Book Review

Diagnostic Ultrastructure of Non-Neoplastic Diseases

N Engl J Med 1993; 328:1505May 20, 1993

Article

Diagnostic Ultrastructure of Non-Neoplastic Diseases
Edited by John M. Papadimitriou, Douglas W. Henderson, and Dominic V. Spagnolo. 728 pp., illustrated. New York, Churchill Livingstone, 1992. $375. ISBN: 0-443-03464-8

The aim of this ambitious book is to present pathologists with basic and reliable information about the ultrastructure of nonmalignant diseases. As the editors stress in their preface, many of these disorders can be diagnosed by techniques other than microscopy, but ultrastructural examination often adds useful and sometimes critical information. Given the broad scope of the topic, a rather schematic text accompanied by representative illustrations of each of the numerous entities might have been expected. In this book, however, crisp descriptions, clear tables, and an extensive bibliography provide a comprehensive introduction to superb electron micrographs enhanced by illuminating legends.

Any undertaking of the magnitude of Diagnostic Ultrastructure of Non-Neoplastic Diseases faces an inevitable risk: new and important information may appear too late for inclusion. This drawback -- admittedly not crucial in an atlas of this type -- is clearly evident here in the fact that the most recent reference is from 1989. This deficiency also appears in the introductory chapter on corollary ultrastructural techniques and tools, which should have mentioned the helpful techniques of ultrastructural autoradiography and ultrastructural in situ hybridization.

By and large, the illustrations are of superb quality, but some lack didactic impact. For example, in the chapter dealing with the ultrastructural features of the pathologic cell, two micrographs, one illustrating a pyknotic cell and the other an apoptotic cell, could have been shown side by side to demonstrate forcefully the morphologic differences between the two processes of cell death., and one wonders why oncogenic viruses are shown in a book devoted to non-neoplastic diseases, especially since these viruses are not discussed in the context of differential diagnosis. It is, by the way, in the study and diagnosis of viral diseases that ultrastructural in situ hybridization, though certainly not a routine procedure, can help detect specific viral nucleic acids in cases in which, as the authors note, morphology alone is helpless. In several chapters, notably the one devoted to collagen and storage diseases, recent advances in molecular biology should have been mentioned, even if only briefly. Unavoidably, some non-neoplastic lesions and diseases are not included. To name just a few of these, Goodpasture's syndrome is not mentioned among kidney disorders, the presence and importance of Dohle bodies are not mentioned, and familial eosinophilia is not listed among blood disorders.

These minor flaws do not detract from the merits of this book, which includes a vast array of very effective electron micrographs and points out other valuable sources of information with abundant references. This all-embracing book is of obvious practical interest to pathologists who, if they need more detailed studies, can turn to several recently published, detailed ultrastructural atlases that deal with specific organs, systems, and diseases.

Janine Andre-Schwartz, M.D.
New England Medical Center, Boston, MA 02111