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The Breast.
  1. P Van Diest

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    Edited by C W Elston and I O Ellis. (£125.00.) Harcourt Brace & Co, 1999. ISBN 044303723x.

    In the previous edition of Systemic Pathology, the breast was covered rather meagrely in a joint volume with some other tracts. In this new series, the breast has now received its well deserved separate volume. The authors, largely from the Nottingham group, have done a good job. In 24 chapters (totalling 552 pages) almost the entire spectrum of breast disease is covered. There are many pictures, all black and white almost all of high quality.

    Going over all the different chapters would lead to unnecessary repetition, as all are of high quality. Let me therefore just pick out a few things that struck me and try to come up with some criticism. I particularly liked the chapters on preinvasive breast lesions, which are comprehensive and clear cut with regard to diagnostic criteria. Of course, some typical controversies remain. I would, for example, diagnose the lobular neoplasia in fig 7.8 as “atypical lobular hyperplasia” rather than “lobular carcinoma in situ”. These part are quite complete, and the DCIS chapter nicely reviews the different classification systems of DCIS. I just missed a statement that papillary carcinoma may be largely solid. These chapters, however, stand a little apart, and it would have been conceptually nice to have included somewhere an overall scheme for progression of preinvasive lesions to invasive cancers, including a discussion of the putative genetic alterations involved.

    The chapter on invasive epithelial cancers is also comprehensive and complete. The only remark I have here is that lymphoepithelioma, like carcinoma, could have been mentioned in the differential diagnosis of medullary cancer, and some words could have been given to the controversial role of Epstein-Barr virus in these lesions.

    There is a big chapter on “The role of pathology in breast cancer”, mainly addressing prognostic factors including no less than 347 references. Being no doubt biased myself, I missed some important data here and therefore found it still not comprehensive enough and a little biased towards the Nottingham results. However, I suppose the authors can be forgiven for this.

    Inheritable breast cancer is briefly dealt with in the chapter “Clinical aspects of malignant breast lesions”, but this deserves to have been addressed more extensively in a separate chapter. No doubt future editions will deal with these points and include recent developments in molecular analysis and important new issues such as the Sentinel Node procedure.

    Despite these small criticisms, this is a very useful volume for any surgical pathologists dealing with breast lesions and can be recommended without reservation.