These case studies and related images are an integral part of the Pathology course at The University of Texas Southwestern Medical School at Dallas. They are based on the text Robbins Pathologic Basis of Disease by RS Cotran, V Kumar and T Collins, 6th edition, 1999. For those who have the previous edition of the book, references to pages of the 5th edition are also provided.
The purpose of these case studies is to highlight mechanisms and manifestations of common and important human diseases. By no means should the list of diseases covered here be considered complete or comprehensive. It is not the primary purpose of these exercises to teach diagnostic pathology, nor are they intended to teach differential diagnosis. That is why in most cases the diagnosis is readily evident from the history or the images that follow. We hope, on the other hand, that the images, their description and the related questions will provide a valuable tool for reviewing the pathogenesis and clinical manifestations of various diseases and relating them to the morphologic alterations. Although the amount of details provided under the images and the related questions varies from case to case, the central focus of all case studies is the same.
Each case is preceded by a set of Learning Objectives with appropriate page references to the 5th and 6th editions of Robbins Pathologic Basis of Disease. The objectives comprise the "syllabus" for the case studies. We strongly recommend that the facts and concepts highlighted in the objectives be reviewed prior to starting the case study. In the case history (called Scenario) that follows the objectives, some important clinical features of the cases are bold faced. This is done to assist students who may not have completed their courses in clinical subjects. The images should be viewed after reviewing the Scenario. Each image has a description that is followed in many cases by one or more questions. An attempt should be made to answer these questions before clicking on the "answer." Many images also have a bulleted list of features, which are active links, on the right side. Moving the mouse over a feature displays the specific feature on the screen, or sometimes reveals another image behind the one on the screen. It should be noted that although the images represent the disease(s) that the patient may have had, they are not necessarily derived from the patient described in the history. For example, in the Scenario the patient may have had a biopsy but the illustrated image may be from a resected lesion, or in some cases from an autopsy. The purpose behind such substitutions is to present a clear image of the lesion, even if it was not derived from the described patient. Also included in each case study are gross and microscopic illustrations of lesions or disease processes that are related to the patient's diagnosis. Thus, the images in each case folder are not merely a catalog of the lesions that the patient may have had. Instead, they represent a group of related diseases that are best discussed together. In addition, the last few images, in some cases, illustrate Learning Objectives for which no specific case study was made. A section called Resources that follows the Learning Objectives indicates which images are directly related to each case.
The gross and microscopic images presented here were not specifically designed to serve as an atlas of pathology. However, for those interested in reviewing gross and microscopic pathology of common and important diseases, this collection, containing over 1000 images, should serve that purpose.
Finally, we welcome any comments or suggestions for improvements from both students and teachers of pathology.
Vinay Kumar, M.D., FRC Path
e-mail: kumar01@utsw.swmed.edu
Herbert K. Hagler, Ph.D.
e-mail: hagler.herb@pathology.swmed.edu
Department of Pathology
UT Southwestern Medical Center
5323 Harry Hines Blvd.
Dallas, TX 75235-9072
USA
Standard mode (recommended for 640x480 screen resolutions) is used to present all information, images, discussion, and answers to questions in one window and is the most compatible with all web browsers. Enhanced mode (recommended for 800x600 screen resolutions) presents the answers to questions in a separate window when Netscape is used and in a separate frame when Internet Explorer is used as the web browser. Return to make your choice of Standard or Enhanced.
A link has been placed after each Scenario heading to provide access to a Normal Reference Range Table which should be consulted regarding any laboratory values for which a reference range has been omitted in the Scenario. A reference range value in the Normal Reference Range Table may differ from a reference range given in the Scenario because reference ranges often differ between laboratories.
On some configurations of computers and web browsers, better performance will be obtained if cache memory is set to 0. Sometimes when the cache fills up, it takes more time to remove items from the cache than it does to load new images from the CD.
Some of the early releases of Netscape Navigator 3.xx and Internet Explorer may not implement JavaScript uniformly, so please try and use one of the later releases of these web browser packages.
It may also be advantageous to minimize the size of the directory, location, and button bars at the top of the web browsers so that there is maximum desktop space for viewing the images.
The editors would like to thank Helene Hoffman, Ph.D. and Ann Irwin, M.D. for willingly sharing their thoughts, time, and support when we first began using computers to assist in the teaching of Pathology. Thanks to Marilyn McKay, MLS for her enthusiasm and insight in locating and procuring some of the key software that was used for these cases. We are grateful to many colleagues in Dallas and elsewhere for providing us with photographic gems for these case studies. We are also grateful to Dr. William B. Neaves, Dean, University of Texas Southwestern Medical School and Dr. Errol C. Friedberg, Chairman, Department of Pathology, University of Texas Southwestern Medical School, for their support of this effort. Without them this undertaking would not have been possible. Last but certainly not least, to our students who have been pioneers during the development of these case studies. Thanks for your patience, understanding, and sense of humor. Thanks to Craig Lampe and Jenson Wong for programming suggestions that have made the software more student-friendly.