Robbins & Cotran Pathologic Basis of Disease (Robbins Pathology) 9th Edition

(Updated for perspective as a now-second year medical student)As a first year medical student, I have found Robbins a wonderful textbook for fundamentals of disease processes as well as pathology of the organ systems. (And this is coming from someone who has found medical textbooks too dense and dry to use as primary resources for courses so far. )Robbins is the "required" pathology textbook at my medical school; I say "required" because every year, class surveys indicate almost no one uses the book, relying instead on course notes and review books. At the urging of my old-school trained father, I decided to buck the trend — and having read multiple chapters of the Robbins, I am shocked that past classes have foregone the text. For one, this is a very well organized book — in fact, it is better organized than our course note packets/syllabi. The figures and tables are high-yield, but the text itself is so well written and full of useful information and examples that I have never felt exhausted reading through it. Because of this, I think Robbins is a practical primary resource to learn MS-1 and MS-2 material. (I would not say the same for similarly massive textbooks "required" for our other courses so far, like Goodman and Gilman's for pharmacology. I found that and other texts so dense and dry that I've only used them as references in the library, and even then only rarely. Instead, like most med students these days, I often turn to review books to clarify concepts that are confusing in lecture.)So what have I gained by reading this thing? I've noticed that my understanding of disease features has increased substantially. The basic pathological processes covered in Robbins are common to so many diseases that cases presented in grand rounds I attend, as well as clinical asides during lectures, make much more sense. Even when I don't understand them, I can at least grasp explanations I look up because the basics always come up.Here I will list the "fundamentals" chapters I have read and found useful.• Chapter 1 is an overview of cell biology, setting the stage for the rest of the book. I bought this book after finishing my cell biology course, so I largely skipped this chapter. However, it would probably be a great way to gain a basic understanding of cellular mechanisms if you have less background in cell biology, or even as a resource during a cell biology course.• Chapter 2 covers cell injury and death. Apoptosis and necrosis are the focuses of the chapter, and the discussion is quite detailed. The basic paths leading to cell injury and death are critical to understanding much of the rest of the book and diseases in general. Great reference or primary source.• Chapter 3 gets into more core disease processes: inflammation and repair. Again, excellent text and summary tables/figures. From my perspective as an MS-1, probably one of the most useful chapters as far as laying down important fundamentals.• Chapter 4 is a little more narrowed, discussing hemodynamics, thrombosis, and infarction. These topics come up all the time (MI, stroke, emboli...), so it's satisfying to understand the material. And despite the complexity of the chapter (coagulation is complicated), it's still quite readable.Some other great chapters cover immunology, infection, neoplasia, genetic disorders, and vascular disorders (that chapter leads right into the heart pathology chapter). All of them are useful, although I would say they need not be read all the way through like the fundamentals chapters. For example, I have some cancer biology background, so I read selected portions of the neoplasia chapter. Same goes if you have background in immuno, microbio, etc. Together, they give a strong foundation for understanding specific diseases.Overall, highly recommended for use as a primary resource or reference text during the preclinical years.Update: Our exam for the pathology course was an NBME shelf exam. With