they have limitations, and traditional morpho- logical studies still comprise the backbone of the pathologist’s work. In this latter group of studies we in- clude electron microscopy, which has continued to be used selectively in diagnostic workups of neoplastic, re- nal, neuromuscular, infectious, hereditary, and meta- bolic diseases. In our own experience, electron micro- scopy has been especially valuable in complementing immunohistochemistry or in superseding immunohis- tochemistry when the latter is equivocal or nonspecific. Aside from the practical application to diagnostic work, electron microscopy has been a valuable tool for educating residents and staff. It reveals cells and tissues at very high magnification, making cell surfaces and in- teriors visible beyond the limits of light microscopy, a seemingly important experience in the study of normal and diseased states. The omission of this basic mor- phological step in the training and continuing educa- tion of pathologists would be, in our opinion, a serious deficiency. In this second edition, we have retained the style and core components of the first edition but have updated the text and bibliography, added new topics, and re- placed and supplemented photographs appropriately. The result has been a larger book and, we hope, one of broader applicability. G. Richard Dickersin, M.D. Boston, Massachusetts vii It goes without saying that a book of this type cannot be produced by one person, at least not within a prac- tical time frame and while simultaneously carrying out routine “service work” in a busy department of pathol- ogy. Thus, there are a number of persons who deserve special acknowledgment for their roles in making this work possible. First, Cheryl Nason and Martin Selig were at the core of the daily labor of the book. Cheryl’s mastery of the computer allowed for rough drafts, Acknowledgments countless additions and revisions, and literature searches to be accomplished in a timely manner. Her work was always outstandingly prompt and accurate, and I am most appreciative of it. Martin was a steady, consistent, right-hand man in the “rescoping,” photog- raphy, and assembly of illustrations. His skills went be- yond the purely technical ones, of which he is such a master, and included an academic familiarity with the particular morphology we were attempting to capture and portray. As will be noticed, Martin is listed as a con- tributing author of the chapter on renal glomerular dis- ease, but he also approached a similar level of involve- ment on several of the other chapters. I wish to acknowledge and thank him for the high quality of his work and for his commitment to the project. An “unsung hero” in the evolution of this book was a person whose skillful and reliable performance of rou- tine technical chores kept our electron microscopy serv- ice viable and efficient. That person is Robert Holmes. To Rob, our emphatic expression of gratitude and ap- preciation. Special appreciation also goes to the authors of Chapters 12 and 13, Shamila Mauiyyedi, Alain P. Mar- ion, Robert B. Colvin, Umberto De Girolami, and Dou- glas C. Anthony. Their expertise and contributions round out this book, making it more comprehensive and authoritative than I could possibly have hoped to accomplish myself. Finally, as for the first edition, I want to thank my wife, daughters, and son for their tolerance during weekends and vacations, when I would usually put in a few hours on “the book.” G. Richard Dickersin, M.D. Boston, Massachusetts ix Contents Preface vii Acknowledgments ix Contributors xix CHAPTER 1 Normal Cell Ultrastructure and Function 1 Cytoplasmic Organelles 1 Cytoskeleton (Cytoplasmic Matrix Structures) 4 Cytoplasmic Inclusions 4 Nuclear Organelles 4 Organization of Organelles Within the Cell 5 Cell Attachment Sites 5 CHAPTER 2 Selective Embryology 7 Embryogenesis from Fertilization Through Three Weeks 7 Differentiation of the Paraxial Mesoderm 9 Differentiation of the Intermediate Mesoderm 10 Differentiation of the Lateral Mesoderm 11 Comparison of Embryonic Mesodermal Differentiation with Embryonal Rhabdomyosarcoma, Wilms’ Tumor, and Mesothelioma 11 CHAPTER 3 Large Cell Neoplasms 27 Carcinoma 27 Adenocarcinoma (and Adenoma) 27 Squamous Cell Carcinoma 65 xi XII CONTENTS Transitional Cell (Urothelial) Carcinoma 65 Undifferentiated Carcinoma 88 Melanoma 88 Mesothelioma 88 Lymphoma 89 Histiocytic Disorders 116 Macrophagic Lesions 116 Dendritic Cell Lesions 117 Mastocytosis and Mastocytoma 124 CHAPTER 4 Small Cell Neoplasms 147 Neuroendocrine Carcinoma 147 Neuroblastoma 147 Ewing’s Sarcoma 161 Primitive Neuroectodermal Tumor 161 Embryonal and Alveolar Rhabdomyosarcoma 169 Rhabdoid Tumor 169 Nephroblastoma (Wilms’ Tumor) 169 Lymphoma (Small Cell) 197 Plasmacytoma 197 Desmoplastic Small Round Cell Tumor with Divergent Differentiation 197 Small Cell Osteosarcoma 197 Mesenchymal Chondrosarcoma 209 CHAPTER 5 Leukemias 217 Myelocytic Leukemia 217 Monocytic and Myelomonocytic Leukemia 227 Lymphocytic Leukemia 227 Erythrocytic Leukemia 227 Megakaryocytic Leukemia 234 Hairy Cell Leukemia (Leukemic Reticuloendotheliosis) 234 CHAPTER 6 Spindle Cell Neoplasms and Their Epithelioid Variants 247 Fibrous Neoplasms 247 Malignant Fibrous Histiocytoma 264 CONTENTS XIII Cartilaginous Neoplasms 278 Osteoblastoma and Osteosarcoma 278 Synovial Sarcoma 295 Adipose Neoplasms 295 Smooth Muscle Neoplasms 320 Skeletal Muscle Neoplasms 320 Vascular Neoplasms 341 Hemangiopericytoma 341 Schwannoma and Malignant Schwannoma 359 Granular Cell Tumor 359 Neurofibroma 369 Sarcomatoid (Spindle Cell) Carcinoma
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