Book Review
book review
O’Malley DP, George TI, Orazi A, Abbondanzo S.
Benign and Reactive Conditions of Lymph Node and Spleen:
Atlas of Nontumor Pathology; First Series, Fascicle 7.
Washington, DC: American Registry of Pathology–Armed
Forces Institute of Pathology, 2009, 572 pages, $165.
DOI: 10.1309/AJCPECF07FDNZHVD
What’s in a name? That which we call a rose, by any other
name would smell as sweet.
—William Shakespeare, Romeo and Juliet
In the theater (and perhaps in botanical circles as well),
one could conceivably get away with calling a rose by another
name. However, the nomenclature of benign conditions of
lymph nodes and spleen is entirely another matter. At the
very least, study of this thorough tome will help curb the
inclination of those among us who, on encountering any
nonneoplastic condition of lymph nodes, readily resort to the
rubric of “reactive.”
The introduction to Benign and Reactive Conditions of
Lymph Node and Spleen states: “…often simply naming a thing
can have great benefit to the patient. It is important to realize
that even in the case of a purely reactive process, finding a
name, a category, a classification, can provide real peace of
mind to the patient. To have a thing named is an important part
of understanding it, and this can be of real reassurance to the
patient who suffers from the process.” Touché!
With increasing subspecialization in anatomic pathology,
specific organ systems (or at least enthusiasts thereof) seem
to be competing for relative relevance. Be that as it may, the
ubiquitous lymph node (if not the spleen) has uncommon
relevance for all organ systems. A lymph node in any
region with a sarcoid-like reaction, or synthetic polymer
deposits, or mycobacterial spindle-cell tumor, or phenytoininduced changes, or nevus cell aggregate may be potentially
misinterpreted by a diagnostic surgical pathologist specializing
in whichever organ system. Benign and Reactive Conditions
of Lymph Node and Spleen provides diagnostic succor in all of
the aforementioned scenarios and in more. Many more!
Virtually all benign disease processes that could
conceivably involve the lymph nodes or spleen, from AA
amyloid to zygomycoses, are covered. This book, authored
by 4 lymphoreticular luminaries, all at their respective career
crests, still manages to be quite compact. For the most part,
the extent of coverage of a specific disease is proportional to
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its significance (eg, there are 12 pages on various EpsteinBarr viral infections and a half page on plague). The
contents are current: even bioterrorism and SARS (severe
acute respiratory syndrome) are discussed, albeit briefly.
The hundreds of images are the greatest asset of this book.
There are extraordinary renditions of such exquisite classic
(yet rarely illustrated) entities: “sago” and “lardaceous”
spleens, “lollipop” and “explosive” lymphoid follicles,
multinucleated measles cells and hyperplastic mesothelial
inclusions, and sundry mystifying diseases, including those
known eponymously: Kawasaki, Kikuchi, and Kimura. These
exceptionally dazzling depictions amply justify the appellation
of “atlas” to the title of this tome. The authors forthrightly
admit to the use of Photoshop CS to “process” the pictures but
maintain that “no critical information was removed or added.”
Nifty bits of clinically relevant information appear
throughout the text, eg, “the largest, deepest and most
abnormal-appearing lymph node should be biopsied.” Alas, a
few statements may be misleading to an uninitiated reader, eg,
“because of the vascular nature of the lymph nodes and spleen,
infarction is a rare event.” Nevertheless, to the book’s credit,
the ominous association of nodal infarction with lymphoma
and other malignancies is cited.
The book could have stretched its scope (and readership)
by including appropriately detailed considerations of fineneedle aspiration cytology. This is no lame lament because
aspiration cytology is often initially used in many clinical
settings (especially for conditions in the head and neck) to
investigate most superficial lymphadenopathy—although
almost never splenomegaly. Fans of forensics would duly
note: an insight into the correlation between malaria and
splenomegaly was historically used by oriental murderers who
punched a metallic instrument between the ribs of their victims
to produce rapidly fatal splenic rupture!
After much perusal of this book, even an inexperienced
pathologist could become less liable to make mistakes in
recognizing—and naming—benign diseases of lymph nodes
and spleen. This is one way to deflect Oscar Wilde’s adage:
“experience is the name everyone gives to their mistakes.”
Syed A. Hoda, MD
Rosanny Espinal-Witter, MD
Department of Pathology
Weill Medical College of Cornell University
New York, NY
© American Society for Clinical Pathology