Book Review

Ultrastructural Pathology of the Cell and Matrix

N Engl J Med 1997; 337:579August 21, 1997

Article

Ultrastructural Pathology of the Cell and Matrix
Fourth edition. By Feroze N. Ghadially. 1414 pp. in two volumes, illustrated. Boston, Butterworth–Heinemann, 1997. $350. ISBN: 0-7506-9635-4

The fourth edition of Ghadially's Ultrastructural Pathology of the Cell and Matrix is as beautiful as its three predecessors. One may even wonder whether the format of a coffee-table art book would not have made the book even more appealing, because the attractions of this publication go beyond the interests of pathologists.

In the preface, Dr. Ghadially confesses that he started “playing” with the electron microscope more than three decades ago, when the instrument appeared unexpectedly at the University of Sheffield “as a sort of Christmas present.” In 1963, such an instrument lent prestige to a department of pathology. At that time, one could not help but make new discoveries. Structures never seen before had to be named. Terms like ribosomal lamellar bodies, the hallmark of hairy-cell leukemia, and confronting cisternae, seen in many tissues and cells under a variety of conditions, date from this era.

During the 1970s, the electron microscope became a research tool. Ultrastructural techniques became standardized, if not routine. Ancillary methods were developed to make experimentation in conjunction with ultrastructural analysis not only possible but also desirable.

Although Dr. Ghadially has never lost his enthusiasm for unadulterated morphology, I have become more jaded. I believe that a book entitled Ultrastructural Pathology ought to provide a deeper understanding of what is seen by routine light microscopy. To some extent, the first three editions may have satisfied this need, but the time has now come to move on. For instance, there should have been images showing how immunoelectron microscopy helps to identify structures. Illustrations of the human immunodeficiency virus and, particularly, the pathological findings associated with AIDS would have been in order but have not been provided. The term “Epstein–Barr virus” is missing from the index, as is “Reed–Sternberg cell,” the ultrastructure of which a pathologist may want to see. The foot processes of healthy glomerular epithelium are well illustrated, but the pathological appearance of absent or fused processes can only be surmised. Yet a diagnosis may hinge on this ultrastructural finding.

Although probably of no use to the pathologist, a handsome illustration shows intracellular crystals found in differentiated midgut cells of the whirligig beetle, but there is no mention that almost identical crystals may be seen in renal tubule cells of patients with IgA myeloma who secrete large amounts of lambda light chains. Charcot–Leyden crystals in eosinophils and the tissues of patients with severe or prolonged eosinophilia may have the same appearance. What looks alike may not be the same. This point cannot be overemphasized, but it is rarely made.

In other areas, the author is more critical. For instance, when discussing the current preoccupation with apoptosis, he states “the distinction between necrosis and apoptosis is ill-conceived and illogical. . . . One can see no need for the term `apoptosis.' ” Although the morphologic evidence of apoptosis is by no means as definitive as the “ladder pattern” of degraded DNA seen on electrophoresis gels, there is an ultrastructural counterpart more frequently associated with apoptosis than necrosis. The generally accepted criteria for the distinction ought to have been better illustrated.

Should readers with an interest in ultrastructural pathology acquire this new edition? If they already own the first, second, or third edition, I don't believe so. However, if they do not yet own “a Ghadially,” this edition will grace their bookshelves as well as any of the previous ones.

Dorothea Zucker-Franklin, M.D.
New York University Medical Center, New York, NY 10016