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Pathology (December 2004) 36(6), pp. 595–597
Rosai and Ackerman’s Surgical Pathology: Ninth Edition JUAN ROSAI.
Mosby, Philadelphia, 2004. ISBN 0-323-01342-2, Hardcover, two-volume
set with CD-ROM, pp 3080, AU$605
It has been eight long years since the last edition of this superb textbook
of surgical pathology, but the ninth edition is now available and it has
been worth the wait.
As Dr Rosai rightly points out in his preface, there have been
momentous changes in the practice of surgical pathology. Thirty years ago
we did not have immunohistochemistry and nowadays it is hard to
contemplate surgical pathology without it. We are, however, in the midst
of a new revolution resulting from the application of the techniques of
molecular biology to surgical pathology. Whilst some of these investigations are of academic interest, several have provided tangible results and
have shown their diagnostic significance. Having said this, a major
strength present throughout this two-volume work is Dr Rosai’s
affirmation of the importance of the tradition of meticulous gross and
microscopic examination, something that unfortunately I feel is being
overlooked by our trainees. I would strongly recommend that both trainee
and consultant alike read through Chapter 1 which is a historical,
philosophical and practical examination of our specialty.
The book comprises 31 chapters covering all major aspects of surgical
pathology ranging from gross techniques, through individual organ
systems, to a collection of appendices including such topics as quality
control, quality assurance, staging of cancer, standardised surgical
pathology reporting for major tumour types, and guidelines for handling
of most common and important surgical specimens. Chapter 3, ‘Special
techniques in surgical pathology’, has an extensive list of antigens which
have been updated and expanded. Information regarding antigen location,
pathophysiological role and degree of expression in various tumours is
provided. A diagram illustrating the commonly used subtypes of
cytokeratins is provided. I also like the breakdown of antigens into ‘top
choice’, ‘desirable’ and ‘optional’. In addition to immunohistochemistry,
there are sections on ‘special’ stains, enzyme histochemistry, quantitative
methods (histometry), X-ray microanalysis, electron microscopy, flow
cytometry and molecular pathology.
The chapters are well laid out and the text is presented in an easy to
read style. There are a number of instances were Dr Rosai’s own personal
viewpoints and preferences are expressed. Reading through the various
chapters I got the feeling that on several occasions I was being mentored
rather than being lectured.
There is insufficient space in this review to discuss the book chapter by
chapter; however, the information presented is overall accurate and up to
date. The chapters are extensively referenced with references to original
descriptions as well as references from 2003.
One of the major strengths of this book is the superb colour
illustrations. The book has 3951 illustrations with over 3100 in full
colour. These images comprise clinical and gross specimen photographs as
well as H&E images and immunohistochemistry. In addition, each volume
comes with a CD-ROM that delivers all of the books illustrations in
digital format. Also, the facility exists for exporting desired images into a
PowerPoint presentation or in HTML format. The images come with an
acknowledgment of their origin from this edition. This facility is ideal for
student teaching and conference presentations. However, I did notice with
some images that enlargement to the full size of the presentation window
in PowerPoint led to a loss of clarity.
This textbook is not meant to replace an AFIP Fascicle or a WHO ‘blue
book’. It provides succinct information about particular entities which aid
in their initial recognition and which may, if desired, be explored in more
specialised textbooks. If we take the section on inflammatory skin lesions
as an example, Dr Rosai points out that the entities discussed were chosen
to encompass the types of non-neoplastic material generally seen in
surgical pathology laboratories.
