Book Review

Pathology of the Gastrointestinal Tract

Gastrointestinal Pathology and Its Clinical Implications

N Engl J Med 1993; 328:517-518February 18, 1993

Article

Pathology of the Gastrointestinal Tract
Edited by Si-Chun Ming and Harvey Goldman. 945 pp., illustrated. Philadelphia, W.B. Saunders, 1992. $185. ISBN: 0-7216-6398-2

Gastrointestinal Pathology and Its Clinical Implications
By Klaus J. Lewin, Robert H. Riddell, and Wilfred M. Weinstein. 1395 pp., illustrated. New York, Igaku-Shoin, 1992. $295. ISBN: 0-89640-153-7

Both these works are major textbooks that will interest all physicians concerned with gastroenterology and gastroenterologic surgery. Both are intended to serve as atlases of gross and microscopical pathology as well as reviews of the classic pathological features, pathophysiology, clinical background, current therapy, and clinical outcome of gastrointestinal diseases. Each succeeds to a varying degree in achieving all these goals.

Pathology of the Gastrointestinal Tract succeeds better as a textbook than as an atlas. Written by 34 experts in gastrointestinal pathology, its chapters vary in their emphasis on subjects, number and quality of supporting illustrations, and style. Most are well done and thorough and include a complete bibliography. However, the rapid accumulation of new knowledge in gastrointestinal pathology, particularly in the area of molecular pathology, has left many of the chapters considerably behind the recently published literature. For example, the chapter on the genetics of gastrointestinal pathology does not include the molecular-probe approach to determining the sequential deletions of tumor-suppressor genes in colorectal cancer. Many chapters have insufficient illustrations of endoscopic photographs, radiographs, and good-quality gross specimens. In addition, the black-and-white photomicrographs are not always of high quality. Many of the chapters dealing with tumors would have been enhanced by tables and illustrations showing the results of immunocytochemical staining. Also, the assessment of the prognosis of esophageal, gastric, and colorectal carcinoma by cell-cycle analysis or by the study of DNA ploidy, oncogene amplifications and point mutations, tumor-suppressor-gene deletions, and other modern molecular methods is not covered in detail.

Despite these drawbacks the book by Ming and Goldman can be recommended to residents, practicing pathologists, and gastroenterologists for its thorough review of the morphologic features of the wide variety of lesions and conditions of the gastrointestinal tract. The chapters on ulcerative colitis and Crohn's disease are excellent and well supported by fine black-and-white illustrations. The chapter on malabsorption is extremely well organized and well presented. Many other chapters clearly discuss the differential pathological diagnosis of controversial entities such as mesenchymal tumors of the stomach, endocrine gastrointestinal tumors, Barrett's esophagus with early adenocarcinoma, and gastrointestinal tract lymphomas. Precursor lesions of gastric and colonic adenocarcinomas are well discussed and well illustrated. All in all, this is a strong book that can serve as both a general reference for gastroenterologic pathology and a day-to-day resource for the surgical-pathology laboratory. At $185 it is not inexpensive, but it is recommended strongly.

Gastrointestinal Pathology and Its Clinical Implications is a truly outstanding two-volume atlas-textbook of gastrointestinal disease. The strong emphasis on clinical correlation, the superb illustrations, and the outstanding text lead me to conclude that it is among the finest textbooks of its type yet produced. Written by two pathologists and a gastroenterologist, it benefits greatly from the interaction between clinical and pathological discussions. The superb full-color endoscopic illustrations are a major asset, as are the numerous high-quality radiographs. All the photomicrographs and photographs of gross specimens are outstanding. The quality of the text is also outstanding, featuring contrasting blue and black print that is very easy to read.

This book suffers from having been published in a field in which knowledge is expanding so rapidly. Nonmorphologic assessment of tumor prognosis, molecular diagnosis, and other issues will require updating in the next edition. Nevertheless, it is an outstanding atlas of gastrointestinal pathology and a thorough review of the clinical background and endoscopic findings in gastrointestinal tract disease. At $295 it is very expensive, even by current standards. However, a department of pathology, a laboratory of surgical pathology, a department of gastroenterology, or a department of surgery would be enhanced by the inclusion of so superb a work on its library shelves. Although the text may be rapidly outdated as new findings on cancer and immunology are published, the superb illustrations will remain of substantial value. It is thus recommended as a beautifully crafted, wonderfully produced example of state-of-the-art medical-textbook publishing.

Jeffrey S. Ross, M.D.
Albany Medical College, Albany, NY 12208