the help of Robbins, I aced it with a 94%, beating the class mean by over 1.5 standard deviations. Seriously, the foundations and understanding of disease mechanism you gain from this book are worth your time.Update 2: Thoughts now that I'm a second-year. Robbins is still excellent, and I still consider it the definitive authority when other resources seem to disagree with each other. If you have the time, reading Robbins will expose you to a wider range of pathology than you'll learn about in your organ systems courses. I mean, there's a lot of pathology out there, and med school curricula really can't spend time on all of it. If you have a particular area of interest or feel your course isn't giving a good representation of a certain system's pathologies, crack open Robbins and enlighten yourself. The downside is that using Robbins for every organ system is nigh-impossible. This is a behemoth text, and in the midst of frantically speeding through organ systems while also stressing about retaining high-yield material for the boards, it might fall lower on your priorities list vs. stripped down review resources like Pathoma. It is a textbook, after all.I used Robbins early in the year but found myself using it less over time as our courses became shorter (physiology-heavy courses like cardiology afforded enough time; 2-3 week courses in some other subjects were way too rapid-fire to allow for it). A couple of my classmates continue to doggedly read through each chapter, although sometimes this can become a little martyr-ish (check out the 150+ page gastrointestinal/hepatobiliary segment). I'd suggest using it as time allows, then just using it as a reference as needed. Curating resources is critical in medical school considering the firehose of information and similar stacks of books available.

Errata will be updated if I find errors more. (Last updated: 3/26/2015)A conclusionThe renowned bible of pathology is revised enough to be sold under the title of "new edition." Students may stick to the previous edition (not so many changes to influence studying for the USMLE review). The new edition is more recommended unless you have got one. Though this book becomes easier and more student-friendly as new editions come out, students (including me) may still find the big Robbins difficult without a strong background of basic sciences. For the purpose of USMLE review, the baby Robbins is more than enough. However, I believe all doctors(-to-be), regardless of their specialties, should read this big Robbins at least once in their lifetime, not for the board review, but for a better understanding of medicine.Overall changes1. "Key Concepts" summary after each section, which may be useful to students.2. Some tables and figures are revised, most (but not all) of which are better than those from the previous edition.3. "References" → "suggested readings." Updated, selected articles with useful comments (except in Ch26 & 28).4. A briefer, readable text with better editing. Many minor text revisions are geared toward pathogeneses and clinical features rather than morphologies. Frequent use of bullets and bold texts makes the contents clearer and easier to understand.Some of more impressive updatesCh1. A new chapter, parts of whose materials are assembled from several chapters of the previous edition. More coherent discussion of cell & molecular biology.Ch2. New pathways of cell death, necroptosis and pyroptosis. Updated discussions regarding autophagy. Minor text revisions.Ch3. The inflammation chapter and tissue repair chapter are combined. A newly written paragraph on neutrophil extracellular traps (NETs). Some primary immunodeficiencies (e.g., leukocyte adhesion deficiency) are moved to the Ch6, and stem cells, extracellular matrix or other stuffs are moved to the Ch1.Ch4. The coagulation cascade in vivo vs. in vitro. Minor text revisions.Ch5. A brief discussion regarding fragile X tremor/ataxia is added to the Fragile X syndrome section. Extensive revisions on "molecular diagnosis." A newly written section on next-generation sequencing (NGS). Several minor & major text revisions throughout the whole textbook accordingly.Ch6. Augmented discussion about innate immunity (e.g., TLRs, NOD-like receptors, inflammasome, etc.). New paragraphs concerning innate lymphoid cells (ILCs) and IgG4-related diseases. A new section on primary immunodeficiencies due to defects in innate immunity. A discussion of ataxia-telangiectasia in the context of immunodeficiency.Ch7. Extensive text revisions but following the similar outline as the 8th edition. Descriptions of several important topics (e.g., Hallmarks of cancer, Darwinian selection and progression of tumor cells, oncogene addition and its therapeutic implications, the Warburg effect, cancer stem cells, molecular profiling of tumors, to name a few) are enhanced, while too detailed ones (e.g., the pocket protein family, etc.) are reduced or omitted. Overall, more organized and easier to understand.Ch8. "General principles" part is reorganized. Several minor text reinforcements that reflect recent advances regarding microbial pathogenic mechanisms. A new paragraph on Cryptococcus gattii is added.Ch9. Updated statistics and results from recent studies. A new paragraph on anticoagulants. Enhanced discussion of pathophysiology of obesity. Details regarding morphology of mechanical trauma are omitted.Ch10. No major changes here. Short additions about neuritogenesis and chromothripsis in neuroblastoma section. Minor text revisions.Ch11. Revised figure captions. Addition of brief paragraphs on various subjects (e.g., syphilitic aneurysm, aneurysm due to IgG4-related disease, Behcet Disease, myocardial vasospasm). Discussions on morphology of some vascular tumors are excluded.Ch12. A short passage about cardiac stem cells. A brief discussion of development of the interatrial septum. Several minor heart diseases are excluded (e.g., atrioventricular septal defect, persistent truncus arteriosus, total anomalous pulmonary venous connection, myocardial diseases associated with iron overload, hyper/hypothyroidism).Ch13. Paragraphs on hemophagocytic lymphohistiocytosis (HLH). A number of new molecular lesions in white cell neoplasms revealed by NGS and recent studies of epigenomics.Ch14. More detailed explanation of the survival benefit against malaria in patients with sickle cell traits. Revised explanation of coagulopathies that reflects coagulation cascade in vivo. A new section on complications of transfusion.Ch15. Paragraphs on pathogenesis of many respiratory disorders (e.g., acute lung injury, asthma, lung cancer, etc.) are rewritten or revised, many of whose details are dropped, but come to the point overall. Brief discussions of pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis and surfactant dysfunction disorders are added. Other minor text revisions.Ch16. No major changes. Overall text length is cut down. A short paragraph on glossitis is deleted. Minor text revisions.Ch17. A short additional explanation on achalasia. Enhanced discussions of some topics (e.g., gastric injury & protection, molecular pathogenesis of GI tumors, pathogenesis of irritable bowel syndrome, etc.). Minor entities (e.g., uncommon esophageal tumors, Cowden syndrome, Bannayan-Ruvalcava-Riley syndrome, Cronkhite-Canada syndrome, peritoneal cysts) are removed.Ch18. An extensively reorganized introductory section with many additions and revisions on hepatocyte injury and repair, liver failure, and morphologies. Many other minor updated or revised sections throughout the whole chapter. Some witty mnemonics in "Key Concepts" summaries. Minor disease entities (e.g., hepatitis G virus, progressive familial intrahepatic cholestasis, Alagille syndrome) are discarded.Ch19. Rearrangements on the pathogenesis of pancreatitis.Ch20. Recent concepts on the pathogenesis of glomerulonephritis due to circulating immune complexes. Several text updates reflecting current clinical viewpoints. A brief mention of Birt-Hogg-Dube