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Hematology: A pathophysiological approach (ed 3)
HUMAN PATHOLOGY
Volume 25, No. 2 (February 1995)
gression. Neural crest cells are highly migratory and thus very likely express ABP, although we did not test this hypothesis. Neither did we list normal melanocytes as expressing ABP because the scant amount of melanocytic cytoplasm relative to the abundant adjacent positive staining keratinocytes did not permit a clear interpretation. However, junctional nevi are frequently identified in young individuals and junctional nevomelanocytic nests often are observed extending into the papillary dermis in young adults, whereas in older individuals junctional nevi are less frequent and intradermal nevi are frequently observed, suggesting a net displacement of cells from the epidermis to the dermis. Similarly, clinicopathological correlation suggests that malignant melanoma in situ often precedes the invasive component by a few years in superficial spreading malignant melanoma and by several years to decades in lentigo maligna melanoma. 1'2 Whether one has primarily an embryological or pathological perspective may lead one to differing interpretations of the changing ABP expression in melanocytic proliferations. Nevertheless, it was the
goal of the article to demonstrate that heterogeneous ABP staining in melanocytic proliferations may have functional implications in individual cell migratory or infiltrative behavior. H. RANDOLPH BYERS,MD, PHD Department of Dermatology Boston University School of Medicine Boston, MA DANIELLE BOUFFARD,MD Department of Pathology Notre Dame Hospital University of Montreal Montreal, Quebec Canada 1. ClarkWH, Elder DE, VanHorn M: The biologicforms of malignant melanoma.HUMPATHOL17:443450, 1986 2. ClarkWH: Tumourprogressionand the nature of cancer.BrJ Cancer 64:631-644, 1991 (review)
BOOK REVIEWS
Hematology:A Pathophysiological Approach
(ed 3). Bernard M. Babior and Thomas P. Stossel. New York, NY, Churchill Livingstone, 1904, 504 pages, $39.95.
The field of hematology has seen rapid advancement over the past few years in both the basic science and clinical arenas. To impart this constantly expanding and ever changing knowledge to medical students and residents has been at times a frustrating endeavor. Few textbooks are available that satisfy the needs of both students and teachers in hematology and yet can be easily understood. To this end the current edition of Babior and Stossel's text is a timely addition to the available texts for medical student training. In the introduction the authors stress the important contributions of physiology, molecular biology, and pathophysiology to the study of blood disorders. This focus dominates all sections of the book, with a close association invoked between normal cellular function and the disregulation that occurs with disease. The book begins with an overview of the major components of blood, artistically tying together the cellular elements, the physiology of stem cells, and hematopoietic growth factors as well as the methods available for their analysis. Three major sections follow: red blood cells and their disorders, coagulation, and white blood cells. The overall organization of the majority of these chapters is excellent, and the authors make use of an abundance of tables, figures, and diagrams to reinforce difficult concepts in the written segments. This ensures that the text is appropriately directed to a student audience and in fact incorporates a good dose of tasteful humor. Descriptions of phagocytes as "messy eaters" or traumatic hemolysis as the "Waring blender syndrome" will be remembered years after they are read. Perhaps the strongest aspect of this text is the ability of the authors to integrate morphology, clinical practice, and the new advances in basic science--biochemistry, physiology, and molecular biology. Particularly well written are the sections on hemoglobinopathies (including the molecular genetics of these disorders), platelets and their physiology, and nonneoplastic disorders of phagocytes. Current and updated information is presented on such diverse topics as the role of adhesion molecules in neutrophil function, the etiology of inherited and acquired immunodeficiencies, and the uses and complications of bone marrow transplantation. Of particular
246
interest is the inclusion of current therapeutic modalities to enhance the discussions of anatomy and cell function. It is perhaps somewhat surprising to find a description of the use of low molecular weight heparin in a medical student text when such topics have not yet found their way into larger, more sophisticated reference books with any regularity. Unfortunately, many of the inaccuracies and typographical errors from the previous edition remain and additional ones have become evident. The chapter on transfusion medicine is outdated, still referring to a 21-day red cell storage limit and manual plateletpheresis procedures with a 50-mL yield. The most c o m m o n transfusion reactions, febrile nonhemolytic transfusion reactions and urticaria, are not even mentioned. The section on acute myeloid leukemia still describes the t(9;22) as involving c-ets-1 on chromosome 22, characterizing a variant of acute monoblastic leukemia. Sickle cell anemia is listed as microcytic, and macrocytic anemias are presented as being "hyperchromic." I am quite sure that regulatory agencies would complain if, as the authors suggest, laboratory personnel describe 20% immature " n u l l " cells, "some of which are TdT positive," in the peripheral blood of our normal patients or perform only an indirect antiglobulin test when a Coomb's test is requested. The majority of included figures and tables are excellent, with the addition of several well executed examples of computer graphics. However, it is unfortunate to note that many of the peripheral blood micrographs are either out of focus or poorly reproduced. Furthermore, not all figures are explained well in the accompanying legends; one figure in the overview appears to illustrate hematopoiesis occurring in the wrist bones but not in the vertebral column or sternum of normal adults. All in all, this book presents the pathophysiology of blood disorders in a concise and easily read m a n n e r that is appropriate to the level of training of medical students. The focus on pathophysiology makes it especially attractive. However, instructors in hematology must be acutely aware of the errors in the written sections and carefully proof each chapter to issue appropriate supplementary information and corrections.--LYNN C. MOSCINSKI,MD, Department of Pathology, Uni-
versity of South Florida, Tampa, FL.
