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Concerning collagen types in fibrosarcoma
HUMAN PATHOLOGY
Volume 16. No. 12 [December '1985)
cyte inclusions in acquired immune deficiencysyndrome:localization in T cells. AmJ Clin Pathol 81:147, 198.t 10. EimotoT, Kikuchi M, Mitsui T: ltistiocyticnecrotizing lymphadenitis: an ultrastructural study in comparison with other types of lymphadenitis. Acta PatholJpn 33:863, 1983
Concerning Collagen Types in Fibrosarcoma
To the Editor:--Concerning the recent description in HUMAN PATHOLOGY of collagen types in fibrosarcoma by Hall et al., 1 I believe that the diagnosis is not straightforward and can be questioned. First, pure fibrosarcoma is a rare lesion; many similar sarcomas with celhdar areas and a herringbone pattern (not mentioned, but required for fibrosarcoma) may be either malignant schwannomas or monophasic synovial sarcomas in disguise. Thus, this case is not "the most straightforward of these tumors." Second, electron microscopic data, from only one o f the three 11athology specimens, were obtained from the study o f less than ideal formalin-fixed tissue and were discussed only superficially. Third, in my opinion, the age (15 years), site
(lower thigh, knee region), anti natural history all, strongly suggest a diagnosis of monophasic synovial sarcoma. Thus, while I am sure that the authors' conclusions as to the types o f collagen present and their meaning are correct, they may be related to the wrong soft tissue phenotype. I would suggest that, if collagen types are to be correctly associated with various phenotypes, and since such infornmtion wotdd be quite valuable, other supportive studies, such as detailed ultrastt'ucture and, particularly, immunohistochemistry, ought to accompany these analyses. In this way, the phenotype studied would be clearly and accurately defined. JoH• J. BROOKS, MD Department of Pathology & l.aboratory Medicine I Iospital o f the University of I'ennsylvania Philadelphia, Pennsylvania I. llallJ, Tsang S, Timpl R, et ah Collagentypes in fibrosarcoma:absence of type 3 collagen in reticulin, tlust PAItIOL16:-t39, 1985
BOOK REVIEWS Textbook of Neuropathology, edited by R. L. Davis anti D. M. Robertson. Baltimore, Williams and Wilkins, 1984. 900 pages, $110.00. "Finally, you have a choice in neuropathology texts"; so reads the promotional brochure for the new Textbook of Neuropathology edited by Richard L. Davis and David M. Robertson, with 17 chapters from 21 contributors. T h e volume represents it comprehensive, up-to-date treatise on nearly all major subjects in neuropathology, designed to be "useful to general pathologists, neurosurgeons, and neurologists as well as neuropathologists." It is well organized and readably written in sufficient d e p t h and detail to present its subjects clearly but to avoid tedious pedantry. It also provides a superb list o f references on each subject, including a n u m b e r of historical interest and many current, as late as early 1984, all well annotated throughottt each chapter. Consistently high quality o f photographic reproduction does seem to be lacking overall; contrast is often too harsh, or, in some instances, backgrounds are too gray. A number o f concise tables and diagrams are informative and add significant information. The reader or potential reader should be aware that, for reasons stated by the editors in the preface, three areas of neuropathology were intentionally omitted, specifically nervous system neoplasms, peripheral nerve pathology, attd disease of muscle. That notwithstanding, the book provides useful and understandable information on subjects in neuropathology that have very often been considered confitsing or vague. The choice provided by this new text is valid, at:el it should be a welcome addition to the resource literatttre for students, postgraduate trainees, and practicing professionals interested in a number o f current concepts in neuropathology.~Wn.t.bxM O. ~VttI'7.TSEt.L,JR, MI), Department
of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee. Clinical Epidemiology, Ah'an R. Feinstein, MD. Philadelphia, WB S:mnders, 198~. 812 pages, $60.00. Epidemiologic and statistical information affects us all; new reports and conclusions appear in the news media daily. How are pathologists, o t h e r physicians, and the public t o j n d g e the qnality, accuracy, and objectivity of the
