Orthopaedic Pathology. Vincent J. Vigorita, with Bernard
Ghelman. Philadelphia, Lippincott Williams and Wilkins, 1999. $239.00,
736 pp.
In the last several years, there has been a proliferation of
textbooks dealing with bone pathology, almost all of which have
focused upon bone tumors. Pathologists who spend a significant part
of their time dealing with orthopaedic diseases realize that the
diagnosis of bone tumors constitutes a small minority of their practice.
In this rather ambitious effort, Dr. Vigorita has not ignored bone
tumors but has placed them in their proper perspective relative
to the remainder of the vast scope of orthopaedic diseases. That
a single individual could accomplish this with any degree of success
is remarkable, but the fact that someone with the responsibilities
and time constraints of Dr. Vigorita has done so is extraordinary.
Most of the chapters address conventional subjects. A few types
of bone tumors are discussed in chapters not devoted to neoplasms,
as they have histological features sufficiently in common with other
entities in those chapters. While this may seem strange initially,
it makes perfect sense from the standpoint of differential diagnosis.
Topics not usually covered in bone-pathology texts are explored
thoroughly, sometimes with an amount of detail not encountered even
in specialty textbooks.
Many of the unusual subjects that are covered are illustrated
with hard-to-find photographs. Of particular interest are the anatomical
and physiological illustrations created especially for this book, some
of which demonstrate complex osseous biological interactions in
ways that make the more intimidating concepts easier to digest.
There are six appendices summarizing pertinent findings of techniques
such as electron microscopy, immunohistochemistry, and cytogenetics.
In these sections, the methodology is demystified for readers who
would like to better understand it without having to digest all
of the technical jargon. There is also an illustrated glossary,
which will be helpful to readers from other specialty areas.
A few of the chapters are particularly noteworthy. The introductory
chapters on bone structure, function, and development, as well as
those dealing with calcification and ossification syndromes, are as
thorough and complete as any that I have ever seen in a textbook.
In addition, the radiographs used to illustrate the various syndromes
provide these chapters with excellent clinical correlations. The
chapters on metabolic bone disease are particularly useful and complete.
Collated information of this type and scope is lacking in pathology
texts, and Dr. Vigorita's common-sense approach is quite refreshing.
Two features of this book should be addressed in the next edition.
First, there are a number of minor typographical errors. Second,
while the detail and content of many of the figure legends are adequate,
a fair number need further exposition, particularly if residents
in orthopaedics, pathology, and radiology are to be among the targeted
audience.
In summary, this book is highly recommended for anyone interested
in the art and science of the diagnosis and treatment of orthopaedic
diseases. Its readability, broad base of coverage, copious illustrations,
and easy portability make it a must for the library of any serious
student of orthopaedic pathology.
Michael J. Klein, M.D.Department of Pathology
The Mount Sinai School of Medicine
New York, N.Y.