The AFIP Atlas of Tumor Pathology has been an indispensable part
of any tumor specialist's institutional and personal library. The recently
published Series 4, Tumors of the Bones and Joints, is beautifully
illustrated and written. It covers the field of bone and joint oncology
thoroughly. Whether you are looking for a specific piece of information, a
review of a general topic, or a cover-to-cover read, you will be better for
the experience. As such, the book—like your favorite credit
card—is something that you wouldn't want to leave behind. All
specialists would feel uneasy ignoring it. Yet, it would be interesting to
know the answers to two questions: How significant is the contribution of this
book to the field, and how does this book compare with the previous versions
of "The Fascicle"?
This edition is authored by five world-recognized experts in skeletal
pathology. Their individual contributions are woven together seamlessly, thus
avoiding the choppiness that plagues many of the textbooks that have multiple
authors. The Mayo Clinic imprimatur brings tight structure and consistency to
the work in a way that none of the other leading texts can match. Furthermore,
new genetic and cytogenetic information is smoothly integrated into each
chapter. Dr. Bridge contributes her own original work and expertly summarizes
complex genetic concepts and all of the important recent literature. This
combination makes the book unique and compelling.
The authors have continued to call this an "AFIP Atlas" even
though two editions ago, the scope and focus were broadened to a monograph,
according to the editors. It retains none of the old catalog of histology with
terse commentary and little of its tenor. It has evolved into a text with
higher ambitions.
There have been many welcome changes. The book is a nicely bound hard-cover
edition to put on your shelf, but it is also available to purchasers as a
web-based version online. This new feature will appeal to younger specialists
and those in search of illustrative educational material. The figures have
changed. Beautiful color illustrations are provided for all histologic,
cytologic, gross pathologic, and even tabular material. Only the imaging
studies (appropriately) remain black and white. The figures, which are more
accessible and instructive, could be further improved by providing a list of
the figures for easy search purposes. Thus, there are some things left to
improve in the next edition.
The authors have borrowed heavily from Dahlin's Bone Tumors by K.
Krishnan Unni (Philadelphia: Lippincott; 1996). For example, they cite
twenty-two illustrations among the many that they reproduced from that Mayo
Clinic text. No other source contributed more than three figures, emphasizing
the single-institution slant to the material. The basic narrative is a
systematic revision of the Dahlin text. This gives the work a clear point of
view, and occasionally a parochialism that was lacking in prior editions of
the fascicle. For example, "neurilemmoma" is fast becoming an
obsolete term, and the nice descriptively named "metaphyseal fibrous
defect" is almost universally called "fibrous cortical
defect" by practitioners outside the Mayo Clinic. Greater sensitivity to
such semantic issues would help the broader mission of this book, which is
education.
The topic coverage has changed in emphasis, with added chapters on
joint-affecting tumors and tumor-like conditions and with drastically reduced
coverage of other lesions, such as intraosseous hemangioma. This lends a
modern, practical sense to the material.
In any book that has the schizophrenic purpose of being comprehensive and
succinct, there will be some areas that are given insufficient coverage. How
authors and editors define the niche of the publication determines its
balance. Even though the authors are pathologists, they bend over backwards to
address the clinico-radiologic component of pathologic diagnosis. It is this
reviewer's opinion that more emphasis could have been given to histologic
variations and controversies. An excessive number of illustrations (232 of 536
figures) is devoted to tumor imaging, genetics, and epidemiology. More
histopathology would be welcomed by this clinician. There are other sources
for the multidisciplinary material. The demographic and/or anatomic
descriptive figures are unnecessarily large, colored, and prominent. They also
reflect the singular Mayo experience. The "Atlas" could better
fill its niche without becoming a tome if it narrowed its focus to
pathology.
There are some inconsistencies in the text that reflect the generational
tension that is gripping the field as genetic analysis trumps our historical
concepts. For example, with regard to osteochondromas, the authors have an
unresolved conflict. Within the same chapter, they state that
"Osteochondromas are not true neoplasms" and that, "Clonal
chromosomal abnormalities in osteochondromas provide compelling evidence that
they represent a true neoplasm." Similar issues arise in the discussions
of Langerhans histiocytosis. Even though one would expect the AFIP
Atlas to resolve such controversies, they often unwittingly present them
to the discerning reader. Ironically, this confusion is a timely reflection of
the state of the art.
The strengths of this edition of an old companion vastly outweigh its
weaknesses. Practitioners and students at all stages will learn from this
compendium.