Book Review

The Difficult Diagnosis in Surgical Pathology

N Engl J Med 1996; 335:64-65July 4, 1996

Article

The Difficult Diagnosis in Surgical Pathology
Edited by Noel Weidner. 944 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $150. ISBN: 0-7216-6464-4

In the preface to this book, Dr. Weidner states that 5 to 10 percent of specimens routinely submitted to surgical pathology laboratories pose difficult diagnostic problems for the pathologist. He notes that a number of excellent textbooks on surgical pathology provide general information on a vast array of common lesions but not on uncommon lesions or difficult diagnostic situations. This book is intended to fill the gap.

Several of the chapters do indeed enhance the information in other surgical-pathology textbooks by providing differential diagnoses in a schematic way, so that a pathologist faced with a particular pattern on a slide can find useful information on how to arrive at an appropriate diagnosis. The chapters that fulfill this role well are those on the pancreas, the adrenal gland, and bone marrow. Other chapters, although not entirely satisfying the need for differential diagnoses, are excellent. The chapter on the uterus is comprehensive, easy to read, and extremely well organized, with an excellent reference section. Another high point is chapter 1, in which Dr. Foucar, in a very succinct and well-organized manner, discusses diagnostic decision making in surgical pathology, including data collection and the definitions and use of specificity, sensitivity, and predictive values. These statistical matters are often ignored by the general surgical pathologist, yet they are critical in the everyday interpretation of diagnostic material. Many of the other chapters contain reviews of common and uncommon entities in specific organ systems and could easily have been included in a more general textbook of surgical pathology.

For the most part, the photomicrographs, all of which are black and white, are good to excellent, although in some chapters they show extensive shadowing, are too dark, or are out of focus. This is especially true of the photomicrographs in the chapters on the liver and the placenta.

In general, the references in each of the chapters include the major papers on the entities discussed. Many of the references are from the late 1980s or early 1990s, with a few from 1994 and 1995.

There are many good points to this book, and the individual chapters noted earlier make it a worthwhile addition to a pathology library. The book will not, however, replace the textbooks on general surgical pathology often found in the personal libraries of pathologists.

Virginia A. LiVolsi, M.D.
University of Pennsylvania School of Medicine, Philadelphia, PA 19104