NEW ERRATA/ADDITIONS RAPID REVIEW

PATHOLOGY 3RD EDITION REVISED REPRINT

(3-8-2013)
Some of the additional material is from Rapid Review 4th ed, which will not be out as a
book until late next year.
Page 15
B. 2. a. (3) Smooth muscle hypertrophy (also hyperplasia) in the urinary bladder.
C.2.a.(3) Benign prostatic hyperplasia due to an increase in sensitivity to dihydrotestosterone
Page 23: Copy and insert as a page into book
3. Rolling of neutrophils in the venules due to expression of selectin adhesion molecules on
neutrophils and endothelial cells
a. Selectins are carbohydrate-binding adhesion molecules.
b. L-Selectin is located on leukocytes (e.g., neutrophils), while E-selectin and P-selectin are
located on the surface of endothelial cells.
(1) P-selectin is produced in the Weibel-Palade bodies in endothelial cells.
(2) Weibel-Palade bodies are the glue factory of the endothelial cells, because they
synthesize P-selectin, an adhesion molecule for leukocytes) and von Willebrands
factor, the adhesion molecule of the platelet (refer to Chapter 15).
c. Interleukin-1 (IL-1) and tumor necrosis factor (TNF) stimulate the expression of selectin
ligands on the surface of neutrophils (L-selectin) and the expression of selectin molecules
on the surface of endothelial cells (E-selectin, P-selectin).
d. Binding of circulating neutrophils to E-selectin and P-selectin molecules on endothelial
cells is weak and transient causing them to roll (bind detach, bind detach) along the
endothelial surface of the venules.

Page 30
3.b.(4)(b) In the event that there is excessive DNA damage, the TP53 suppressor gene produces protein
products that inhibit the translation of the BCl2 anti-apoptosis genes, which leads to apoptosis
of the cell.

Page 41
Figure 3-1 legend second sentence and the mother is haplotype A2B2C2D2

Page 49
D. Acquired immunodeficiency syndrome (AIDS)
1.
Epidemiology
c. Virus characteristics
(2) HIV-1 most common cause of AIDS in United States; HIV-2 more restricted (most
prevalent in Western Africa).
MN: HIV-2: more restricted than HIV-1; most prevalent in Western Africa

Page 52
Fig. 3-5: Change 4b2b to 4b2a; change C4b2b3b to C4b2aC3b; change C3bBb3b to C3bBbC3b
Page 114
First Margin note top of page, add arrow before VLDL as shown:
Kwashiorkor: fatty liver
apoB synthesis; VLDL synthesis
Second Margin note from top of page
Marasmus: total calorie deprivation; protein and CHO
Page 119
H.3.Excess intake.renal calculi composed of calcium oxalate.
Page 127
Fig. 8-2: D. Radiograph showing osteolytic lesions. Note the radiolucent areasin the midshaft of
the fibula (arrow).
Page 130
4.a. Treatment of H. pylori infections
Decreases risk for developing malignant lymphoma of the stomach (not adenocarcinoma)
Margin Note: 3rd from bottom: Rx H. pylori infection: risk for developing malignant lymphoma
Page 139
Box: 140/190 mm Hg
Page 140
Blue box: Non-pharmacologic treatment
Page 150
Fig. 9-9 legend
D. Sturge Weber syndrome. Nevus flammeus (birthmark) on the face in the distribution of the
ophthalmic and/or maxillary branch of cranial nerve V (trigeminal).
Page 161
Systolic dysfunction is characterized by(EF < 40%)
Page 161-162
Shaded area 8 sentences down from the top: aldosterone blockers) compliment
3.

Gross and microscopic findings

a.
b.

