The thing about pathology is that it is the widest medical discipline of all. Not only does it comprehend the diseased state of every organ and tissue of the human body but also, in order to be correctly interpreted, the pure morphological description of the present state of tissue (macroscopic and microscopic) needs to be embedded in a physiopathological context and confronted by radiological and clinical data in order to avoid misinterpretation, since the only data generated by the pathologist are their impression of an abstract, bi-dimensional microscopic (and macroscopic) image. As a result, in general, pathology textbooks are large and full of knowledge, to the point where the required advice needs to be distilled from an ocean of information in order to efficiently help the accurate, but speedy, routine pathologist with their daily task. This is where the logical structure of a good textbook, the chapter arrangement, the main content, the contextual additional considerations, and the images/practical examples it contains are important because, in practice, ill-distributed or poorly presented information is lost information.
The sixth edition of a classic, Spencer's Pathology of the Lung, is a double-volume pathology textbook (including two DVDs) discussing one organ. There is no question that it must contain abundant information, and it has been complied by an international panel of renowned pathologists. However, the relevant question is whether the information is accessible or whether the reader is snorkeling in murkey waters.
Both volumes offer good visibility to the reader due to their uniform chapter structure with mostly identical sub-chapters, numerous and (at least visually) not too overloaded tables, and many figures/photographs, which are mostly of high resolution. In addition, the figures mostly fit the text page, appearing as close to the initial citation as possible, avoiding the usual quest of the related figure, a common and annoying issue in textbooks. Unfortunately, however, there are some poorly designed figures in the second volume. Importantly, there are only a few chapters with overambitious, page-long subchapters of minor interest (e.g. historical overview of the disease; again predominantly in the second volume). In contrast, space is given to ancillary matters when of interest to the routine pathologist (e.g. molecular findings in adenocarcinoma with updated and therapeutically relevant mutations).
The first volume on non-neoplastic conditions allows, as is usual in this type of comprehensive textbook, a concise and efficient revision of lung histology, embryology and some physiology. For instance, the histological illustrations of the different stages of lung development are of particular interest, since the general pathologist is usually lost in the depths of neonatal lung histology. The second chapter on specimen handling and practical considerations includes extremely useful information on incidental findings and artefacts, a considerable challenge in lung pathology. The following large chapters on paediatric lung pathology, infectious diseases, interstitial lung diseases, etc., share a well-balanced selection of microscopic, macroscopic (gross dissection) and radiographic illustrations; an essential and complementary feature to the verbose descriptions of histological patterns (the microscopic figures on bacterial/mycobacterial, viral and mycotic infections are outstanding). Late in this volume, place is given to more orphan conditions, such as metabolic and inherited connective tissue disorders involving the lung or pulmonary vascular diseases, including a brilliant and up-to-date assessment of typical vascular lesions in pulmonary hypertension.
The second volume addresses neoplastic conditions of the lung, beginning with benign or tumour-like lesions. Here, photographs from histology, fine-needle aspirates or brushing cytology help to overcome the difficulties in interpretation and distinction from pre-invasive or malignant disease. A chapter of high interest in volume two is Immunohistochemistry in the diagnosis of pulmonary tumours from an author who has created a practical and extremely popular internet tool with his blog-like “immunohistochemical vade mecum”. The chapter helps to understand the diagnostic use of antibodies in neoplastic lung pathology, and prevents misuse/overinterpretation of this common technique. Last but not least, a very concise chapter on pleural disease (neoplastic and non-neoplastic) concludes volume two with non-asbestos and asbestos-related disease.
In summary, the sixth edition of Spencer's Pathology of the Lung is an outstanding, modern and complete opus, which, together with one or two other comparable textbooks, can be easily considered as “the” standard work on lung pathology. The book primarily addresses clinical/surgical pthologists (and is rather a “must have” for lung pathologists), and may be useful to interested pulmonologists and researchers in the field of lung disease. However, it is probably too loaded with information to be used as a quick overview for the occasional medical bystander or medical student.
- ©ERS 2014