syndrome and Xp11 translocation carcinoma. Overall text length is cut down by deleting redundant descriptions and minor entities.Ch21. Pathogenesis and clinical portion of prostate cancer are updated.Ch22. Some new figures. More abridged anatomy & embryology. Enhanced coverage on the pathogenesis of endometriosis, uterine fibroids, and ovarian tumors. Recent WHO classification of endometrial hyperplasia (from previously 4-tiered to 2-tiered). Vulvar malignant melanoma is deleted. Many minor text revisions.Ch23. "Breast cancer" section is revised extensively (statistics, pathogenesis, and morphologies according to the new classification scheme).Ch24. Updated diabetes subsection (separation of acute & chronic complications, an addition of "incretin effects," hexosamine pathways in the pathogenesis of chronic complications). Newly identified molecular lesion in pancreatic neuroendocrine tumors.Ch25. Text rearrangements to improve readability. Morphologic features of epithelial cysts are omitted.Ch26. Better summary paragraphs and tables. Parts of some arthropathies are curtailed. A small new section on undifferentiated pleomorphic sarcoma (UPS). Several entities (chondroblastoma and chondromyxoid fibroma, myositis ossificans, etc.) are out.Ch27. The anatomically rearranged chapter with many text revisions accordingly. A simplified approach to inheried peripheral neuropathies with detailed discussions being dropped. Several miscellaneous topics are added (e.g., Lyme disease, HIV/AIDS neuropathy, congenital myasthenic syndromes, rare musculodystrophies, etc.). Peripheral nerve sheath tumors are moved from Ch28.Ch28. Frontotemporal dementia → frontotemporal lobar degeneration (FTLD). TDP-43 and C9orf72 in the pathogenesis of FTLD and amyotrophic lateral sclerosis (ALS). The enhanced paragraph on spinal muscular atrophy (SMA), which is mentioned independently of the SMA in Ch27. Updates on the pathogenesis of brain tumors and paraneoplastic syndromes. Some minor entities (e.g., Pelizaeus-Merzbacher disease, Alexander disease, vanishing white matter leukoencephalopathy, Kearn-Sayre syndrome, Alpers disease) are excluded.Ch29. The molecular pathogenesis of uveal melanoma.Errata (not meant to be complete; mostly editorial errors) (last updated: 3/26/2015)p. xvi Contents, Chapter 21: Incorrect page number. 859 → 959p. 25 Right column, 3rd line: cycin CDK4 and cycline CDK6 → cyclin D-CDK4 and cyclin D-CDK6p. 49 Left column, 16th line: cross-lins → cross-linksp. 55 Left column, 9th line: proteins This → proteins. Thisp. 56 Left column, Figure 2-25 caption : FAAD → FADDp. 58 Left column, 3rd line: Table 2-4). → Table 2-4.p. 67 Left column, 4th line: a proteins → proteinsp. 76 Table 3-3: α4β7 (CD49DCD29) → α4β7 (CD49dCD29)p. 81 Right column, 4th line: meshwork of of → meshwork ofp. 118 Left column, 3rd line: he → thep. 118 Right column, 16th line: Glanzmann thrombasthenia). → Glanzmann thrombasthenia.p. 150 Right column, Figure 5-10: Wrong location of the "primary storage" box in the center of the figurep. 152 Left column, 14th line: Chapter 1 → Chapter 2p. 156 Left column, 13th line: Fig. 5-16 → Fig. 5-15p. 165 Left column, 19th line: genes All → genes. Allp. 168 Right column, 12th line: gene (2) → gene. (2)p. 171 Left column, 4th line: FRMP-mRNA → FMRP-mRNAp. 171 Left column, 10th line: FRMP → FMRPp. 190 Right column, Figure 6-5: ξ → ζ (not 'xi' chain, but 'zeta' chain)p. 208 Left column, 19th line from the bottom: Figs. 6-31 and 6-32 → Fig. 6-32p. 224 Left column, 9th line: ( IV-S) → (IV-S)p. 266 Right column, last line: capable of capable of → capable ofp. 277 Figure 7-21B. 72.3 → ≥ 72.3, 17.1 → ≤ 17.1p. 279 Left column, 19th line: genotoxic. as well as → genotoxic, as well asp. 329 Right column, 12th line: Rb and p53 → p53 and Rbp. 345 Right column, 4th line: Transmission and Dissemination of Microbes → How Microorganisms Cause Diseasep. 348 Left column, 15th line from the bottom: Burkholdaria → Burkholderiap. 350 Right column, 5th line from the bottom: How Microorganisms Cause Disease → Host Damagep. 