Book review

Abstract

This ‘atlas of structural and molecular pathological changes’ is an edited English language edition of a German textbook on the pathology of peripheral nerves originally published as part of the series ‘Spezielle Pathologische Anatomie’, edited by Doerr, Siefert and Uehlinger and published by Springer-Verlag. It is exactly as the name implies – an atlas of over 1000 figures, supported by over 2000 references, largely derived from the collection of material assembled by the author during a professional life of more than 35 years. The atlas is beautifully produced on high quality paper and it contains many examples of superb microscopy. The atlas is organized into defined sections. The first chapters cover general topics. The introduction is a good summary of basic information on axonal growth, myelination, nodal and paranodal axon diameter and the relationships between these variables. Most data are drawn from measurements made on sural nerve biopsies. There follows a very brief chapter on the epidemiology and classification of peripheral nerve disorders and a more substantial chapter on the general reactions of peripheral nerves to a variety of lesions. Subsequent chapters deal with more specific topics: toxic neuropathies, paraneoplastic syndromes and tumours of the peripheral nervous system are typical. It is a complete compendium and could be considered complementary to the 2nd edition of Experimental and Clinical Neurotoxicology (Spencer, Schaumburg and Ludolph) and the new publication Medical Neurotoxicology (Blain and Harris). An investigator using this atlas to help in the interpretation of clinical pathological data will probably start by reading the introductory chapters. These chapters are accurate but they are curiously limited. ‘Peripheral nerve’ in the context of this book means axon. The cell body and the nerve terminal (motor or sensory) is ignored. This has probably arisen because the volume is based on the author's own collection of biopsies, and the majority of diagnostic nerve biopsies are made on sural nerve. However, there are quite distinct morphological differences between, for example, the motor end-plates of human muscle and those of laboratory mammals and there is a growing literature on the pathology and pathophysiology of the human neuromuscular junction. It is unfortunate that this important area of neuropathology is not covered at all in this book The subtitle of the book ‘An atlas of structural and molecular pathological changes’ is rather misleading. This is an atlas of structural changes of axons. Those changes are well illustrated and they are described in some detail in extensive legends to each illustration. The approach is not mechanistic in any way and contains very little molecular information at all. It neither addresses nor illustrates (except in a rather cursory way) the use of immunocytochemistry at light and electron microscopic level and I found no mention at all in situ hybridisaton. All of these techniques are now used in modern neuropathology laboratories, and they are essential techniques if any attempt is to be made to understand the relationships between genome, protein expression and structural pathology. There is also a lack of information on functional change. This is a significant gap if one believes that structure and function are essential components of the discipline of neuropathology. Despite these criticisms, this is an excellent atlas – without doubt the best available. No young clinical or experimental neuropathologist should fail to use it when trying to understand the mysteries of the organization of real tissue in health and disease. It is a book for regular consultation and enjoyment. John Harris Newcastle upon Tyne, UK