NEWSPath

ANATOMIC PATHOLOGY

Neoplasm of hepatic stellate cells (spongiotic pericytoma): A new tumor entity in human liver

E. Kaiserlingand H. Müller

The purpose of this investigation was to classify a previously unknown tumor entity in human liver observed in a 35-year-old woman. It was characterized by an unusual accumulation of fusiform CD34-positive cells and was initially misconceived as a tumor of the liver sinusoids.

The tissue was examined by light and electron microscopy and by immunocytochemical techniques with a broad spectrum of antibodies.

The polycyclic tumor contained multiple nodular cell aggregates. The tumor cells possessed extensive cytoplasmic processes, rough endoplasmic reticulum, a prominent Golgi complex, and, in isolated cases, fat droplets. They expressed vimentin, CD34, CD105, CD99, CD56, and sm-actin. The matrix surrounding these cells was reactive for collagen types I, III and V, and fibronectin.

The unusual aspect of this tumor is that it contained collections of cells that appeared to be hepatic stellate cells (Ito cells). It also contained hepatic cells arranged in plates, lobules, and capillarized sinuses. These findings suggest that the tumorous proliferation of hepatic stellate cells is functionally linked to the hepatocytes. It is unclear whether there is a link between the tumor and the patient's use of oral contraceptives. Referring to animal studies, different hepatocarcinogens may cause neoplastic Ito cell proliferation. The patient has remained recurrence-free during the 12 months since operation.

Pathology - Research and Practice, Volume 201, Issue 11, 25 November 2005, Pages 733-743

Clinical and pathological features of non-alcoholic steatohepatitis

Nonomura A, Enomoto Y, Takeda M, Tamura T et al

Clinical and pathological features were reviewed in 76 Japanese patients with non-alcoholic steatohepatitis (NASH). Forty-one were male and 35 were female with the mean age of 49.7 years old (range 15-75 years old, males; 46.3, females; 53.7 years old). Fifty-four percent of patients were preobese with a body mass index (BMI) between 25 and 30, while 16% of the patients were non-obese, and only 30% of the cases were morbidly obese, indicating that Japanese have a greater tendency to develop insulin-resistance and fatty liver disease than Western people. Hyperlipidemia was found in 51%, diabetes mellitus in 38%, and hypertension in 33% of the patients. Abnormally elevated liver function tests were found in one-third to two-thirds of the patients and were characteristically mild with 2- to 3-fold elevation from the normal range in the majority of the cases. Histological features of the liver were similar or identical to those reported in English literature and were characterized by fatty change, perivenular and pericellular fibrosis in zone 3, hepatocyte ballooning and necrosis with occasional Mallory's body formation and polymorphonuclear leukocyte infiltration. Mallory's bodies were found in 39% of patients and were characteristically small and poorly formed compared with those in alcoholic hepatitis. Eosinophilic granular or dirty foggy aggregated, not sufficient to be identified as Mallory's bodies, were a rather characteristic cytoplasmic expression in NASH patients. Portal inflammation and fibrosis were not found in the early stage of NASH, but were found as the disease progresses with formation of C-C and/or P-C bridging fibrosis, and eventually resulting in liver cirrhosis.

Hepatol Res. 2005 Nov 4;

Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review

J Roulson, E W Benbow, P S Hasleton

The autopsy is in decline, despite the fact that accurate mortality statistics remain essential for public health and health service planning. The falling autopsy rate combined with the Coroners Review and Human Tissue Act have contributed to this decline, and to a falling use of autopsy histology, with potential impact on clinical audit and mortality statistics. At a time when the need for reform and improvement in the death certification process is so prominent, authors felt it important to assess the value of the autopsy and autopsy histology. Authors carried out a meta-analysis of discrepancies between clinical and autopsy diagnoses and the contribution of autopsy histology. There has been little improvement in the overall rate of discrepancies between the 1960s and the present. At least a third of death certificates are likely to be incorrect and 50% of autopsies produce findings unsuspected before death. In addition, the cases which give rise to discrepancies cannot be identified prior to autopsy. Over 20% of clinically unexpected autopsy findings, including 5% of major findings, can be correctly diagnosed only by histological examination. Although the autopsy and particularly autopsy histology are being undermined, they are still the most accurate method of determining the cause of death and auditing accuracy of clinical diagnosis, diagnostic tests and death certification.

