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‘cost-effective’(?cheap) protocols on those workers whose sole
interest is to undertake quality investigation, with the families
of patients in mind. Perhaps even more important may be the
raising of the eyebrows of some pathologists performing
autopsies on cases of sudden death in infancy and childhood, who may also wrongly imagine that the recommended
investigations are superfluous!
This book represents good value at E60.00 and will find a
place on the reference shelves of paediatric, general, and
forensic pathological laboratories.
The Queen’s University of BeEfast
Major Problems in Pathology Volume 33. Pathology of the
Thjwus and Mediastinunz
and G. G. DE BLOIS.Published by W. B.
Saunders. No. of pages: 247. Price: E46.
Most specialist textbooks are based on an organ system or
disease. The contents of this book, however, are determined by
the boundaries of those spaces in the thorax included in the
mediastinum. Thymic epithelial neoplasms and high-grade
thymic B-cell lymphoma clearly fall within these spaces but
other conditions, such as Hodgkin’s disease, present more
commonly elsewhere in the body. This poses a problem for the
author as to whether conditions such as Hodgkin’s disease
should be dealt with in depth. The reader, faced with a possible
case of Hodgkin’s disease, might question whether he or she
would do better to turn to a textbook of haematopathology for
guidance, rather than a textbook on the mediastinum. Pathologists serving thoracic surgical units will probably find this book
of value. Its usefulness would, however, have been enhanced if
the authors had provided more detail on how to deal with and
interpret biopsies obtained at mediastinoscopy which frequently suffer traction artefact, particularly if they are fibrotic.
These problems may be compounded by emergency chemotherapy or other treatments for obstructive symptoms that
may precede the biopsy. The differentiation between nodular
sclerosing Hodgkin’s disease, high-grade thymic B-cell lymphoma, germ-cell neoplasms, and bronchial carcinoma may be
extremely difficult in such cases, demanding a combination
of interpretive skills, immunohistochemistry, and possibly
molecular biology. The balance between a misdiagnosis and an
unnecessary thoracotomy can be a fine one.
A test that I sometimes apply, when reviewing books, is to
ask what help they would have provided with difficult cases
that I have encountered over the years. A young woman with
myasthenia gravis and mastocytosis of the thymus, not mentioned, but it may have been a unique case. Extramedullary
haematopoiesis forming a mediastinal mass in a patient with
thalassaemia, not mentioned. Composite Hodgkin’s disease
and high-grade thymic B-cell lymphoma, not mentioned.
Despite failing this test, the text is generally well written, well
referenced, and up-to-date. It provides a detailed account of
the pathology of thymic epithelial tumours, mediastinal lymphomas, mediastinal germ-cell tumours, and neuro-endocrine
tumours, as well as a miscellany of other lesions that may
arise or present in the mediastinum. The illustrations are of
variable quality, although most are satisfactory. Despite its
limitations, this book will find a useful role in our reporting
room library.
Professor of Puthology
Southumpton University Hospita1.r Trust
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