Book Review

Clinical Gynecologic Pathology

N Engl J Med 1996; 335:360August 1, 1996

Article

Clinical Gynecologic Pathology
Edited by Enrique Hernandez and Barbara F. Atkinson. 567 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $135. ISBN: 0-7216-5170-4

The past two decades have witnessed tremendous advances in knowledge about lesions in the female genital tract and their histopathologic features. To some extent, these advances have been mirrored by the formation of subspecialty organizations such as the International Society of Gynecological Pathologists, numerous postgraduate courses on the subject, and the publication of at least four textbooks on gynecologic pathology: Malcolm Anderson's Female Reproductive System (New York: Churchill Livingstone, 1991), Harold Fox's Haines and Taylor — Obstetrical and Gynaecological Pathology (New York: Churchill Livingstone, 1995), Claude Gompel and Steven Silverberg's Gynecologic Pathology (Philadelphia: J.B. Lippincott, 1994), and Robert Kurman's Blaustein's Pathology of the Female Genital Tract (New York: Springer-Verlag, 1995). These four textbooks assume that the reader, who is most likely a pathologist, is conversant with the basics of histopathology. Each provides substantial clinical information and stresses clinical and pathological correlations, but the primary emphasis is morphologic.

Clinical Gynecologic Pathology is intended more for obstetricians and gynecologists than for pathologists. Most of the 14 authors have their primary appointments in departments of obstetrics and gynecology. The purpose of the book is to “allow the clinician to go through the diagnosis of a condition from the time the gross lesion is identified, examined with the colposcope (if applicable), biopsied or excised, and examined under the microscope.”

Unfortunately, this book falls short of its promise. In a book dealing with morphology, the scope and clarity of the illustrations are key. There is a nice mix among the 500 gross photographs, colposcopic photographs, and photomicrographs, and all are in color, for which the authors are to be congratulated. But too many photographs suffer from poor quality or poor printing. Many pictures are fuzzy, and in a few, the nature of the lesion cannot be deduced without the caption. Numerous photographs waste substantial space with overly generous margins; greater attention to cropping would have helped highlight the lesion in question. Labeling, which is almost nonexistent, would also have helped the reader.

The text is ambiguous in areas, and some chapters are up to date whereas others are not. The chapter on the endometrium provides a thorough and concise presentation of recently described lesions, such as atypical polypoid adenomyoma and the relation between treatment with tamoxifen and the development of endometrial polyps in patients with breast cancer. References are as recent as 1994. In contrast, other chapters leave the reader uncertain about the field's current status and the authors' perspective. For example, the chapter on the vulva is ambiguous with respect to terminology and beliefs. The authors note that “vulvar intraepithelial neoplasia” is the term preferred by the International Society for the Study of Vulvar Disease, yet they raise the dead issue about the existence of Bowen's disease and bowenoid papulosis — conditions long ago excluded from the diagnostic terminology used by pathologists. Many discussions include overly burdensome commentary about older findings but relatively few new findings. A more synthetic analysis of the current literature and greater use of diagrams would have helped the reader understand the importance of the lesions and the histopathological relations among them. More schematic drawings and tables might also have helped organize the information better for the reader.

Stanley J. Robboy, M.D.
Duke University Medical Center, Durham, NC 27710