Biopsy Pathology of the Endometrium

Biopsy Pathology of the Endometrium 2nd ed, by C. Hilary Buckley and Harold Fox, 264 pp, with illus, London, England, Arnold Publishing, 2002. Although the endometrial biopsy is one of the most commonly encountered specimens in the practice of general surgical pathology, it frequently engenders both fear and loathing in the hearts of the pathologist! Like its predecessor, the second edition of Biopsy Pathology of the Endometrium, by Buckley and Fox, is an accessible and useful book for the generalist and specialist alike. Since the focus of this book is interpretation of biopsies, descriptions of sampling techniques and their possible artifacts are addressed, and the vast majority of photomicrographs are taken from biopsy (rather than hysterectomy) material. Not only do the authors address the usual topics of normal microscopic anatomy, functional disorders, infections, hyperplasia, and malignant neoplasms, but iatrogenic changes, such as those related to hormonal manipulation, are covered thoroughly as well. Throughout the book, the authors make such a convincing case for the necessity of clinical information that no reader will accept only “abnormal bleeding” or “on the pill” again. The opening chapter covers the myriad of sampling techniques, their morphologic pitfalls, and elements of reporting. In this discussion, we learn how to glean useful information from the most scanty biopsies, and how to confidently acknowledge our limitations. The next 2 chapters describe normal anatomy and histology, with chapter 3 focusing on findings specifically in biopsy material. (Many readers will also be grateful for the authors' inclusion of the postmenopausal endometrium in the “normal” category!) Chapter 4, dealing with functional disorders, presents elegant discussions of the spectrum of morphologic changes associated with noniatrogenic hormonal abnormalities. Some terminology is a bit confusing; is there really a difference between the “prolonged proliferative” and “disordered proliferative” endometrium? Iatrogenic hormonal effects are covered in chapter 5, which is noteworthy for the inclusion of important current references. Although the discussions in this chapter may be a bit cumbersome for the general surgical pathologist, the chapter serves as an excellent reference and reminds all of us how crucial exact clinical information can be. Following the chapters on effects of intrauterine devices, infections, and miscellaneous benign conditions (including epithelial and stromal metaplasias), we reach the difficult topics of hyperplasia and malignancy. If the reader chooses only 1 chapter to read in this book, he or she must choose the chapter on hyperplasia, chapter 9. This chapter not only discusses what we know about the categories of hyperplasia and making a diagnosis of adenocarcinoma in biopsy samples, but also raises important unanswered questions about these same issues. Citing numerous references from the past 5 years, the authors lead us to understand that this is still a work in progress. The next 3 chapters cover neoplasms, including some that are admittedly unusual in biopsy material. Some controversies arise here, including the debate over adenofibroma versus adenosarcoma. Although the authors cite references such as the 1992 Gynecologic Oncology Group study of adenosarcoma, they do not note the conclusion of studies such as this one that periglandular stromal cuffing is a more reliable criterion for diagnosing adenosarcoma than the mitotic count. Chapters 13 and 14, dealing with findings of normal and abnormal pregnancies, are useful and cite excellent current references. Chapter 15 is a true jewel. The culmination of all topics covered in the book, this chapter approaches the endometrial biopsy from the basis of the clinical problem, helping the pathologist formulate a differential diagnosis based on clinical information before even turning on the microscope. It is regrettable that there are no color pictures and that the book's binding is of such poor quality that I accidentally stuck my thumb through it when I picked it up, but the value of the words compensates for these material defects. This book is readable, current, thought-provoking, and useful in daily practice.