Histopathology Volume 47 Issue 6 Page 551 - December 2005

CYTOPATHOLOGY

Histologic and clinical significance of atypical glandular cells on pap smears

A. Daniel, D. Barreth, A. Schepansky, G. Johnson, V. Capstick and W. Faught

Objective: To determine the association between atypical glandular cells (AGC) on Pap smear and clinically significant histology, in a large health region.

Methods: A cytologic database of over one million Pap smears was reviewed for a result of AGUS/AGC. Cytologic and histologic follow up was obtained to establish the presence of significant histology.

Results: 456 patients available for follow up had AGUS/AGC cytology results (0.043% of all Pap smear results). 197(45.2%) patients had a clinically significant diagnosis including 40 with adenocarcinoma in situ (AIS) of the cervix and 48 with endometrial cancer.

Conclusion: AGC on a Pap smear is frequently associated with a clinically significant diagnosis.

International Journal of Gynecology & Obstetrics, Volume 91, Issue 3, December 2005, Pages 238-242

CLINICAL PATHOLOGY

Evaluation of a New Rapid Immunochromatographic Assay For Serodiagnosis of Acute Hepatitis E Infection

Khin s. A. Myint, Ming Guan, Hsiao Ying Chen, Yang Lu, David Anderson et al

A rapid and reliable diagnostic assay for acute hepatitis Evirus (HEV) infection is needed. Authors evaluated a rapid, immunochromatographicassay for IgM antibodies to HEV (ASSURE^TM HEV IgM Rapid Test)using acute-phase HEV samples (n = 200) from Indonesia and Nepaland convalescent-phase HEV samples (n = 70) from Nepal. Blooddonors in Thailand (n = 100), individuals with hepatitis A (n= 80), hepatitis B (n = 45), and hepatitis C (n = 50) in Thailandand Nepal, acute-phase sera of individuals with Epstein-Barrvirus infection (n = 20), and rheumatoid factor–positiveblood (n = 26) served as negative controls. The assay had asensitivity of 93% (95% confidence interval [CI] = 88.5–96.1%)and a specificity of 99.7% (95% CI = 98.3–100%). The positiveand negative predictive values were 99.5% (95% CI = 97.1–100%)and 95.8% (95% CI = 93.1–97.7%), respectively. These resultssuggest that this assay is a sensitive and specific tool forthe rapid diagnosis of acute HEV infection.

Am. J. Trop. Med. Hyg., 73(5), 2005, pp. 942-946

Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis.

Tueller C, Chhajed PN, Buitrago-Tellez C et al

At present, further investigations are needed in patients with suspected pulmonary tuberculosis (TB) and either negative sputum smear or without sputum. The aim of the present study was to analyse the yield of bronchoalveolar lavage fluid (BALF) smear and PCR in patients with confirmed pulmonary TB. Patients with a positive culture for Mycobacterium tuberculosis complex in sputum or BALF were analysed over 5 yrs. In total, 90 out of 230 (39%) patients with culture-positive pulmonary TB had a positive sputum smear, and 120 patients underwent bronchoscopy. BALF smear was positive in 56 (47%), BALF PCR in 93 (78%) patients, and BALF smear and/or PCR was positive in 83%. In total, 71 patients who underwent bronchoscopy and had complete clinical records were further analysed. BALF (smear or Mycobacterium tuberculosis complex-PCR) allowed a rapid diagnosis in 10 (59%) out of 17 patients who had a negative sputum smear, and 49 (91%) out of 54 patients without sputum production. Of these 71 patients, 12 (17%) were only culture positive. Rapid diagnosis of pulmonary TB by smear and/or PCR was made in 190 out of 210 patients (90%) in sputum or BALF. In conclusion, combined use of bronchoalveolar lavage fluid smear and Mycobacterium tuberculosis complex-PCR has a good diagnostic yield in patients with sputum smear-negative tuberculosis or without sputum production.

Eur Respir J. 2005 Nov;26(5):767-72.

