Book Review

Diagnostic Histopathology of Tumors

N Engl J Med 1996; 335:1327-1328October 24, 1996

Article

Diagnostic Histopathology of Tumors
Edited by Christopher D.M. Fletcher. 1358 pp. in two volumes, illustrated. New York, Churchill Livingstone, 1996. $295. ISBN: 0-443-04295-0

The diagnostic histopathologist makes judgments primarily on the basis of examining sections of tissue stained with hematoxylin and eosin and viewed under the light microscope. This process can be considered as an art from the point of view of analyzing the image, and as a science by which the image is placed in the context of a knowledge of pathobiology. This combination of art and science in diagnostic histopathology relies primarily on visual information. The presentation of such information on the histopathology of tumors is particularly successful in this two-volume work. In this new addition to the comprehensive textbooks of surgical pathology, all the illustrations are in color. They are of high quality and truly represent what one sees under the microscope. The accompanying text varies in quality from chapter to chapter but generally complements the figures and gives clinical correlations sufficient for the book to be useful outside the province of histopathological diagnosis. The roster of contributing authors gives the book a distinctly international flavor and a broad approach to classification and taxonomy, which in this field are too often parochial.

The material covered is well documented, in both the illustrations and the text. If there is a fault, it is the focus on the histopathology of tumors rather than the broader field of diagnostic surgical histopathology. One other minor criticism is that there is inadequate integration between the chapters. For example, “small, blue cell” tumors of childhood are not treated as one subject but are included in the chapters on neuroectodermal tumors, bone, and soft tissue. Similarly, diagnostic ultrastructural and molecular evaluations are frequently not included in the appropriate chapters. This organization limits the value of all the material available for a differential diagnosis. Despite these minor criticisms, this book excels at what it does best — illustrating the histopathology of tumors. Its value as a reference work will be greatly enhanced if the publishers offer it in an electronic format with hypertext searches and linkage to primary sources.

Chapter 1, which presents Dr. Fletcher's personal philosophy, is well worth reading and rereading. Its global viewpoint sets the proper tone for the diagnostic histopathologist and reminds us of some important simple truths. The ability to make a good diagnosis depends on the quality of both the specimen and the information accompanying it. And, the criteria for prognostication must be adjusted in the case of each neoplastic disease. This is especially important for oncologists, who need this information for clinical management. Perhaps most important, simplicity and clarity of diagnosis are essential for pathologists to communicate with clinical colleagues.

The organization of the other chapters, the selection of contributors, and the material covered support this philosophy. The book catalogues and illustrates the lesions clearly and does not needlessly subclassify them except when such classifications have clinical significance. The essentials of histologic diagnosis and clinical correlations are presented succinctly, without unnecessary embellishment. The work as a whole is thus an ideal resource for the busy surgical pathologist. The inclusiveness of this book, the qualifications of its contributors, the completeness of the references, and most of all, the abundance and quality of the illustrations make it an essential addition to the library surgical pathologists keep adjacent to their microscopes.

Michael Kashgarian, M.D.
Yale University School of Medicine, New Haven, CT 06510