BONE MARROW PATHOLOGY

In their fourth edition of “Bone Marrow Pathology,” Dr Bain and colleagues provide a comprehensive overview of both benign and malignant entities. The book is organized into 11 chapters, similar to the third edition, but with updates and numerous references to reflect advancements and evolving terminology in the burgeoning field of hematopathology. Various tools facilitate learning, including ample use of illustrations, high-yield tables to guide the generation of differential diagnoses and diagnostic algorithms, summary boxes, and regular and extended use of “problems and pitfalls” sections. The introductory chapter on normal bone marrow is detailed and systematic, with plenty of figures and depictions of a variety of artifacts that might confound interpretation and are important to recognize. The next chapter thoughtfully summarizes “special techniques” such as cytochemical and histochemical stains, flow cytometry, immunohistochemistry, cytogenetic analysis, and molecular genetic analysis. The third chapter addresses infections and reactive changes affecting the bone marrow, featuring a very impressive collection of photomicrographs of microorganisms and discussing differential diagnoses for a variety of injury patterns, such as fibrosis, necrosis, granulomas, and hemophagocytic syndromes. Chapters 4 and 5 cover the full range of myeloid neoplasms, including histiocytic neoplasms, as well as acute leukemias of ambiguous lineage and blastic plasmacytoid dendritic cell neoplasm; lymphoid neoplasms are discussed in chapters 6 and 7 and include precursor lymphoid neoplasms, lymphomas, and plasma cell neoplasms. Classification schemes are described in chronological order, generally beginning with the French-AmericanBritish schemes but followed by detailed and updated descriptions of the World Health Organization schemes, with incorporation of entities defined by genetics and certain clinical considerations. Mature B-cell neoplasms and mature T-cell neoplasms are reviewed quite thoroughly, whereas discussion of precursor lymphoid neoplasms is relatively brief. Numerous photomicrographs of non-Hodgkin and Hodgkin lymphomas involving the bone marrow are included, along with systematic summaries of each of the entities with separate subheadings for peripheral blood, bone marrow cytology, bone marrow histology, immunophenotypic features, cytogenetic and molecular genetic analysis, and problems and pitfalls. The last subheading is particularly helpful for generating differential diagnoses in difficult cases and perhaps redirecting the reader to review a more appropriate entity. The next 2 chapters deal primarily with nonneoplastic conditions and perhaps could have been included earlier in the text before discussion of malignancies. The eighth chapter, entitled “Disorders of Erythropoiesis, Granulopoiesis, and Thrombopoiesis,” discusses both congenital and acquired non-neoplastic hematologic disorders. It is somewhat brief and would have been greatly enhanced by the use of tables for more systematic and comprehensive differential diagnoses, but the reader is directed to another textbook by Dr Bain for more detailed descriptions. The next chapter covers “miscellaneous disorders,” including those associated with various systemic disorders, storage diseases, the effects of drugs or irradiation on bone marrow, both inherited and acquired forms of aplastic anemia, and paroxysmal nocturnal hemoglobinuria. Brief discussions of bone marrow transplantation and graft-versus-host disease are also provided. The penultimate chapter, “Metastatic Tumors,” illustrates many excellent examples, and the last chapter provides a brief overview of bone diseases that one might encounter while evaluating bone marrow biopsies. In addition to containing a tremendous amount of clinically relevant information, one of the particular strengths of this book is its integration of peripheral blood findings, cytologic evaluation of bone marrow aspirate films, and histologic assessment of biopsy sections, with consideration of immunophenotypic, cytogenetic, and molecular genetic characteristics. A unique feature is an appendix with detailed laboratory methods for processing and staining of bone marrow. The final product is a very practical guide and extremely valuable resource for any pathologist or pathologist-in-training who evaluates bone marrow biopsies.