353 Right column, 19th line: flow.. → flow.p. 368 Left column, 20th line from the bottom: die → die.p. 387 Left column, 10th line, inflammation cause → inflammation, causep. 397 Left column, 11th line, The → Pathogenesis. The (for editorial consistency)p. 398 Left column, Figure 8.54: Oblique → straight cutting line between A & Bp. 425 Left column, 18th line: a subsequent a post-use → a subsequent, post-usep. 491 Left column, 3rd line: disorder , → disorder,p. 499 Left column, 5th line: matrice → matrix (or matrices)p. 500 Right column, 14th line: inflammatiion → inflammationp. 514 Right column, 8th line from the bottom: Trousseau sign → Trousseau syndrome (which I think is better because Trousseau sign can also be used in hypocalcemia)p. 524 Right column, 26th line: [MMPs], → [MMPs]),p. 550 Right column, 4th line from the bottom: (see later) → (see later).p. 575 Right column, 14th line: Myxomas → Myxoma. Myxomas (for editorial consistency)p. 584 Left column, 10th line: organs,- the → organs, the (duplicated punctuation)p. 584 Left column, 11th line: T cells-, lymphocytes → T cells, lymphocytes (duplicated punctuation)p. 586 Left column, 11th line: NK to → NK cells top. 586 Right column, 23rd line from the bottom: so that is some → so that in somep. 607 Right column, 25th line: M-CSF) chemokines → M-CSF), chemokinesp. 609 Table 13-8, 6th row, 2nd column: C30-; EB- → CD30-; EBV-p. 609 Right column, Figure 13-26: Incorrect figure; figure 13-26 & 13-27 are switched.p. 610 Left column, Figure 13-27: Incorrect figure; figure 13-26 & 13-27 are switched.p. 629 Chapter Contents, 3rd column, 2nd line: Purpura and → Purpura (TTP) andp. 630 Right column, 1st line: when sufficiently → sufficientlyp. 635 Right column, 7th line: O2 → O₂(subscript)p. 649 Right column, Table 14-6: incorrect spacing in the 3rd & 4th rowp. 660 Right column, 15th line from the bottom: is caused by → is an autosomal recessive disorder caused by (not concordant with 'also' in the next paragraph)p. 669 Right column, 6th line: The mainstem bronchus → The right mainstem bronchusp. 675 Right column, 5th line from the bottom: Chapter 17 → Chapter 18p. 678 Left column, 4th line: change → change.p. 679 Right column, 20th line from the bottom: most notable → most notablyp. 683 Left column, 1st line: IL13 → IL-13p. 683 Left column, 2nd line: IL17 and IL9 → IL-17 and IL-9p. 718 Left column, 4th line: Chapter 11 → Chapter 12p. 749 Chapter Contents, 1st column, 5th line from the bottom: a missing line "Complications of Chronic Gastritis 766" (refer to the page 766)p. 749 Chapter Contents, 3rd column, 11th line: a missing line "Other Causes of Chronic Colitis 802" (refer to the page 802)p. 750 Left column, 4th line from the bottom: (17-1B) → (Fig. 17-1B)p. 794 Left column, 15th line from the bottom: Necator duodenale → Necator americanusp. 794-795 Paragraph titles: Italicize species names in paragraph titles. (e.g., Ascaris lumbricoides)p. 794-795 Paragraph titles: De-italicize paragraph titles without species names. (e.g., Schistosomiasis)p. 816 Left column, 19th line: oxyuriasis vermicularis → Oxyuriasis vermicularis or Enterobius vermicularis(case sensitive, italic)p. 816 Right column, 5th line from the bottom: outflow → outflow.p. 824 Figure 18-4C. PE with veno-portal approximation → Parenchymal extinction with veno-portal approximation (PE is indicated nowhere, which resulted from the original source.)p. 828 Left column, 14th line from the bottom: ( resulting → (resultingp. 829 Right column, 4th line, 8th line, 15th line: absent bullets (●)p. 839 Right column, 30th line: diseases , → diseases,p. 848 Right column, 17th line from the bottom: severity) → severity):p. 854 Right column, 3rd line from the bottom: mechanisms → mechanisms:p. 863 Left column, 1st line: may be may → may bep. 870 Left column, 5th line: Familial → familialp. 875 Left column, 19th line: delta-gamma T cell → gamma-delta T cellp. 