Volume 25, No. 2 (February 1995)
gression. Neural crest cells are highly migratory and thus very likely express ABP, although we did not test this hypothesis. Neither did we list normal melanocytes as expressing ABP because the scant amount of melanocytic cytoplasm relative to the abundant adjacent positive staining keratinocytes did not permit a clear interpretation. However, junctional nevi are frequently identified in young individuals and junctional nevomelanocytic nests often are observed extending into the papillary dermis in young adults, whereas in older individuals junctional nevi are less frequent and intradermal nevi are frequently observed, suggesting a net displacement of cells from the epidermis to the dermis. Similarly, clinicopathological correlation suggests that malignant melanoma in situ often precedes the invasive component by a few years in superficial spreading malignant melanoma and by several years to decades in lentigo maligna melanoma. 1'2 Whether one has primarily an embryological or pathological perspective may lead one to differing interpretations of the changing ABP expression in melanocytic proliferations. Nevertheless, it was the
goal of the article to demonstrate that heterogeneous ABP staining in melanocytic proliferations may have functional implications in individual cell migratory or infiltrative behavior. H. RANDOLPH BYERS,MD, PHD Department of Dermatology Boston University School of Medicine Boston, MA DANIELLE BOUFFARD,MD Department of Pathology Notre Dame Hospital University of Montreal Montreal, Quebec Canada 1. ClarkWH, Elder DE, VanHorn M: The biologicforms of malignant melanoma.HUMPATHOL17:443450, 1986 2. ClarkWH: Tumourprogressionand the nature of cancer.BrJ Cancer 64:631-644, 1991 (review)
BOOK REVIEWS
Hematology:A Pathophysiological Approach
(ed 3). Bernard M. Babior and Thomas P. Stossel. New York, NY, Churchill Livingstone, 1904, 504 pages, $39.95.
The field of hematology has seen rapid advancement over the past few years in both the basic science and clinical arenas. To impart this constantly expanding and ever changing knowledge to medical students and residents has been at times a frustrating endeavor. Few textbooks are available that satisfy the needs of both students and teachers in hematology and yet can be easily understood. To this end the current edition of Babior and Stossel's text is a timely addition to the available texts for medical student training. In the introduction the authors stress the important contributions of physiology, molecular biology, and pathophysiology to the study of blood disorders. This focus dominates all sections of the book, with a close association invoked between normal cellular function and the disregulation that occurs with disease. The book begins with an overview of the major components of blood, artistically tying together the cellular elements, the physiology of stem cells, and hematopoietic growth factors as well as the methods available for their analysis. Three major sections follow: red blood cells and their disorders, coagulation, and white blood cells. The overall organization of the majority of these chapters is excellent, and the authors make use of an abundance of tables, figures, and diagrams to reinforce difficult concepts in the written segments. This ensures that the text is appropriately directed to a student audience and in fact incorporates a good dose of tasteful humor. Descriptions of phagocytes as "messy eaters" or traumatic hemolysis as the "Waring blender syndrome" will be remembered years after they are read. Perhaps the strongest aspect of this text is the ability of the authors to integrate morphology, clinical practice, and the new advances in basic science--biochemistry, physiology, and molecular biology. Particularly well written are the sections on hemoglobinopathies (including the molecular genetics of these disorders), platelets and their physiology, and nonneoplastic disorders of phagocytes. Current and updated information is presented on such diverse topics as the role of adhesion molecules in neutrophil function, the etiology of inherited and acquired immunodeficiencies, and the uses and complications of bone marrow transplantation. Of particular
246
interest is the inclusion of current therapeutic modalities to enhance the discussions of anatomy and cell function. It is perhaps somewhat surprising to find a description of the use of low molecular weight heparin in a medical student text when such topics have not yet found their way into larger, more sophisticated reference books with any regularity. Unfortunately, many of the inaccuracies and typographical errors from the previous edition remain and additional ones have become evident. The chapter on transfusion medicine is outdated, still referring to a 21-day red cell storage limit and manual plateletpheresis procedures with a 50-mL yield. The most c o m m o n transfusion reactions, febrile nonhemolytic transfusion reactions and urticaria, are not even mentioned. The section on acute myeloid leukemia still describes the t(9;22) as involving c-ets-1 on chromosome 22, characterizing a variant of acute monoblastic leukemia. Sickle cell anemia is listed as microcytic, and macrocytic anemias are presented as being "hyperchromic." I am quite sure that regulatory agencies would complain if, as the authors suggest, laboratory personnel describe 20% immature " n u l l " cells, "some of which are TdT positive," in the peripheral blood of our normal patients or perform only an indirect antiglobulin test when a Coomb's test is requested. The majority of included figures and tables are excellent, with the addition of several well executed examples of computer graphics. However, it is unfortunate to note that many of the peripheral blood micrographs are either out of focus or poorly reproduced. Furthermore, not all figures are explained well in the accompanying legends; one figure in the overview appears to illustrate hematopoiesis occurring in the wrist bones but not in the vertebral column or sternum of normal adults. All in all, this book presents the pathophysiology of blood disorders in a concise and easily read m a n n e r that is appropriate to the level of training of medical students. The focus on pathophysiology makes it especially attractive. However, instructors in hematology must be acutely aware of the errors in the written sections and carefully proof each chapter to issue appropriate supplementary information and corrections.--LYNN C. MOSCINSKI,MD, Department of Pathology, Uni-
versity of South Florida, Tampa, FL.