Burger P, Scheithauer B. Diagnostic Pathology: Neuropathology. Amirsys 2012, 800 pages, $299.
Amirsys has taken their brilliant concept of medical education for neuroradiology one step further by the publication of the newest in their series, Diagnostic Pathology: Neuropathology. For someone (like this reviewer) who has had the classic textbook by Russell and Rubenstein Pathology of Tumors of the Central Nervous System on his bookshelf for years, this new textbook, authored by 7 neuropathologists led by Drs. Peter Burger and Bernd Scheithauer, brings new life and relevance to neuropathology. What more can one say about the incredible importance that Amirsys has had in bringing new concepts in educational material to radiologists in general, and to neuroradiologists in particular? Understand that this book is far more than a text on CNS tumors: it includes both neoplastic and non-neoplastic conditions and furthermore uses, as appropriate, representative MR images to make more pertinent the associated pathologic features. The pathology shown is predominately histopathology, but gross anatomic images are illustrated in many sections.
The Neoplastic part of the book is divided into (a) Brain/Spinal Cord (infiltrative astrocytic neoplasms – 6 chapters; oligodendroglioma neoplasms – 3 chapters; localized astrocytic neoplasms – 4 chapters; tumors of ependyma and related cells – 7 chapters; choroid plexus neoplasms – 2 chapters; neuronal and glioneuronal neoplasms – 11 chapters; pineal parenchymal neoplasms – 3 chapters; embryonal neoplasms – 5 chapters; germ cell neoplasms – 3 chapters; hemangioblastoma – 1 chapter; lymphoma and hematopoietic neoplasms – 6 chapters; metastatic neoplasms – 1 chapter); (b) Sellar Region (adenohypophyseal neoplasia and hyperplasia – 10 chapters; neurohypophyseal and hypothalamic neoplasms – 3 chapters; craniopharyngioma – 2 chapters; miscellaneous neoplasms – 3 chapters); (c) Meninges – 10 chapters; (d) Cranial, Spinal, Peripheral nerves – 11 chapters; and (e) Familial Tumor Syndromes – 6 chapters. The non-neoplastic portion of the book is divided into (a) Benign Cysts – 9 chapters and (b) infectious, inflammatory, and reactive lesions (21 chapters, which include MS, bacterial/viral/ fungal/parasitic infections, other inflammatory conditions such as sarcord, Rasmussen’s, pseudotumors, etc., and reactive conditions and non-inflammatory pseudotumors). The third section deals with Vascular Malformations (8 chapters), while the fourth section deals with cortical dysplasia.
The last part of the book is unique to radiology texts (at least to this reviewer): it has an antibody index and a molecular factors index. In the former index there is a list of over 200 antibodies, their alternative names, and, importantly, under what pathological condition in the book where it is mentioned/described. So as just one example, the book describes capase-1 in the table as promoting maturation of IL by proteolytic cleavage, mentions its role in inflammation, and refers the reader to HIV encephalitis. When one goes to HIV encephalitis and reads the portion under microscopic pathology, one sees the immunoreactivity listed for a number of entities, including capase-1. In the latter index, the many molecular factors are listed, where their chromosomal location is centered, and again where in the book a description or mention of the factor is located is centered. These 2 long tables are excellent and will be helpful as one reads papers where these factors (either antibody or molecular) are mentioned.
For the major part of the book, in a format which is familiar to most radiologists, each disease is described under bullet points concerning terminology, etiology, clinical issues, pathological findings, differential diagnosis, and references.
Of course, in a book so encompassing, it is impossible for a review like this to do it justice; nonetheless, a few examples will suffice. An intracranial tumor that is rarely encountered, a solitary fibrous tumor, is shown and described fully with its MR, gross pathology, and microscopic features, including those that are of the hemangiopericytoma type (news to me!). Here the terminology is described under “definitions,” where we learn this is a spectrum of lesions, the clinical issues, image findings (briefly), and where ancillary tests are mentioned. As expected the macroscopic and microscopic features along with immunohistochemical features are beautifully shown. A differential diagnosis for every disease is listed, and one should know that this is pathologic differential, not an imaging differential.
In the non-tumoral section, take herpes simple encephalitis as an example. A high quality artist’s drawing imbeds in our mind the temporal lobe, cingulate cortex, and insular cortex involvement. The text reminds us that HSE1 is more common in immunocompetent as compared to immunocompromised patients, describes the epidemiology, the clinical issues, the microscopic pathology, the associated ancillary tests and the differential. What follows are MR images of florid HSE cases and a series of 16 histopathology images showing different stages and forms of this infection (acute, hemorrhagic, microglial clusters, neutrophilic infiltrates, red dead neurons, plasmacytoid lymphocytes, intracellular viral particles, immunopositive stain, CD68 positive macrophages, late-stage HSE with tissue cavitation). This type of in-depth description is found in every disease included in the book.
Of course the book cannot cover every entity with which we deal; enumerating diseases not included would require a long list, so the reader should not expect to see or have discussed all the diseases we encounter. Nonetheless, a very large majority of neuropathological diseases are included.
This reviewer’s strong advice is that every neuroradiologist ought to own his/her own copy of this wonderful textbook. Certainly it ought to be in every Departmental library. If you are uncertain as to whether this book should be in your personal library, make sure you look through it at the next meeting you attend. You will be sold. Remember that, as in all books in this series, you can access the online version with a unique license key.
In summary, this is an outstanding textbook which can expand and deepen one’s understanding of neuropathology and, as a result, improve one’s practice of neuroradiology.