876 Right column, 17th line: gallstones → gallstones:p. 892 Figure 19-12 caption, 3rd line: p16 sta occurs → p16 occursp. 894 Right column, 3rd line from the bottom: Trousseau sign, → Trousseau syndrome, (the same reason as mentioned above)p. 903 Left column, 18th line: composted of → composed ofp. 915 Left column, 12th line: (NSAIDs). → [NSAIDs]).p. 915 Right column, 23rd line from the bottom: dense also deposits → dense depositsp. 934 Right column, 12th line: Fig. 20-33B → Fig. 20-32Bp. 943 Left column, 10th line from the bottom: aberration → aberrantp. 946 Left column, 2nd, 5th, 26th line from the bottom: Ca2+ → Ca²⁺ (superscript)p. 946 Right column, 12th, 15th, 17th, 21st line: Ca2+ → Ca²⁺ (superscript)p. 961 Right column, 24th line from the bottom: bladde → bladderp. 964 Right column, Table 21-2: absent indentation in the 2nd-6th row (from exophytic papilloma to carcinoma in situ)p. 969 Right column, 7th line from the bottom: adeno carcinomas → adenocarcinomasp. 975 Right column, Table 21-5, 3rd row from the bottom: Insert "Sex Cord-Stromal Tumors" in a separate row, as they are not parts of germ cell tumors, but an independent entity.p. 982 Right column, 11th line from the bottom: Benign Prostatic Hyperplasia → Benign Prostatic Hyperplasia (BPH) (BPH is defined nowhere within the chapter 21.)p. 985 Left column, 3rd line: (RB, CDKN2A, → (RB, CDKN2A),p. 996 Right column, 2nd line from the bottom: Chapter 21 → Chapter 8p. 997 Right column, 11th line: (VIN) → (classic VIN) (as a counterpart of the differentiated VIN in the next paragraph)p. 1021 Left column, 14th line from the bottom: de novo → de novo.p. 1031 Left column, 11th line from the bottom: thought that to be → thought to bep. 1035 Left column, 6th line: there little → there is littlep. 1074 Right column, 13th line: in males → in males.p. 1080 Right column, 16th line: and infertility → and infertility.p. 1115 Left column, 10th line: hyperosmolar hyperosmotic syndrome → hyperosmolar hyperglycemic syndrome (or state)p. 1115 Left column, 24th line from the bottom: diabetic macrovascular → diabetic microvascularp. 1163 Right column, 6th line: common lymphocyte antigen → cutaneous lymphocyte antigenp. 1164 Left column, 8th line: (hyperkeratotic and acanthotic). → hyperkeratotic and acanthotic.p. 1171 Left column, 19th line: Fig. 25-34C → Fig. 25-34Ap. 1171 Left column, 21st line: Fig. 25-34A → Fig. 25-34Cp. 1177 Right column, 6th line from the bottom: (or primary infection of the nails) → (or primary infection of) the nailsp. 1179 Chapter Contents, 2nd column, 14th line: 2 missing lines "Chondroma 1201" and "Chondrosarcoma 1202"p. 1182 Left column, 6th line from the bottom: RANK ligand, (RANKL) → RANK ligand (RANKL),p. 1189 Left column, 12th line from the bottom: and, when multiple, → and when multiple,p. 1207 Right column, 19th line from the bottom: during development → during development.p. 1218 Figure 26-49A: the absent arrowp. 1222 Right column, 1st line: arcomas → sarcomasp. 1222 Right column, 6th line: or(1;13) → or (1;13)p. 1242 Left column, 2nd line from the bottom: infancy.While → infancy. Whilep. 1249 Left column, 23rd line: skeletal defects pigmented → skeletal defects, pigmentedp. 1294 Left column, 25th line from the bottom: FTLD-TPD → FTLD-TDPp. 1300 Right column, 22nd line: innervat ed → innervatedp. 1304 Left column, 10th line: other that → other thanp. 1312 Right column, 23rd line from the bottom: Chapter 10), → (Chapter 10),p. 1327 Left column, 10th line: keratoepithelin.Some → keratoepithelin. Somep. 1330 Left column, 14th line: open-angle glaucoma → open-angle glaucoma.p. 1336 Left column, 22nd line from the bottom: "designated by the nebulous term neovascularization elsewhere" → designated by the nebulous term "neovascularization elsewhere"p. 1337 Left column, 4th line from the bottom: detachment.. → detachment.ps. I'm not a pathologist nor a well-trained editor, but a general practitioner who loves to read Robbins. If you have any different opinions as to my errata, please comment below. Your cooperation will be very much appreciated.