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Tumors of the Gallbladder, Extrahepatic Bile Ducts and Ampulla of Vater. Atlas of Tumor Pathology.
  1. G J A Offerhaus

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    Albores-Saveedra J, Henson DE, Klimstra DS. Armed Forces Institute of Pathology, 2000. ISBN 1 881041 58 1.

    It is difficult to envision how one could practise the surgical pathology of neoplastic lesions and diseases without the fascicles of the Atlas of tumor pathology of the Armed Forces Institute of Pathology (AFIP) on the bookshelf. It is now in its third series of publication and compared with the second edition of the fascicle on Tumors of the gallbladder and extrahepatic bile ducts, in this third edition tumours of the ampulla of Vater were added and the author list was extended with yet another recognised expert in the field from the USA, notably Dr David S Klimstra.

    The first chapters of fascicle 27 deal with normality and histological classification, and subsequent chapters are dedicated to the tumour pathology of the different anatomical sites separately; that is, gallbladder, extrahepatic bile ducts, and ampulla. With some variation, the layout follows the well known structure used in the AFIP atlases of tumor pathology and the different entities are discussed generally. There are sections on definition and nomenclature, general features, and clinical epidemiology, the gross anatomy, the microscopy, the ulrastructural and immunohistochemical findings, and biological behaviour and prognosis. In this third edition, an additional section on the molecular pathology of most entities has also been incorporated. The text is illustrated by high quality illustrations, mostly colour photo micrographs. At the end of each chapter, the references are subdivided according to the specific subheadings, which greatly facilitates their use. For the different anatomical sites, the minimal requirements of a standard surgical pathology report are summarised at the end of that particular chapter.

    As mentioned in the beginning, the AFIP atlases of tumor pathology can be considered the mainstay of the day to day histopathological diagnosis of neoplastic disease and therefore these fascicles have to meet high standards of quality. The fascicle written by Albores-Saveedra, Henson, and Klimstra on tumours of the gallbladder, extrahepatic bile ducts and ampulla of Vater certainly does so, and the authors have done an excellent job. However, there is no mention of the Phrygian cap, potentially a tumour-like condition caused by congenital inward folding of the fundic mucosa and present in up to 6% of gallbladders. The adenoma–carcinoma sequence of the gallbladder receives a separate section, but surprisingly the adenoma–carcinoma sequence of the ampulla of Vater is only touched upon in general terms in the text, although in this type of tumour a true adenoma–carcinoma sequence similar to the large bowel seems to be relatively well established. The Spigelman classification that serves as a guidance for clinical management of peri-ampullary adenomas in patients with familial adenomatous polyposis is not provided. One will also search in vain for well articulated criteria to delineate tumours of the distal common bile duct, the ampulla, and the pancreatic head from each other when a peri-ampullary tumour is encountered, a distinction that nevertheless has important implications for tumour biology, as is well illustrated by the figure depicting the various survival curves of these different tumours. The value of p53 immunocytochemistry on brush cytology of biliary stenoses as a diagnostic adjunct to K-ras is not mentioned. Nonetheless, these are only minor criticisms and they are not meant to detract from this comprehensive work, which is well written, extensively illustrated, and adequately referenced. This book will be an invaluable asset and aid for pathologists at various levels of training and a “sine qua non” for the adequate sign out of tumours of the gallbladder, extrahepatic bile ducts, and ampulla of Vater.

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