Lungs are heavy, congested, and exude a frothy pink transudate (edema) on the cut surface or
in the airways.
Alveoli are filled with a pink staining fluid and alveolar macrophages containing hemosiderin
(heart failure cells).
(1) Latter finding implies that the pulmonary capillaries have ruptured under pressure and
RBCs entered the alveoli and were phagocytosed by alveolar macrophages.
(2) Excess iron in the macrophage binds to ferritin, which degrades into hemosiderin (rusty
colored granules with H:E stain or blue with Prussian blue stain) producing a rusty
colored sputum.

Page 182
K.4.c. Microembolization findings (occurs in > 50% of cases)
(3) Oslers nodes are painful hemorrhagic nodules on the pads of the fingers or toes (10% to
23% of cases).
(a) Although most references state that Oslers nodes are an example of an
immunocomplex vasculitis, more recent studies have contradicted that belief.
(b) Early biopsies frequently demonstrate bacteria within microabscesses without any
evidence of a vasculitis, which favors microembolization as the initial process.
(c) However, as time progresses, the microabscess become sterile and an immunemediated vasculitis develops.

Page 184
Top Margin note: Viruses: most common known cause myocarditis and pericarditis
VII.A.1.b. (1) (a) Viruses most common cause
Adenovirus, coxsackievirus, HIV, parvovirus B19, human herpesvirus-6
B.1.b. Viruses are the most common overall known cause
Last Margin note: Pericarditis delete margin note
188
D.1.b.(4) Genes involved are mapped to chromosomes 11 (most common) and 14q.
Page 199
e. Ascorbic acid DELETE e. ENTIRELY
Page 201
3.

Laboratory findings
a.
Normal to decreased MCV
(1) ACD, in some cases, presents as a normocytic anemia.
(2) It is most likely to be a microcytic anemia in the setting of rheumatoid arthritis and
Crohn disease.

Page 204
c.1. Abdominal colic with constipation

Page 213
B.1. c. Membrane protein defect results in a loss of RBC membrane ( surface/volume ratio)
and spherocyte formation.
(1) Mutation in spectrin followed by ankyrin is the most common defect.
d. Increased permeability of spherocytes to potassium and water
3. c. Increased RBC osmotic fragility

(1) Decreased surface/volume ratio in spherocytes is the most critical factor for
increased RBC osmotic fragility.
D.1.a. Acquired stem cell disease with a somatic mutation after birth in the PIG (phosphatidyl
inositol glycan) group A gene in a myeloid stem cell clone
Page 226
D.3.d.(1)(b) Atypical lymphocytes are antigenically stimulated B cells (Fig. 12-3).
Page 233
7.b. Clinical findings
(3) Vessel thrombosis may also occur.

Page 259
D.4.a. Mild cases respond to desmopressin acetate
VWF release from Weibel-Palade bodies; stabilizes circulating VIII:c
Page 260
E.5.a. Desmopressin.
VWF release from Weibel-Palade bodies; stabilizes circulating VIII:c
Page 282
V.B.4.c. Respiratory acidosis or normal Paco2
Page 288
Table 16-4
Pneumocystis jiroveci
Diffuse intra-alveolaror Giemsa stains. Serum lactate dehydrogenase (LDH) elevated
in 90% of cases (predictive of increased morbidity/mortality).
Page 290
7.a.(2) Produces a protein (cord factor) that prevents.
Page 293
3.b. Pulmonary infarction
(7) Elevation of ipsilateral hemidiaphragm (most common finding)
Page 320
N.1.c.(1) Smoking (DELETE THE REST)
(4) HPV most common risk factor
Page 329
Margin Note 4th from top of page: Rx H. pylori risk for developing gastric lymphoma not
adenocarcinoma
E.2.e.(4) Serologic tests have been discontinued.

G.1.a. Majority (> 60%) are malignant and are located in the duodenum followed by the islet
cells in the pancreas
d. Ulcers are single and in the usual locations or there may be multiple ulcers.
Page 330
Table 17-2 Copy and insert as a page into book
Epidemiology

Male/female ratio 1:1

Male/female ratio 1:1

Smoking may delay healing.