massive flow of statistical epidemiologic research? I f one is neither trained in statistical theory or practice nor gifted mathematically, one is likely at the mercy of those who are. Feinstein's new Clinical ls is a clear, witty, comprehensive, and eminently iiPstructive tutorial course in how to do medical epidemiologic studies and how to evaluate the publications. The chapters end with exercises, as in an old-fashioned arithmetic book, and the answers in the back are both educational and refreshing: "Ans 1 2 . 4 . . . T h e dccision here is largely a nmtter of ideologic viewpoint with respect to the role of individuals, industry, and government in a free society. As long as reasonable evidence can be offered, Bayer has the right to advertise that it is " b e t t e r " , . . . Members of the public have the right and the responsibility to be skeptical about advertising claims..." Once the reader knows more about the strengths and weaknesses o f case-control, cross-sectional, cohort, and noncohort research studies and appreciates the difference between mathematical significance and biologic significance probabilities, a m o n g other important distinctions, the medical literature can be read more critically and profitably. Susceptibility bias, d i a g n o s t i c a s c e r t a i n m e n t bias, the missing denominator, epidemiologic artifacts, and many other sources o f confusion and e r r o r are explained so clearly that even this reviewer was able to understand. It is a book worth reading and rereading in the present age of uncertainty.--SHELDO• C. SO.XtMERS, MD, Council for To-
bacco Research, New York, New York. Biomedical Bestiary: An Epidemiologic Guide to Flaws and Fallacies in the Medical Literature, Max Michael IIl, MD, W. Thomas Boyce, MD, and Allen J. Wilcox, MD, PhD. Boston, Little, Brown, 1984. 161 pages, $12.50. If you appreciate Feinstein's Clinical Epidendology, you will enjoy tile cartoons and brief text o f this small paperback. "It describes the strange and wily beasts that htrk, sallow and yellow-eyed, in tile most respectable medical studies." Characters include the Grand Confounder, Diagnostic Accuracy Bias (the con man o f the biomedical bestiary), and the beady-eyed Significance Turkey, a m o n g others. T h e tone is warm, charnfing, and sensitive to the need for good medical science.--SllELDON C. SOMMERS, MD, Council for Tobacco Research, New York, New York.
Volume 16. No. 12 [December '1985)
cyte inclusions in acquired immune deficiencysyndrome:localization in T cells. AmJ Clin Pathol 81:147, 198.t 10. EimotoT, Kikuchi M, Mitsui T: ltistiocyticnecrotizing lymphadenitis: an ultrastructural study in comparison with other types of lymphadenitis. Acta PatholJpn 33:863, 1983
Concerning Collagen Types in Fibrosarcoma
To the Editor:--Concerning the recent description in HUMAN PATHOLOGY of collagen types in fibrosarcoma by Hall et al., 1 I believe that the diagnosis is not straightforward and can be questioned. First, pure fibrosarcoma is a rare lesion; many similar sarcomas with celhdar areas and a herringbone pattern (not mentioned, but required for fibrosarcoma) may be either malignant schwannomas or monophasic synovial sarcomas in disguise. Thus, this case is not "the most straightforward of these tumors." Second, electron microscopic data, from only one o f the three 11athology specimens, were obtained from the study o f less than ideal formalin-fixed tissue and were discussed only superficially. Third, in my opinion, the age (15 years), site
(lower thigh, knee region), anti natural history all, strongly suggest a diagnosis of monophasic synovial sarcoma. Thus, while I am sure that the authors' conclusions as to the types o f collagen present and their meaning are correct, they may be related to the wrong soft tissue phenotype. I would suggest that, if collagen types are to be correctly associated with various phenotypes, and since such infornmtion wotdd be quite valuable, other supportive studies, such as detailed ultrastt'ucture and, particularly, immunohistochemistry, ought to accompany these analyses. In this way, the phenotype studied would be clearly and accurately defined. JoH• J. BROOKS, MD Department of Pathology & l.aboratory Medicine I Iospital o f the University of I'ennsylvania Philadelphia, Pennsylvania I. llallJ, Tsang S, Timpl R, et ah Collagentypes in fibrosarcoma:absence of type 3 collagen in reticulin, tlust PAItIOL16:-t39, 1985