BOTTOM LINE

How to Write a Medical Paper to Get It Published in a Good Journal

George D. Lundberg, MD

The purposes of a medical journal are to shed light, to take heat, and to give heat. A physicist named Faraday once said, "Work; finish; publish.^[^1]" If you started and did not finish, why did you start? If you finished and did not publish, why did you start? Follows like the night the day: Work, finish, publish, if you want anyone else to ever know what you did. Francis Bacon once said, "reading maketh a full man; conference a ready man; but writing an exact man.^[^2]" Writing is hard work. So you want to write a paper? What do you have to say? Is it worth writing? Has the information already been published? What format should it be? What is the audience? What journal is appropriate? Beginning in 1978, the International Committee of Medical Journal Editors^[^3] began to set the rules for how authors, editors, peer reviewers, advertisers, and publishers ought to behave. The peer review process began some 300 years ago in France and in England,^[^4] revolutionizing science by creating a culture of peer criticism and self-criticism. Peer reviewers are asked: Is the manuscript original, important, interesting; are the data valid; are the conclusions justified by the data; is the writing clear; and what is the priority and timing? Is it new? Is it true? All journals make messes. They clean them up in the letters column and by corrections and retractions. In July 2005, we were privileged to give a 3-hour seminar on this topic to hundreds of student authors. The Kaiser Family Foundation videotaped all of this program, and it is available to you live.^[5] Also, Dr. Bill Tierney of Indiana University has given us permission to provide to you his basic helpful writing instructions.^[6] That's my opinion.

Dr. George Lundberg isEditor-in-Chief of MedGenMed.

References

1. Wikipedia. Michael Faraday. Available at: http://en.wikipedia.org/wiki/Michael_Faraday Accessed October 28, 2005.

2. The Literature Page. Sir Francis Bacon. Available at: http://www.literaturepage.com/authors/Sir-Francis-Bacon.html Accessed October 28, 2005.

3. International Committee of Medical Journal Editors (ICMJE). October 2005. Available at: www.ICMJE.org Accessed October 28, 2005.

4. Lock S. A Difficult Balance: Editorial Peer Review in Medicine. London, United Kingdom: Nuffield Provincial Hospital Trust; 1985.

Kaiser Family Foundation. 3rd IAS Conference on HIV Pathogenesis and Treatment. Kaisernetwork.org. Available at: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1458 Accessed October 28, 2005.
Adapted from Bill Tierney IUPUI, Indianapolis, Ind. Instructions on How to Write a Paper for Publication in a Medical Journal

Medscape General Medicine, November 2005

Principles of Molecular Pathology

Martine Roudier

"Happy is he who gets to know the reasons for things." —Virgil, 70-19 BC

For a surgical practicing pathologist like myself, born before the 1970s, the book Principles of Molecular Pathology is an illuminating guide to understanding the powerful tools of molecular biology and how these tools can be used in the practice of pathology.

When I started to extract RNA from tissue a few years ago, a colleague told me that molecular biology is not like cooking. We do not see any of the materials during the process, but, at the end, the tangible results are there, striking, having appeared from an invisible world. I found myself confronted with a poignant contradiction: I had chosen pathology as my career because the disease was visible; and with a lot of confidence (if not happiness) I could, in most cases, live with a peaceful mind even in the face of having made a dreadful diagnosis. The microscopic features of diseases were the symptoms and signs of a patient's disease leading to a well-defined diagnosis. Nowadays, those signature features can be invisible—molecular. Cancer can be characterized and is beginning to be understood at the molecular level. The transition from cellular to molecular in the pathologist's practice was needed. Principles of Molecular Pathology clearly testifies for the first time to the values and broad applications of molecular pathology in medicine.

The book of fewer than 350 pages is so well written that a less molecularly oriented pathologist can read the entire text within only 30 hours. The book is small (half an A4 format) and compact with a font and an overall layout of text and essential schematics that make it a pleasure to peruse. One of its best features is an extremely lucid text, without repetition. The text covers topics chosen to provide a broad overview of the subject. Concise basic concepts of molecular biology and genetics are followed by an accurate description of the most commonly and currently used analytic methods. One chapter explains the acquired genetic abnormalities that underlie inherited disorders. Two essential chapters describe, masterfully, the important genetic determinants of human malignancies, acquired and hereditary. These 2 chapters are beautifully crafted and provide the reader with lasting enlightenment. One entire chapter is dedicated to the molecular understanding of myeloid and lymphoid malignancies, which reads like a police novel by pathologists who excel in the morphologic and immunologic diagnosis of hematologic disorders. Chapters on pharmacogenetics and identity testing emphasize the current importance and futuristic implications of these areas in clinical practice. Finally, the current application of molecular methods is described in the detection of a few major bacterial and viral infections.

This is a wonderful and unique book that should be purchased by a wide readership, including residents and fellows in laboratory medicine and pathology, practicing pathologists desiring to easily understand the current transition of their practice, and specialized research pathologists interested in broadening their general knowledge in the powerful tool of molecular pathology.

Am J Clin Pathol. 2005;124(5):816.