Notwithstanding the above, the book has flaws. Typographical errors
are present: e.g., p. 1584 ‘atypical polypoid leiomyomas’, p. 1592 ‘CD114
(c-kit)’, and misspelt authors’ names, e.g., p. 1726, reference 650. In
addition, I found errors with some of the figures and/or legends; e.g.,
p. 1686, Fig. 19.287, is not ‘polyembryoma of ovary showing well-formed
embryoid bodies’ but is the same image as Fig. 19.236 on page 1662 which
is of a borderline serous tumour with microinvasion. Another example
is an incorrect cross-reference to a figure; e.g., Fig. 19.312 A and B, the
legend asks that this figure be compared with Fig. 19.309 when it should
be Fig. 19.310. The same type of error is seen with Fig. 19.295. In
addition, on page 1681, the reference to the Silverberg paper (line 12) is
incorrect with regards to the roles of grading and histological typing in
predicting outcome and tumour responsiveness to chemotherapy in ovarian
carcinoma. Also, it might be wise to check that all of the pages of the
book are present (which was not the experience of one of my colleagues).
The book is printed on high quality paper and appears to be adequately
To summarise, the strengths of this two-volume book include: (1) a
practical day to day approach to surgical pathology, (2) its clinically
oriented structure for each organ system, including normal morphology,
congenital abnormalities, inflammatory disorders and benign and malignant
neoplasms, (3) information about the immunohistochemical and ultrastructural findings, differential diagnosis and prognosis of various tumours and
(4) excellent colour illustrations which are available on CD-ROM and which
can be exported for teaching purposes. The book’s main weaknesses lie in
typographical errors and occasional errors with some figures and legends.
This book is one that will not sit on your shelf. It will be placed close to
your microscope and you will refer to it continually. In my judgement this
is the test of a good book.
Richard Jaworski
Department of Anatomical Pathology, ICPMR, Westmead Hospital
Westmead, New South Wales
Gleason Grading of Prostate Cancer: A Contemporary Approach MAHUL
Lippincott Williams & Wilkins, Philadelphia, 2004. ISBN 0-7817-4279-X,
Hardcover, pp xiz116, AU$330
A detailed review of the Gleason grading system is well overdue, as more
than three decades have passed since Donald Gleason in conjunction with
the Veterans Administration Cooperative Urological Research Group
(VACURG) study established the grading system for prostate cancer that
has since been adopted worldwide.
The text begins (Chapter 1) with an historic outline of the grading
system and then follows with the specific details of its application to the
various histological grades (Grades 1–5) as visualised in needle biopsy,
transurethral resection and radical prostatectomy specimens. These initial
chapters (Chapters 1–3) contain numerous photomicrographs illustrating
the large variety of morphological tumour patterns and assist the reader in
allocating these patterns a specific grade. Areas of difficulty in pattern
interpretation are addressed. The book re-iterates the importance for
practising pathologists to recognise that the Gleason grading system was
essentially based on transurethral prostatic curettings and needle biopsy
and extrapolation of this data to radical prostatectomy is clearly
challenging. These initial chapters give some insight in accomplishing
reproducible Gleason grading and the numerous illustrations will provide
a useful desk reference for many pathologists.
Of some concern is the disregard of more recent biological discoveries
that expose some defects in the Gleason grading system. This particularly
relates to the entity of intraductal carcinoma and the continued
application of the Gleason grading system to tumour cells surrounded
by a basal cell population. Intraductal carcinoma, now described in many
publications,1–5 encompasses the entities of ductal carcinoma, many forms
of cribriform carcinoma/prostatic intraepithelial neoplasm (PIN) and is
easily recognised in radical prostatectomy specimens. This observation
clearly exposes errors, which could not be appreciated in Gleason’s
original biopsy samples, particularly without the assistance of immunostains. Similarly, recently published histological detail as applied to
Gleason Grade 1 carcinoma that assists in histological diagnosis6 is
ignored. This is particularly important as Gleason Grade 1 tumours are
frequently accompanied by higher-grade carcinoma, often Gleason Grade
Chapter 4 relates to reproducibility of the Gleason grading system and
provides useful websites for pathologist education.
Chapter 5 is a review of the prognostic significance of the Gleason
grading system and reconfirms its significant value, particularly at
extremes of grade. Prognostic issues related to intermediate grade
tumours, ‘Gleason sum (score) 7’, which currently account for most
ISSN 0031-3025 printed/ISSN 1465–3931 # 2004 Royal College of Pathologists of Australasia
DOI: 10.1080/00313020400010906
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