Clinical Pathology of Soft Tissue Tumours

Reviewed by:


E Montgomery et al (eds)
Published by Marcel Dekker Inc (2001)
ISBN: 0-8247-0290-5.
770 pages plus index.
RRP: US$225.00

This chunky, 16 x 24 x 3.7 cm book by 27 authors is edited by Elizabeth Montgomery of the Pathology Department of the John Hopkin’s University and Alan Aaraon of the Department of Orthopaedic Surgery, Georgetown University Hospital, Washington DC. It is written by pathologists, plastic and orthopedic surgeons, radiologists, adult and paediatric oncologists, radiotherapists and a specialist in rehabilitation medicine.

The 20 chapters are divided into three sections. The first concerns the clinical evaluation and initial diagnosis of soft tissue tumours (three chapters). The next evaluates the pathology of soft tissue tumours (12 chapters) and the third covers the management (five chapters).

The pathology section, which makes up most of the book, is handled in a professional fashion by authors who are well-known experts in the field, and all chapters are of a uniformly high quality. However, I was surprised to read that the famous Australian pathologist, Rupert Willis, has been awarded a posthumous knighthood, apparently by a Southern University of The Great Republic (pages 543 and 566).

The editors’ stated aim is “to provide a single and concise multidisciplinary reference”. Certainly, the different disciplines are represented, but the various chapters are not well correlated. For example, the important chapter on radiological imaging gives an excellent overview of soft tissue organ imaging, but the pathology is weak.

The chapter on surgical management briefly reviews the surgery of lipomas, hemangiomas, benign tumours of peripheral nerves and desmoids before proceeding to an excellent account of the general principles of the surgery of soft tissue, soft tissue reconstruction and surgery without radiotherapy. Sarcomas in various locations are discussed, followed by atypical lipomas, paediatric sarcomas and the treatment of metastases.  The overall approach is sound, but many different sarcomas are lumped together. For example, fibrosarcoma in childhood appears as a single entity, with no reference to the comparatively good prognosis of infantile fibrosarcoma (page 624). Similarly, the other chapters concerning treatment are bedevilled by references to all soft tissue sarcomas as a single entity.

The rehabilitation chapter explores an aspect that is too often neglected and provides interesting and relevant information, but once again the authors’ knowledge seems to be confined to rehabilitation. Thus figure one on page 734 illustrates an “inoperable soft-tissue sarcoma” on the dorsum of the forearm in a patient of unstated age. The authors have not troubled to find out the diagnosis, even for this illustrated case.

To do justice to the book’s title, it would be necessary for radiologists, pathologists, surgeons and oncologists to discuss each specific entity in a coordinated manner. That is the standard approach at clinical meetings, but I have never seen more than lip service paid to this admirable method in any soft tissue tumour textbook. No doubt it would take much more work and time to edit such a book but until that is done, multi-authored soft tissue books are likely to have more in common with loose alliances of freedom fighters than with a coordinated war against sarcomas.

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