Layfield LJ:

Cytopathology of Bone and Soft Tissue Tumors, 266 pp, Hong Kong, Oxford University Press, 2002 ($149.50).

Cytology texts of a single organ system are always a bit chancy for publishers due to perceived limited appeal or sales versus the “profit” motive. When the cytology diagnosis of that organ system has less widespread acceptance for definitive diagnosis and deals with rare entities within general pathology practice, then it can be even more difficult to get a publisher to commit to the idea of “profiting medical knowledge.” Thus I must give Oxford University Press credit for bringing us this enlightening and sensible approach to cytology of soft tissue and bone lesions.

Dr. Layfield does an excellent job, starting with a well-written preface and continuing throughout the text of placing conditions and cautions upon the diagnosis of malignancies in this difficult arena of cytology. Chapters are broken into subheadings that are similar to the popular soft tissue surgical pathology texts (by order of differentiation). Unfortunately, one minor deficiency is that by following this type of outline it misses discussing some sarcomatous tumors such as GIST and solitary fibrous tumors that may enter differentials of spindle cell neoplasms for clinical management decisions. However, it is otherwise very comprehensive as to bone and soft tissue lesions. There are excellent tables and flow diagrams that are useful while signing out FNAs that accompany the detailed written descriptions. Accompanying color photos give very satisfactory representation with modified Giemsa stain and Pap stain for smears with H&E for tissue or cell block preparations. There are outlines of the major diagnostic features for each entity for a quick run-through during sign-out. What is also quite helpful is a section titled “problems in diagnosis” for each entity that is discussed with suggestions for ancillary testing if sufficient sampling exists.

I found it to be quite useful when presented with the occasional fine needle aspiration of bone or soft tissue when identifying something other than the more common confirmation of metastasis of a known primary malignancy. In addition, it was also useful due to its histological correlations for the small core biopsies with accompanying touch preps. It gave a very honest, balanced approach that clearly cautions against overconfidence based solely on cytological features but gets you into the differential “ball park” with its clearly described cytological features. I was able to find discussion of both non-neoplastic and neoplastic rarer entities that I could not find in comprehensive cytology texts. I would definitely recommend Dr. Layfield's text for all cytology teaching departments as well as for those pathologists that have interventional radiology departments and/or oncological orthopedic surgical departments.