Risk increased with MEN I

Risk for developing gastric cancer

Smoking may delay healing.

(increased risk with blood group A

Chronic intake NSAIDS

individuals)

Risk factors: H. pylori (most common),

Risk factors: H. pylori (most

Helicobacter pylori

chronic intake of NSAIDS, type O

common), chronic intake NSAIDS

blood group (lack blood group antigens

(synergism with H. pylori),

that are protective to the mucosal

moderate alcohol consumption

surface)

Duodenal ulcer > gastric ulcer

Duodenal ulcer > gastric ulcer

association
Complications

Bleeding (most commonly ulceration Bleeding (anterior ulcer; most commonly

of left gastric artery; Fig. 18-14E).

ulceration of gastroduodenal artery).

Bleeding spontaneously ceases in

Fig. 18-14E). Bleeding spontaneously

80% of cases.

ceases in 80% of cases.

Perforation (air under diaphragm,

Perforation (anterior ulcer; air under

pain radiates to left or right

diaphragm, pain radiates to left or right

shoulder; Fig. 18-14D)

shoulder)
Gastric outlet obstruction, pancreatitis
(posterior ulcer)

Page 338
8. Tests for bile salt/acid deficiency
Total bile acids
9. Tests for bacterial overgrowth a., b., and c. discussions are all okay and no changes need to
be made
Page 342
G.3.a.(1) Atrial fibrillation.
Add underneath:
SMA has the greatest velocity of blood flow and the most acute angle off the aorta of all the
arteries originating from the abdominal aorta.

Page 348
Table 17-7
Clinical findings

Okay as is

Recurrent right lower quadrant colicky

pain (obstruction) with diarrhea and
weight loss
The rest is okay

Page 367
Margin note 4th from the top of the page
Reyes syndrome: transaminases, ..
Margin note on bottom: Fulminant hepatic failure: transaminases
G.1.a. Viral hepatitis (most common infectious cause)
b. Acetaminophen most common overall cause fulminant liver failure
Margin Note: Fulminant hepatic failure: viral hepatitis most common infectious cause
Fulminant hepatic failure: acetaminophen most common overall cause
Page 402
Table 19-7
Post-streptococcal glomerulonephritis
Usually resolves; CRF uncommon in children but common in adults
Page 403
Table 19-10
Diffuse membranous glomerulopathy
Subepithelial.
Highest incidence renal vein and deep vein thrombosis (loss of antithrombin III in urine)
Treatment.
Page 414
B.2.g. Urine pH alterations
(1)
(2)

Alkaline urine pH favors crystallization of calcium- and phosphate-containing stones.

Acidic urine pH favors crystallization of uric acid, cystine, stones

Page 420
Blue box; line 12:
Reads mechanisms for outflow incontinence are outflow obstruction..
Should read overflow incontinence are outflow obstructions (e.g., BPH)
Page 429
C.2.a. DHT is the prime mediator.
Causes hyperplasia of glandular and stromal cells due to increased sensitivity to DHT (see Fig.
1-14)
Page 430
4.d.(1) (e) Bladder smooth muscle hypertrophy and hyperplasia
Page 434
A.1.a.(2)(c) Decreased sperm count
Loss of seminiferous tubules (delete: and decreased testosterone)

Page 437
Table 21-1
HPV (see Fig. 21-1E)

Second most common STD (a few books say it is the most common)

Page 438
Table 21-1
Trichomonas Vaginalis Most common STD;
As an aside: the stats are Trichomonas incidence 7.4 million, HPV incidence 6 million
Page 465-466 (excerpted from new RRPath 4th ed.; copy and fold paper into book
E. Gestational trophoblastic neoplasms
1.
Hydatidiform moles
a.
Benign tumors of the chorionic villus

Complete and partial moles

MN: Hydatidiform mole: benign tumor in chorionic villus; look like grapes
b.
c.

