Book Review

Pediatric Neoplasia: Morphology and biology

N Engl J Med 1996; 335:1326October 24, 1996

Article

Pediatric Neoplasia: Morphology and biology
Edited by David M. Parham. 554 pp., illustrated. Philadelphia, Lippincott–Raven, 1996. $169. ISBN: 0-7817-0273-9

Authors know that finding a title is never the easiest part of their work. Technical treatises might seem exempt from this difficulty, but one can imagine the authors and the editor of Pediatric Neoplasia grappling with various ways to convey the actual scope of their endeavor, before coming up with the subtitle “Morphology and Biology.” Such, indeed, is the two-pronged emphasis of this textbook. Therapy is only incidentally referred to as the occasion requires it, and systematic diagnostic investigation of patients is an equally peripheral concern. But the morphologic diagnosis, which notwithstanding the proliferation and increasing sophistication of other approaches continues to be nothing less than the gold standard in diagnostic oncology, is expounded lucidly, comprehensively, and with judicious advertency to recent scientific developments.

Twenty-six collaborators are listed, many among the most distinguished names in pediatric oncology or surgical pathology. It has become trite to remark that multiauthorship and unevenness of style go hand in hand. That this shortcoming is so little in evidence must be credited to Dr. David Parham's editorial savvy. His own authorship or coauthorship of 8 of the 16 chapters no doubt does much for the homogeneity of style. More important, his wide learning and vast experience with childhood tumors ensure the appropriate emphasis in the different sections of the work. Thus, neuroblastoma, rhabdomyosarcoma, and Ewing's sarcoma, justly thought to epitomize solid pediatric cancer, are dealt with in superb respective chapters.

A chapter on tumors of the central nervous system succeeds in clearing up (the word that comes to mind is “translating”) traditionally dense, brackish terrain. Seven different grading systems for astrocytomas are tabulated, compared, and furnished with informative glosses. The reader is refreshed to learn that of more than 120 neoplastic categories sanctioned by the World Health Organization, only 3 — medulloblastoma, juvenile pilocytic astrocytoma, and diffuse astrocytoma of low or high grade — account for three fourths of all cases encountered in practice. As befits a chapter dealing with the most common solid tumors of childhood, more than 400 references are listed.

It is not the most heavily referenced chapter. This distinction (more than 600 references) belongs to the coverage of leukemias, which are, after all, the commonest cancers of children. The scholarly review of the basic concepts and the flow cytometric and chromosomal findings in leukemias is as detailed as could be expected, short of resorting to a specialized treatise on hematologic neoplasia.

I found it irksome to have to look up color figures many pages away from their place of citation and difficult to locate on account of an awkward numbering system. It was perplexing to see an index of color figures that omits the page number. A jaundiced eye might attribute parochialism or bias to the choice of contemporary honorees in a historical chapter. Likewise, the finicky may think that the chapter on “diagnostic and biologic technics” is redundant, since some technics discussed are now commonplace, while others would consider it incomplete, since certain technics mentioned are not routine and justice can scarcely be done to them in the short space of a chapter.

But the perceptive reader must realize that all this is merely caviling and cannot possibly obscure the fact that this is a major reference work on pediatric tumors. My own students find it most helpful by the workbench, and pathologists, oncologists, and all who are interested in tumors of childhood will consider it indispensable.

F. Gonzalez-Crussi, M.D.
Children's Memorial Hospital, Northwestern University, Chicago, IL 60614