		November 2005
		ANATOMIC PATHOLOGY Neoplasm of hepatic stellate cells (spongiotic pericytoma): A new tumor entity in human liver E. Kaiserlingand H. Müller The purpose of this investigation was to classify a previously unknown tumor entity in human liver observed in a 35-year-old woman. It was characterized by an unusual accumulation of fusiform CD34-positive cells and was initially misconceived as a tumor of the liver sinusoids. The tissue was examined by light and electron microscopy and by immunocytochemical techniques with a broad spectrum of antibodies. The polycyclic tumor contained multiple nodular cell aggregates. The tumor cells possessed extensive cytoplasmic processes, rough endoplasmic reticulum, a prominent Golgi complex, and, in isolated cases, fat droplets. They expressed vimentin, CD34, CD105, CD99, CD56, and sm-actin. The matrix surrounding these cells was reactive for collagen types I, III and V, and fibronectin. The unusual aspect of this tumor is that it contained collections of cells that appeared to be hepatic stellate cells (Ito cells). It also contained hepatic cells arranged in plates, lobules, and capillarized sinuses. These findings suggest that the tumorous proliferation of hepatic stellate cells is functionally linked to the hepatocytes. It is unclear whether there is a link between the tumor and the patient's use of oral contraceptives. Referring to animal studies, different hepatocarcinogens may cause neoplastic Ito cell proliferation. The patient has remained recurrence-free during the 12 months since operation. Pathology - Research and Practice, Volume 201, Issue 11, 25 November 2005, Pages 733-743 Clinical and pathological features of non-alcoholic steatohepatitis Nonomura A, Enomoto Y, Takeda M, Tamura T et al Clinical and pathological features were reviewed in 76 Japanese patients with non-alcoholic steatohepatitis (NASH). Forty-one were male and 35 were female with the mean age of 49.7 years old (range 15-75 years old, males; 46.3, females; 53.7 years old). Fifty-four percent of patients were preobese with a body mass index (BMI) between 25 and 30, while 16% of the patients were non-obese, and only 30% of the cases were morbidly obese, indicating that Japanese have a greater tendency to develop insulin-resistance and fatty liver disease than Western people. Hyperlipidemia was found in 51%, diabetes mellitus in 38%, and hypertension in 33% of the patients. Abnormally elevated liver function tests were found in one-third to two-thirds of the patients and were characteristically mild with 2- to 3-fold elevation from the normal range in the majority of the cases. Histological features of the liver were similar or identical to those reported in English literature and were characterized by fatty change, perivenular and pericellular fibrosis in zone 3, hepatocyte ballooning and necrosis with occasional Mallory's body formation and polymorphonuclear leukocyte infiltration. Mallory's bodies were found in 39% of patients and were characteristically small and poorly formed compared with those in alcoholic hepatitis. Eosinophilic granular or dirty foggy aggregated, not sufficient to be identified as Mallory's bodies, were a rather characteristic cytoplasmic expression in NASH patients. Portal inflammation and fibrosis were not found in the early stage of NASH, but were found as the disease progresses with formation of C-C and/or P-C bridging fibrosis, and eventually resulting in liver cirrhosis. Hepatol Res. 2005 Nov 4; Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review J Roulson, E W Benbow, P S Hasleton The autopsy is in decline, despite the fact that accurate mortality statistics remain essential for public health and health service planning. The falling autopsy rate combined with the Coroners Review and Human Tissue Act have contributed to this decline, and to a falling use of autopsy histology, with potential impact on clinical audit and mortality statistics. At a time when the need for reform and improvement in the death certification process is so prominent, authors felt it important to assess the value of the autopsy and autopsy histology. Authors carried out a meta-analysis of discrepancies between clinical and autopsy diagnoses and the contribution of autopsy histology. There has been little improvement in the overall rate of discrepancies between the 1960s and the present. At least a third of death certificates are likely to be incorrect and 50% of autopsies produce findings unsuspected before death. In addition, the cases which give rise to discrepancies cannot be identified prior to autopsy. Over 20% of clinically unexpected autopsy findings, including 5% of major findings, can be correctly diagnosed only by histological examination. Although the autopsy and particularly autopsy histology are being undermined, they are still the most accurate method of determining the cause of death and auditing accuracy of clinical diagnosis, diagnostic tests and death certification. Histopathology Volume 47 Issue 6 Page 551 - December 2005 CYTOPATHOLOGY Histologic and clinical significance of atypical glandular cells on pap smears A. Daniel, D. Barreth, A. Schepansky, G. Johnson, V. Capstick and W. Faught Objective: To determine the association between atypical glandular cells (AGC) on Pap smear and clinically significant histology, in a large health region. Methods: A cytologic database of over one million Pap smears was reviewed for a result of AGUS/AGC. Cytologic and histologic follow up was obtained to establish the presence of significant histology. Results: 456 patients available for follow up had AGUS/AGC cytology results (0.043% of all Pap smear results). 