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Advances in Anatomic Pathology:
doi: 10.1097/PAP.0b013e31827b6539
Book Review

Book Review of Histology for Pathologists

Hoda, Syed A. MD

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Author Information

Weill Cornell Medical College, Cornell University, New York, NY

The author has no funding or conflicts of interest to disclose.

In the preface to the latest edition of Histology for Pathologists, Stacey Mills, the editor, states that as the third edition was published in 2007 it is reasonable to ask if “normal has changed enough in the ensuing 5 years to justify a new edition. The answer, of course, is that normal has not changed at all (evolution is indeed a slow process!) but our perception of normal continues to expand and improve.” Histology for Pathologists continues to be an invaluable resource of such changes in “perception” and myriad practical information for all practicing anatomic pathologists. Herein, multiple quotes from the book will highlight the catholic scope of the book.

Important anatomic information is extensively shared, for example, regarding the adrenal glands, “most of the medulla is in the head of the gland (medial), some occurs in the body, and there is usually none in the tail (lateral)” and regarding urinary bladder, “many urologists are unaware of the existence of a superficial muscle layer (muscularis mucosae).” The book provides diagnostic nuggets that relate primarily to histological issues, for example, the demonstration of “invasion of stroma remains the gold standard for the distinction of reactive mesothelium from malignant mesothelium” and “…the best defense against the misdiagnosis of another tumor as a lipocytic one is strict adherence to the definition of a lipoblast.”

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Technical issues that relate to biopsy interpretation are described. For example, regarding the small bowel “…in a very superficial mucosal biopsy specimen” the tissues “tend to spread laterally, resulting in villi becoming more widely spaced and appearing short and broad” and in the colon, “the appearance of acini (doughnouts) rather than ‘test tubes’ within the lamina propria is a clear indication of tangential sectioning.” Specimen processing issues are not overlooked. Proper specimen handling is emphasized in the book. For example, if sections are taken directly from a fresh gastrectomy then “irregular orientation of mucosa” invariably results. The book recommends that routine sampling of the margin of resection of the appendectomy specimen be performed as neoplasms are “not infrequently discovered incidentally during microscopic evaluation.” Regarding bone marrow evaluation, the informational nugget that cellularity of paraffin-embedded sections is “about 5% lower than in plastic-embedded sections” is imparted.

Clues regarding frozen section evaluation are disclosed; for example, in the thyroid, the identification of oxalate crystals “can be useful in distinguishing it from parathyroid gland tissue.” Uncertainties regarding normal and abnormal are readily unveiled, for example, regarding prostatic postatrophic hyperplasia, “whether this is truly a hyperplastic process or not remains unknown.” Physiological points relevant to histology are stressed, for example, in the fallopian tube, “ciliogenesis is promoted by estradiol and deciliation by progesterone.”

Artifacts that hinder diagnostic evaluation of various tissues are depicted in multiple sections. Those relating to the brain are said to be the result of “crush—burn—freeze—suck—soak.” The observation that “telescoping” of small arteries in endomyocardial biopsies can be confused with luminal occlusion by thrombus and transplant-related arterosclerosis is communicated.

The book points out wherever disease may not be readily evident in the biopsy material, for example, “…conditions that might be missed as ‘normal skin’ include café au lait spots, cutis laxa (elastolysis), myxoedema, scleromyxedema…” and lung biopsies that “look normal at first glance” include pulmonary vascular disease, small airway disease, emboli, pulmonary edema, etc.

The fact that histology is not a static science is borne out by the following passage regarding the spleen, “the old division into red and white pulp is probably oversimplified and should be expanded.” As readily evident from all of the foregoing, Histology for Pathologists’ span is “expanded” enough, and its content remains rather remarkable—and not quite static!

Syed A.Hoda, MD

Weill Cornell Medical College, Cornell University, New York, NY

© 2013 Lippincott Williams & Wilkins, Inc.

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