More common at the extremes of age

Occurs in 1:1200 pregnancies in the United States

Occurs in 1:200 pregnancies in Indonesia

d.
Complete mole is the most common type.
(1) The entire placenta is neoplastic.
(2) Dilated, swollen villi without fetal blood vessels or parts (Fig. 22-16A)
(3) Ovum 46, XX (90% of cases)
MN: Complete mole: MC type; whole placenta neoplastic; no fetal blood vessels or parts; 46,XX
(both male Xs)
(a) Ovum lacks maternal chromosomes.
(b) Chromosomes are paternally-derived.

Duplication of 23X sperm in ovum (46XX; most common), or

Two separate 23X or Y sperm enter ovum (called dispermy;

46XX or 46XY)
MN: Complete mole: dilated villi with no fetal parts
MN: Complete mole: empty ovum; fertilization by 23X sperm that has duplication of its
chromosomes (46XX; most common)
MN: Complete mole: empty ovum; fertilization by 2 separate sperm (23X or Y; dispermy); 46XX
or 46XY
(4) Increased risk for developing choriocarcinoma (15% 20%)
(5) Clinical findings
(a) Vaginal bleeding at 6 to 16th week gestational age (80% 90%)
(b) Severe vomiting (hyperemesis gravidarum; 8%)
(c) Preeclampsia is present in 1% of patients.
(d) Uterus is too large for gestational age (~30%).
(e) Increased beta-hCG for gestational age (>100,000; 15%)
(f) Bilateral theca lutein cysts (15%)
Develop in response to high levels of beta-hCG
(g) Snowstorm appearance with ultrasound (Fig. 22-16B)
MN: Complete mole: US with snowstorm appearance; too large for gestational age
(6) Treatment

(a)
(b)

Dilation and curettage

Must remove all the material

Follow patient with beta-hCG levels

Should go down to zero

e.

Partial mole
(1) Normal villi are intermixed with neoplastic villi.
(2) Fetal parts are intermixed with neoplastic villi

Amnion and fetal vessels with fetal erythrocytes are present within the
mesenchyme of the villi.
MN: Partial mole: normal villi intermixed with neoplastic villi; fetal parts intermixed with
neoplastic villi
MN: Partial mole: fertilization of 23X ovum by 2 sperm either X or Y (69XXY most common)
(a) Ovum triploid (69 XXY in 70% of cases; XXX in 27% of cases)
(b) Most commonly due to fertilization 23X ovum by 2 sperm that are
either 23X or Y producing an ovum with 69XXY (most common) or
XXX.
(3) Preeclampsia in 5% of patients
(4) No risk for developing a choriocarcinoma
(5) Clinical findings
(a) Incomplete or missed abortion (90%)
(b) Vaginal bleeding (75%)
(c) Uterine enlargement 5% of patients
(d) Theca lutein cysts and hyperemesis gravidarum extremely rare
(e) Majority have beta-hCG <100,00 for gestational age
MN: Partial mole: incomplete/missed abortion; vaginal bleeding; very high -hCG for gestational
age
(6) Treatment: similar to complete mole
Page 466
2. Choriocarcinoma
c. (1) Lungs, vagina, liver brain
Page 467
X.C.1.d. Drugs
Also add tricyclic antidepressants
Page 480
2.b.(9) Increased risk of colon polyps/tumors
Page 501
3.f. Nonclassic 21 hydroxylase deficiency
(1) Cortisol and mineralocorticoid activity are normal.
Margin Note: Nonclassic 21-OHase deficiency: androgens
Page 503
2. Hyperaldosteronism
a.(3)(a) High normal to mild hypernatremia.
Page 512
E.1.e. Glycosylated hemoglobin 6.5% (45.6%) is diagnostic of diabetes

