Flow Cytometric Analysis of Hematologic Neoplasms

Reviewed by:


T Sun
Published by Lippincott Williams & Wilkins (2002)
ISBN: 0-7817-2964-5.
266 pages plus index.
RRP: A$427.90

This is the second edition of Tsieh Sun’s book on the use of flow cytometry in the diagnosis of haematological malignancies. From a clinical viewpoint it represents a timely update as the classification of these disorders has undergone extensive revision since publication of the first edition in 1993. The new REAL and WHO classification systems encompass many new entities, and immunophenotyping plays a central role in diagnosis. However, as the author correctly states, some of the entities described in REAL and WHO have yet to be studied in a uniform manner using flow cytometry.

The book begins with a brief introductory chapter on the principles of flow cytometry. This explains the basic components of a flow cytometer and the principles of computer analysis of the derived signals and generation of scatter plots. This is provided in sufficient detail to aid understanding of subsequent chapters by those from different disciplines. An outline of the classification of haematological neoplasms follows, including a discussion of the developmental stages of normal T and B-lymphocytes and antigenic expression profiles, which is central to the classification of the corresponding T and B cell malignancies. Supplementary tests are then reviewed including cytochemistry, immunohistochemistry, molecular diagnostics and cytogenetics. A useful chapter then highlights the major criteria that are used in flow cytometry to distinguish haematological neoplasms from normal leucocytes, including immunoglobulin light chain restriction, aberrant phenotypes and selective loss of antigen expression. Selection of appropriate monoclonal antibody panels is discussed, with an up-to-date table of cell specificity and clinical application of most monoclonal antibodies used in flow cytometry.

The bulk of the book consists of a series of 38 case studies. Each case consists of a brief clinical history with flow cytometry findings. The relevant morphology is then discussed and illustrated with colour plates. In most cases the number and quality of illustrations is markedly improved over the first edition. A detailed discussion of the immunophenotype in each disease is then given, including recognised variants and immunophenotypic features that help in differential diagnosis. Relevant molecular studies and a brief overview of the clinical manifestations of the disease are also included. For easy reference, each case has clear tables summarising important morphological and laboratory features of diagnosis.

One of the main strengths of the book lies in the fact that it provides flow cytometry findings in the context of other diagnostic information. This approach makes it a very practical aid to diagnosis. Common lymphoid malignancies such as SLL, CLL and follicular lymphoma are covered in detail. However, many haematologists will find the chapters on rarer disorders, such as T-CLL, LGL and mantle cell lymphoma more useful, as these diseases are much less likely to be seen by the average haemato-pathologist and may lead to greater diagnostic confusion. I would highly recommend this book to any haematologist or pathologist involved in the diagnosis of haematological malignancies.

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