scope:

PREFACE

Haematopathology has become the subject of specialist reporting in many countries in the developed world. This is seen as a necessary evolution and a consequence of the increasing complexity of the subject, the need for sophisticated ancillary investigations in some cases and the fundamental need for an accurate diagnosis on which to base further patient management. Nevertheless most lymph node biopsies will land on the desks of general pathologists who will need to make the judgement as to whether the pathology is that of a reactive or neoplastic process and whether referral is necessary. We have aimed this book at general pathologists and trainees, although we hope that dedicated haematopathologists may find some gems between its covers. In the light of our target readership we have placed our main emphasis on morphology rather than molecular techniques.

A number of authors have tried to base lymph node diagnosis on the low power structure of the node. While this is a good starting point it is not always helpful and can be misleading. For example, although an overall nodular pattern is characteristic of follicular lymphoma it can also be the dominant low power feature of mantle cell and marginal zone lymphomas. We would nevertheless emphasise the importance of both low power and high power morphologic examination based on good quality sections. It is wise to arrive at a diagnosis, or differential diagnosis, based on morphology before ordering or embarking on the interpretation of immunohistochemical preparations. In the final analysis the morphology and immunohistochemistry should be compatible, and it is the concordance of these techniques that provides security of diagnosis. We are aware of the time constraints facing pathologists and have aimed to make the basic information on entities easily accessible by presenting the clinical, morphological and immunohistochemical features of each disease together with illustrations in boxes. More detailed information is provided in the text.

Since we began writing this book we have seen a year on year growth of the proportion of lymph node biopsies received as needle biopsies. These are usually taken by radiologists using CT guidance. The most obvious value of this technique is in taking biopsies of deep seated lesions and thus avoiding the need for surgery. Most pathologists would probably wish that superficial nodes were obtained by whole lymph node biopsy. However, as clinicians realise that a definitive diagnosis can be obtained on a high proportion of superficial nodes using needle biopsies, this type of biopsy is likely to become more common in view of its ease of application and low morbidity. We have therefore included in the book a chapter specifically on the interpretation of needle biopsies.

Authour: Leong, Anthony