A Pattern Based Approach
Atlas of Pulmonary Pathology
YASMEEN M. BUTT, MD
Assistant Professor
Department of Laboratory Medicine and Pathology
Mayo Clinic Alix School of Medicine
Mayo Clinic Arizona
Scottsdale, Arizona
HENRY D. TAZELAAR, MD
Geraldine Zeiler Colby Professor of Cytopathology
Department of Laboratory Medicine and Pathology
Mayo Clinic Alix School of Medicine
Mayo Clinic Arizona
Scottsdale, Arizona
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Dedication
As with any written work, this atlas was not created in a vacuum, and I would like to dedicate this work to all the people in my life who have helped me reach this point in my life and career.
Thank you to Dr. Patricia M. Jones for introducing me to pathology and being the best friend one could ask for. Thank you to Dr. Dinesh Rakheja for introducing me to anatomic pathology and correctly diagnosing me as a future pathologist at the age of 19. My infinite gratitude to Dr. Charles F. Timmons for taking a chance on me and supporting me in so many ways over the years.
My gratitude to Dr. Jose R. Torrealba for his mentorship and for introducing me to pulmonary pathology while uttering that fateful statement to me as a first-year resident: This is not usual interstitial pneumonia, this is pleuroparenchymal fibroelastosis. Thank you to Dr. S. Tunc Gokaslan for being an amazing mentor and friend. The good control is coming tomorrow; they didnt want to delay the case.
Thank you to Dr. Brandon T. Larsen and Dr. Maxwell L. Smith for sharing their wealth of experience with me and for being wonderful colleagues. Many of the pearls in this book I learned from them! Thank you to Dr. Henry D. Tazelaar for his mentorship and agreeing to write this book with meit has been quite the journey, and I have learned so much!
Thank you to Dr. Laura L. Kwan, for always lending an ear and being a steadfast friend.
Thank you to my Dad for all the love, support, and talks on the steps. Words are not sufficient to thank him. Thank you to my Mom for her unconditional love and support through the years. I literally would not be here without her.
Most importantly, thank you to Jake and Aya. You both are the lights of my life and give everything meaning.
Yasmeen M. Butt, MD
This work is dedicated to my patient and encouraging wife, Peggy, and to our sons, Jeff and Andrew, and Andrews wife, Christina, for their strong support of me and the many hours spent reviewing clinical cases and research materialwithout them and their understanding, this work would not have been possible; and to Isaiah and Lydia, with hopes that you learn to love science as much as your papa.
Henry D. Tazelaar, MD
ACKNOWLEDGMENTS
Many of the cases photographed for this atlas are from the Charles B. Carrington Memorial Teaching Collection, established and curated for over 40 years by Dr. Thomas V. Colby. Tom, we owe you a huge debt of gratitude. We also thank the many pathologists and clinicians who have trusted us enough to share their complicated thoracic pathology cases with us, and for other Mayo Clinic pathologists who have helped build this collection, including Dr. Jeffrey L. Myers, Dr. Kevin O. Leslie, Dr. Maxwell L. Smith and Dr. Brandon T. Larsen. Our sincere thanks to Dr. John M. Carney for helping with the initial preparation of the text and figures for Chapters 5-7, and 9. Many thanks also go to Ariel Winter, our development editor, and Julie Kostelnik, our editorial coordinator from Wolters Kluwer, for their infinite patience and assistance as we completed this book.
YASMEEN M. BUTT, MD
Assistant Professor
Department of Laboratory Medicine and Pathology
Mayo Clinic Alix School of Medicine
Mayo Clinic Arizona
Scottsdale, Arizona
HENRY D. TAZELAAR, MD
Geraldine Zeiler Colby Professor of Cytopathology
Department of Laboratory Medicine and Pathology
Mayo Clinic Alix School of Medicine
Mayo Clinic Arizona
Scottsdale, Arizona
PREFACE
Pulmonary pathology, both neoplastic and nonneoplastic, can be quite challenging, and this atlas aims to create a high yield and figure heavy reference based on patterns: nodules; interstitial disease, cellular; interstitial disease, fibrotic; alveolar filling; and minimal change. Chapters 2-6 (Lung) and Chapters 9 and 10 (Pleura) are split into neoplastic and nonneoplastic entities attributed to a particular pattern. Chapters 1 and 9 highlight normal lung and pleura, respectively. Chapter 7 is a special section covering lung transplantation.