197(45.2%) patients had a clinically significant diagnosis including 40 with adenocarcinoma in situ (AIS) of the cervix and 48 with endometrial cancer. Conclusion: AGC on a Pap smear is frequently associated with a clinically significant diagnosis. International Journal of Gynecology & Obstetrics, Volume 91, Issue 3, December 2005, Pages 238-242 CLINICAL PATHOLOGY Evaluation of a New Rapid Immunochromatographic Assay For Serodiagnosis of Acute Hepatitis E Infection Khin s. A. Myint, Ming Guan, Hsiao Ying Chen, Yang Lu, David Anderson et al A rapid and reliable diagnostic assay for acute hepatitis Evirus (HEV) infection is needed. Authors evaluated a rapid, immunochromatographicassay for IgM antibodies to HEV (ASSURE^TM HEV IgM Rapid Test)using acute-phase HEV samples (n = 200) from Indonesia and Nepaland convalescent-phase HEV samples (n = 70) from Nepal. Blooddonors in Thailand (n = 100), individuals with hepatitis A (n= 80), hepatitis B (n = 45), and hepatitis C (n = 50) in Thailandand Nepal, acute-phase sera of individuals with Epstein-Barrvirus infection (n = 20), and rheumatoid factor–positiveblood (n = 26) served as negative controls. The assay had asensitivity of 93% (95% confidence interval [CI] = 88.5–96.1%)and a specificity of 99.7% (95% CI = 98.3–100%). The positiveand negative predictive values were 99.5% (95% CI = 97.1–100%)and 95.8% (95% CI = 93.1–97.7%), respectively. These resultssuggest that this assay is a sensitive and specific tool forthe rapid diagnosis of acute HEV infection. Am. J. Trop. Med. Hyg., 73(5), 2005, pp. 942-946 Value of smear and PCR in bronchoalveolar lavage fluid in culture positive pulmonary tuberculosis. Tueller C, Chhajed PN, Buitrago-Tellez C et al At present, further investigations are needed in patients with suspected pulmonary tuberculosis (TB) and either negative sputum smear or without sputum. The aim of the present study was to analyse the yield of bronchoalveolar lavage fluid (BALF) smear and PCR in patients with confirmed pulmonary TB. Patients with a positive culture for Mycobacterium tuberculosis complex in sputum or BALF were analysed over 5 yrs. In total, 90 out of 230 (39%) patients with culture-positive pulmonary TB had a positive sputum smear, and 120 patients underwent bronchoscopy. BALF smear was positive in 56 (47%), BALF PCR in 93 (78%) patients, and BALF smear and/or PCR was positive in 83%. In total, 71 patients who underwent bronchoscopy and had complete clinical records were further analysed. BALF (smear or Mycobacterium tuberculosis complex-PCR) allowed a rapid diagnosis in 10 (59%) out of 17 patients who had a negative sputum smear, and 49 (91%) out of 54 patients without sputum production. Of these 71 patients, 12 (17%) were only culture positive. Rapid diagnosis of pulmonary TB by smear and/or PCR was made in 190 out of 210 patients (90%) in sputum or BALF. In conclusion, combined use of bronchoalveolar lavage fluid smear and Mycobacterium tuberculosis complex-PCR has a good diagnostic yield in patients with sputum smear-negative tuberculosis or without sputum production. Eur Respir J. 2005 Nov;26(5):767-72. BOTTOM LINE How to Write a Medical Paper to Get It Published in a Good Journal George D. Lundberg, MD The purposes of a medical journal are to shed light, to take heat, and to give heat. A physicist named Faraday once said, "Work; finish; publish.^[^1]" If you started and did not finish, why did you start? If you finished and did not publish, why did you start? Follows like the night the day: Work, finish, publish, if you want anyone else to ever know what you did. Francis Bacon once said, "reading maketh a full man; conference a ready man; but writing an exact man.^[^2]" Writing is hard work. So you want to write a paper? What do you have to say? Is it worth writing? Has the information already been published? What format should it be? What is the audience? What journal is appropriate? Beginning in 1978, the International Committee of Medical Journal Editors^[^3] began to set the rules for how authors, editors, peer reviewers, advertisers, and publishers ought to behave. The peer review process began some 300 years ago in France and in England,^[^4] revolutionizing science by creating a culture of peer criticism and self-criticism. Peer reviewers are asked: Is the manuscript original, important, interesting; are the data valid; are the conclusions justified by the data; is the writing clear; and what is the priority and timing? Is it new? Is it true? All journals make messes. They clean them up in the letters column and by corrections and retractions. In July 2005, we were privileged to give a 3-hour seminar on this topic to hundreds of student authors. The Kaiser Family Foundation videotaped all of this program, and it is available to you live.