Book Review

Tumors of the Fetus and Newborn

N Engl J Med 1998; 338:1164-1165April 16, 1998

Article

Tumors of the Fetus and Newborn
(Major Problems in Pathology. Vol. 35.) By Hart Isaacs, Jr. 384 pp., illustrated. Philadelphia, W.B. Saunders, 1997. $85. ISBN: 0-7216-3813-9

In the past several decades, advances in fetal sonography, neonatal intensive care, and pediatric surgery have greatly expanded our understanding of the variety of diseases that may afflict the youngest of humans. Perinatal tumors are among the rarest of these disorders, with an estimated incidence of only 7.2 per 100,000 live births (S.E. Parkes, K.R. Muir, L. Southern, et al. “Neonatal Tumours: A 30-Year Population-Based Study.” Medical and Pediatric Oncology, 1994;22(5):309-17). Despite such rarity, an extensive recent literature attests to the growing interest in the variety of neoplasms and tumorlike conditions that occur in this age group. Clinical and pathological aspects of this topic are concisely summarized in Tumors of the Fetus and Newborn. As stated in the preface, the pragmatic goal of this treatise is “to help the pathologist and clinician achieve an accurate diagnosis and a clear understanding” of a tumor or tumorlike condition affecting an infant. In addition to pathologists, pediatric surgeons, and oncologists, however, other specialists who participate in fetal and neonatal care should profit from reading this book, including ultrasonographers, radiologists, perinatologists, and pediatricians.

After an introductory chapter that discusses the definitions, prevalence, and pathogenesis of perinatal tumors, the next 18 chapters systematically review neoplasms and tumorlike conditions of various organs. The writing is thorough, concise, and well referenced. Many illustrations and tables from the author's institution attest to an extensive personal experience in diagnostic pathology. A substantial portion of the book focuses on the practical pathological aspects of tumor diagnosis, including immunohistochemistry, electron microscopy, and cytogenetics. In addition, the discussion frequently emphasizes unusual clinical facets of these tumors that relate to their development during the perinatal period. For instance, the section on neuroblastoma, the most common perinatal malignant condition, comprehensively covers staging, pathological findings, cytogenetics, and prognostic data but emphasizes in addition clinical vignettes relevant to the perinatal occurrence of this tumor. These include the observations that congenital neuroblastomas occasionally mimic idiopathic hydrops fetalis; that antenatally (sonographically) diagnosed neuroblastomas are often unusual cystic tumors with a good prognosis; that fetal neuroblastomas may disseminate widely in the placenta within the fetal vasculature; and that fetal neuroblastomas have occasionally metastasized through placental anastomoses to a second fetus (a monozygous twin).

Although this concise textbook is intended largely as a handbook for pediatric pathologists, surgeons, and oncologists, its thorough coverage of the perinatal clinicopathological milieus should make it accessible and interesting to other physicians who care for fetuses and newborn babies.

David R. Genest, M.D.
Brigham and Women's Hospital, Boston, MA 02115