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that a lot of experience is distilled into the various sections.
There are many useful pointers and generalizations to guide
the practising histopathologist using immunohistochemistry
and electron microscopy in tumour diagnosis. The emphasis
throughout is on the complementary role of these investigative
tools and their limitations, with a lucid correlation of the
possible findings using each modality. The scene is set by
an overview of the principles employed in both techniques
with pertinent aspects of technical aspects including useful
practical hints. Unconventional methods are placed in
context, such as formalin-free microwave fixation of routine
The traditional layout of pathology texts according to
organ system is avoided in the chapters which follow, instead
focusing on the diagnostic approach to commonly encountered
histological conundrums. Morphological scenarios are presented in a clinical setting with expected immunohistochemical
and, where appropriate, ultrastructural findings in relation to
each different diagnosis. I found some of the diagnostic
algorithms a little cumbersome to use, though the immunohistochemical tables were useful. The classical features of a
wide variety of specific tumour entities are described in an
informative manner. For example, the section covering
desmoplastic and non-desmoplastic ‘polyphenotypic’ small
cell tumours and their relationship to Ewing’s sarcoma and
primitive peripheral neuroectodermal tumour (PNET) is well
presented. Some areas such as subclassification of lymphomas
are obviously beyond the remit of the book. Similarly,
exhaustive organ-based tumour subclassifications such as
those for renal cell carcinoma or salivary gland tumours are
clearly not the intention. Illustrative examples of individual problematic cases are provided throughout, and the
importance of clinical context in reaching or questioning a
considered diagnosis is emphasized.
My main criticism of the book relates to the illustrations,
particularly the electron micrographs, many of which are too
small and not of sufficient magnification to visualize all of the
features that they claim to illustrate. None of the illustrations
is more than one of the double columns in width and the
reproduction resembles high quality photocopies of ‘real’
micrographs. In many, ultrastructural details such as dense
core granules or lamina are very difficult to visualize. A futher
example is the suboptimal illustration of microvilli amongst
collagen fibres, purported in the text to be a feature of
malignant rather than benign mesothelium. The needs of
those without wide experience hoping for emphasis on
pictorial instruction are therefore not likely to be fully met.
Magnifications are not included for electron micrographs. I
can’t help feeling that my disappointment with micrograph
reproduction must be shared by the electron microscopist
amongst the authors. The last chapter on biological
parameters and prognostic markers amounts to a brief
overview, with inevitable simplifications for the sake of
brevity. I was able to find only a single spelling error—‘must’
should be ‘most’ at the bottom of page 123.
? 1998 John Wiley & Sons, Ltd.
The limitations mentioned should not detract from the novel
approach of the book and the general quality of information
contained in the text. All histopathologists who encounter
problematic tumour cases will find this a valuable addition to
their bookshelves.
J. H. S
Christie Hospital NHS Trust, Manchester
Tumors of the Adrenal Gland and Extra-Adrenal Paraganglia.
Atlas of Tumor Pathology. Third Series, Fascicle 19.
E. E. L.
The combination of the previous two volumes on tumours
of the adrenal gland and extra-adrenal paraganglia into one
makes sense not only in anatomical/embryological terms, but
also because Dr Lack is an acknowledged expert in both fields.
This is a comprehensive book, encompassing development,
normal anatomy, appropriate elements of physiology and
biochemistry, and the full range of primary and secondary
neoplasia to be found at these sites. The text is wide-ranging
and fully referenced. The number of illustrations has increased
significantly since the previous series, with much more
emphasis on colour. These are, almost without exception, of
extremely high quality. Gross and microscopic figures are
complemented by clinical pictures and illustrations of imaging
techniques. The latter are of particular relevance, since many
adrenal lesions which would have been detected only at
autopsy are now identified in vivo during scanning of the
abdomen in the investigation of other diseases. They also
reinforce the importance of considering the whole clinical
picture in endocrine disease. The emerging role of fine
needle aspiration cytology in diagnosis, particularly of lesions
discovered incidentally, is highlighted. This will certainly be an
expanding field in future.
The main diagnostic problems in the pathology of the
adrenal cortex are the differentiation of nodules, adenomas,
and tumours with malignant potential. Dr Lack deals with
these in a detailed manner, with critical analysis not only of
classical approaches to diagnosis, but also of the usefulness (or
otherwise) of electron microscopy, immunocytochemistry, and
measurement of tumour ploidy. Our lack of knowledge of the
basic molecular processes involved in the pathogenesis and
progression of these tumours is highlighted by the relative
paucity of information provided in that area. The paraganglia
are dealt with in an equally comprehensive manner, with
general and site-specific data well presented.
This volume is to be highly recommended. As a bench book,
pathologists will find in it the means to diagnosis of difficult
cases and the reassurance that, even for an expert, it is not
possible accurately to define malignant potential in some cases.
It also contains much of educational value. It should be on
the shelves of the reporting rooms of at least all Teaching
Departments and those linked with an Endocrine Unit.
A. M. MN
  , . 184: 226–227 (1998)
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