BOOK REVIEWS Textbook of Neuropathology, edited by R. L. Davis anti D. M. Robertson. Baltimore, Williams and Wilkins, 1984. 900 pages, $110.00. "Finally, you have a choice in neuropathology texts"; so reads the promotional brochure for the new Textbook of Neuropathology edited by Richard L. Davis and David M. Robertson, with 17 chapters from 21 contributors. T h e volume represents it comprehensive, up-to-date treatise on nearly all major subjects in neuropathology, designed to be "useful to general pathologists, neurosurgeons, and neurologists as well as neuropathologists." It is well organized and readably written in sufficient d e p t h and detail to present its subjects clearly but to avoid tedious pedantry. It also provides a superb list o f references on each subject, including a n u m b e r of historical interest and many current, as late as early 1984, all well annotated throughottt each chapter. Consistently high quality o f photographic reproduction does seem to be lacking overall; contrast is often too harsh, or, in some instances, backgrounds are too gray. A number o f concise tables and diagrams are informative and add significant information. The reader or potential reader should be aware that, for reasons stated by the editors in the preface, three areas of neuropathology were intentionally omitted, specifically nervous system neoplasms, peripheral nerve pathology, attd disease of muscle. That notwithstanding, the book provides useful and understandable information on subjects in neuropathology that have very often been considered confitsing or vague. The choice provided by this new text is valid, at:el it should be a welcome addition to the resource literatttre for students, postgraduate trainees, and practicing professionals interested in a number o f current concepts in neuropathology.~Wn.t.bxM O. ~VttI'7.TSEt.L,JR, MI), Department
of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee. Clinical Epidemiology, Ah'an R. Feinstein, MD. Philadelphia, WB S:mnders, 198~. 812 pages, $60.00. Epidemiologic and statistical information affects us all; new reports and conclusions appear in the news media daily. How are pathologists, o t h e r physicians, and the public t o j n d g e the qnality, accuracy, and objectivity of the
massive flow of statistical epidemiologic research? I f one is neither trained in statistical theory or practice nor gifted mathematically, one is likely at the mercy of those who are. Feinstein's new Clinical ls is a clear, witty, comprehensive, and eminently iiPstructive tutorial course in how to do medical epidemiologic studies and how to evaluate the publications. The chapters end with exercises, as in an old-fashioned arithmetic book, and the answers in the back are both educational and refreshing: "Ans 1 2 . 4 . . . T h e dccision here is largely a nmtter of ideologic viewpoint with respect to the role of individuals, industry, and government in a free society. As long as reasonable evidence can be offered, Bayer has the right to advertise that it is " b e t t e r " , . . . Members of the public have the right and the responsibility to be skeptical about advertising claims..." Once the reader knows more about the strengths and weaknesses o f case-control, cross-sectional, cohort, and noncohort research studies and appreciates the difference between mathematical significance and biologic significance probabilities, a m o n g other important distinctions, the medical literature can be read more critically and profitably. Susceptibility bias, d i a g n o s t i c a s c e r t a i n m e n t bias, the missing denominator, epidemiologic artifacts, and many other sources o f confusion and e r r o r are explained so clearly that even this reviewer was able to understand. It is a book worth reading and rereading in the present age of uncertainty.--SHELDO• C. SO.XtMERS, MD, Council for To-
bacco Research, New York, New York. Biomedical Bestiary: An Epidemiologic Guide to Flaws and Fallacies in the Medical Literature, Max Michael IIl, MD, W. Thomas Boyce, MD, and Allen J. Wilcox, MD, PhD. Boston, Little, Brown, 1984. 161 pages, $12.50. If you appreciate Feinstein's Clinical Epidendology, you will enjoy tile cartoons and brief text o f this small paperback. "It describes the strange and wily beasts that htrk, sallow and yellow-eyed, in tile most respectable medical studies." Characters include the Grand Confounder, Diagnostic Accuracy Bias (the con man o f the biomedical bestiary), and the beady-eyed Significance Turkey, a m o n g others. T h e tone is warm, charnfing, and sensitive to the need for good medical science.--SllELDON C. SOMMERS, MD, Council for Tobacco Research, New York, New York.