Page 518 Copy and insert as a page into book

E.2.c. Dual-photon absorptiometry
(1) Non invasive test that evaluates bone marrow density (BMD)
(2) The World Health Organization uses a T-score to define osteoporosis.
(a) It is calculated by subtracting the mean BMD (in g/cm2) of a young-adult reference
population from the patient's BMD and dividing this by the standard deviation (SD) of
the young-adult reference population.
(b) Using the T-score, osteoporosis is defined as 2.5 SD and below.
Page 531
3. Lyme disease
a. Epidemiology
(1) Transmitted..
(2) Ticks acquire the spirochete by feeding on an infected animal host (reservoir for the disease).
(a) Preferred reservoirs are the white-footed mouse for nymphs and white-tailed deer for
adults.
(b) Nymphs are responsible for the majority of human cases (90%), particularly in the
summer months.
Page 538
Table 23-3

Please add additional sentence

Knee joint injuries

(Fig. 23-23C)

Unhappy triad: most common internal derangement of the

knee joint. Valgus injury (acute): damage to the lateral
meniscus, medial collateral ligament, anterior cruciate
ligament. If chronic, the medial meniscus is most
commonly injured rather than the lateral meniscus.

Page 561 Copy and insert as a page into book

I.
Erythema multiforme (make a copy of the addition and put insert it in the book)
1.
Type IV immunologic hypersensitivity reaction of skin that is triggered by
3.
Stevens-Johnson syndrome (SJS)
a.
Recently separated from EM as a distinct entitity.
b.
Type IV hypersensitivity reaction that primarily involves the skin and mucous
membranes (e.g., mouth, genitals)

Infections (e.g., HIV, group A streptococcus), drugs (antibiotics most common

[penicillin, sulfa drugs]), and maligancies have been implicated; however, most
cases are idiopathic.
c.
Erosions develop on the mucous membranes and small blisters develop on purpuric or
erythematous macules on the skin (different from target lesions of EM)
d.
It can be fatal.
MN: SJS: involves skin/mucous membranes; type IV HSR
4.
Toxic epidermal necrolysis syndrome (TENS)
a.
Idiosyncratic reaction most commonly drug-induced (e.g., sulfonamides, NSAIDS,
anticonvulsants)
b.
May occur alone or overlap with SJS
MN: TENS: necrosis, skin detachment; overlap with SJS
c.
Characterized by extensive areas of erythema, necrosis, and bullous detachment of the
epidermis and mucous membranes exfoliation of skin
d.
Mucous membrane involvement can result in gastrointestinal bleeding, respiratory
failure, and genitourinary complications.

5.

e.
It can be fatal.
Treatment of EM

Page 566
I. Cerebral Edema, Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)..
Page 571
II.A.2. Maternal findings
Increased maternal alfa fetoprotein (AFP) in serum or amniotic fluid in anencephaly,
meningocele, myelomeningocele, but not spinal bifida occulta
Page 581
Table 25-1 Copy and insert as a page into book
TABLE 26-1. CEREBROSPINAL FLUID (CSF) FINDINGS IN VIRAL, BACTERIAL,
AND FUNGAL MENINGITIS
CSF FEATURE
BACTERIAL
VIRAL
FUNGUS
Total cell count
Increased
Usually normal or
Usually normal or
slightly increased
slightly increased
Differential count
Predominantly
First 2448 hours,
Lymphocytes
neutrophils;
neutrophils, then
tuberculosis usually
switches to lympholymphocytes
cytes after 48 hours
CSF glucose
Decreased
Normal: exceptions
Decreased
mumps, herpes, LCM
CSF protein
Increased
Increased
Increased
Gram stain
Frequently positive
Negative
Frequently positive
(60%90%)
Culture positive (65%
90%)
LCM, lymphocytic choriomeningitis
Page 582
Change heading to Table 25-3 and line up Severe Dementia sentence as shown below
TABLE 25-3 SLOW VIRUSES AND SPONGIFORM ENCEPHALOPATHY OF THE CENTRAL
NERVOUS SYSTEM