^[5] Also, Dr. Bill Tierney of Indiana University has given us permission to provide to you his basic helpful writing instructions.^[6] That's my opinion. Dr. George Lundberg isEditor-in-Chief of MedGenMed. References 1. Wikipedia. Michael Faraday. Available at: http://en.wikipedia.org/wiki/Michael_Faraday Accessed October 28, 2005. 2. The Literature Page. Sir Francis Bacon. Available at: http://www.literaturepage.com/authors/Sir-Francis-Bacon.html Accessed October 28, 2005. 3. International Committee of Medical Journal Editors (ICMJE). October 2005. Available at: www.ICMJE.org Accessed October 28, 2005. 4. Lock S. A Difficult Balance: Editorial Peer Review in Medicine. London, United Kingdom: Nuffield Provincial Hospital Trust; 1985. Kaiser Family Foundation. 3rd IAS Conference on HIV Pathogenesis and Treatment. Kaisernetwork.org. Available at: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1458 Accessed October 28, 2005. Adapted from Bill Tierney IUPUI, Indianapolis, Ind. Instructions on How to Write a Paper for Publication in a Medical Journal Medscape General Medicine, November 2005 Principles of Molecular Pathology Martine Roudier "Happy is he who gets to know the reasons for things." —Virgil, 70-19 BC For a surgical practicing pathologist like myself, born before the 1970s, the book Principles of Molecular Pathology is an illuminating guide to understanding the powerful tools of molecular biology and how these tools can be used in the practice of pathology. When I started to extract RNA from tissue a few years ago, a colleague told me that molecular biology is not like cooking. We do not see any of the materials during the process, but, at the end, the tangible results are there, striking, having appeared from an invisible world. I found myself confronted with a poignant contradiction: I had chosen pathology as my career because the disease was visible; and with a lot of confidence (if not happiness) I could, in most cases, live with a peaceful mind even in the face of having made a dreadful diagnosis. The microscopic features of diseases were the symptoms and signs of a patient's disease leading to a well-defined diagnosis. Nowadays, those signature features can be invisible—molecular. Cancer can be characterized and is beginning to be understood at the molecular level. The transition from cellular to molecular in the pathologist's practice was needed. Principles of Molecular Pathology clearly testifies for the first time to the values and broad applications of molecular pathology in medicine. The book of fewer than 350 pages is so well written that a less molecularly oriented pathologist can read the entire text within only 30 hours. The book is small (half an A4 format) and compact with a font and an overall layout of text and essential schematics that make it a pleasure to peruse. One of its best features is an extremely lucid text, without repetition. The text covers topics chosen to provide a broad overview of the subject. Concise basic concepts of molecular biology and genetics are followed by an accurate description of the most commonly and currently used analytic methods. One chapter explains the acquired genetic abnormalities that underlie inherited disorders. Two essential chapters describe, masterfully, the important genetic determinants of human malignancies, acquired and hereditary. These 2 chapters are beautifully crafted and provide the reader with lasting enlightenment. One entire chapter is dedicated to the molecular understanding of myeloid and lymphoid malignancies, which reads like a police novel by pathologists who excel in the morphologic and immunologic diagnosis of hematologic disorders. Chapters on pharmacogenetics and identity testing emphasize the current importance and futuristic implications of these areas in clinical practice. Finally, the current application of molecular methods is described in the detection of a few major bacterial and viral infections. This is a wonderful and unique book that should be purchased by a wide readership, including residents and fellows in laboratory medicine and pathology, practicing pathologists desiring to easily understand the current transition of their practice, and specialized research pathologists interested in broadening their general knowledge in the powerful tool of molecular pathology. Am J Clin Pathol. 2005;124(5):816.
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