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Advances in Anatomic Pathology:
doi: 10.1097/PAP.0b013e3181a9ac54
Book Reviews

Diagnostic Problems in Breast Pathology

Renshaw, Andrew MD

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Department of Pathology, Baptist Hospital Miami, FL

Diagnostic Problems in Breast Pathology


Title: Diagnostic Problems in Breast Pathology

Author: Frederick C. Koerner, MD

Publishers: Saunders Elsevier

Year/ISBN: 2009/978-1-4160-2612-9

Pages: 369


Two small books on the surgical pathology of the breast have come out recently, and represent 2 very different approaches to this difficult organ. In my opinion, Drs Schnitt and Collins' Biopsy Interpretation of the Breast focuses on the question of “what,” whereas this text by Dr Koerner focuses on “why.” Drs Schnitt and Collins' book is an attempt to simplify the approach to breast pathology, keeping their text focused on descriptive terminology and a specific approach to each lesion. In contrast, the text by Dr Koerner, is an attempt to synthesize an entire approach to breast disease, including basic science approaches to not only how breast pathology looks, but why. The continuity of this book with that by Azzopardi (Problems in Breast Pathology, 1979) is obvious to anyone who is old enough to have read the text. Certainly, individual readers will prefer one or the other orientation. However, there is no question that most practicing pathologists would do well to be familiar with both approaches to this difficult organ.

This text begins with a chapter on “basic concepts to the analysis of epithelial proliferations,” and examines cellular proliferation, intercellular cohesion, cellular polarization, cytologic atypia, and architectural atypia. The author explores how these features arise, what can mimic them, and why they might be associated with a variety of different entities. He then tries to build a framework to approaching breast disease using these fundamental concepts. Thus the approach to all entities begins at the same place, and involves analysis of these fundamental features.

But this book is much more than a diagnostic text. It is also a discussion of the origins and underlying causes of breast lesions. For example, the chapters on usual hyperplasia and ductal carcinoma in situ contain not only descriptions but also analysis of their “glandular heritage,” the origin of lumen, and their biologic and morphologic relationship, or more precisely nonrelationship. It is not enough to describe calcifications in association with usual ductal hyperplasia, but the author also notes, “it seems possible that certain examples arise from the engulfment of preexisting calcifications.” Atypical ductal hyperplasia is not fundamentally one entity, or a lose description of entities that do not fit well in any one category, but a mixture of 3 different specific entities (extremely small lesions, an intermediate stage in the evolution of ductal carcinoma, and conventional ductal hyperplasia showing unexpected cytologic features) that have morphologic overlap and that presumably will be able to be better differentiated in the future.

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One could go on describing the insights in this book, because there are many. I am not sure I agree with everything that Dr Koerner says, but at least he gives a rationale for why he thinks what he does. I have many books that concentrate on describing the pathology of disease, and I have many books that concentrate on the science of disease, but I have very few that focus on the science of why disease looks the way it does under the microscope. Any textbook that can continue the tradition of Azzopardi should be a welcome addition to any pathologist's library.

Andrew Renshaw, MD

Department of Pathology, Baptist Hospital Miami, FL

© 2009 Lippincott Williams & Wilkins, Inc.


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