Pathology of Asbestos-Associated Diseases

Abstract

2nd ed, edited by Victor L. Roggli, Tim D. Oury, and Thomas A. Sporn, 421 pp, with illus, New York, NY, Springer-Verlag, 2004.The first edition of this book (1992) is a comprehensive evaluation of asbestos-related medical, mineralogic, and legal issues. I found that book useful as a quick reference on different matters, and I always keep it handy. For my students, I still recommend the book as a well-written synopsis. Maybe it is because I had high expectations that I was a little disappointed in the second edition. Many chapters are basically identical to those written for the first edition. The only differences I could detect in the first chapter was the addition of 4 references to the reference list; in chapter 3, the only difference I noted was the addition of reference 54 to table 3.1; in chapter 11, a new reference was added to Table 11.11; and all figures and tables in these 3 chapters are identical to those of the previous edition. The text is almost identical. Other chapters have some minimal rewriting; for example, chapter 2 includes some new figures and a revised reference list. Even some of the chapters that have been written by different authors, chapter 6, for example, show minimal rewriting and identical figures. Some chapters (chapter 9) show extensive rewriting and some new figures, whereas others (chapter 8) show some updating, although the figures remain identical. The first half of chapter 10 is identical to the 1992 edition; the second half, finally, shows extensive rewriting, although the figures are the same. Therefore, although I find the book well written and useful, especially for those who want to rapidly become familiar with the complex scientific, public health, and legal issues related to asbestos pathogenesis, I could not find compelling reasons to recommend buying the new edition if you have the old one.Research on asbestos and mesothelioma has progressed tremendously in recent years; thus, there is room for extensive updating of this book. For example, the authors mention the issue of chrysotile carcinogenicity, but they avoid discussing how they interpret the discordant literature on this topic. A book is also an occasion for the authors to express their opinions and explain the basis for such opinions. Considering that the authors of this book are extensively involved in litigation, often on opposite sides, I had hoped for a thorough analyses and discussion of why some experts support chrysotile carcinogenesis and some do not.The chapter on mesothelioma (chapter 5) has some rewriting, but the newest molecular issues related to mesothelioma pathogenesis are dealt with in just a few lines.Progress in molecular pathology has revealed that some malignancies that show a morphologic and immunohistochemical pattern similar to mesothelioma can be distinguished by molecular studies. The X;18 translocation allows the molecular pathologist to identify pleural synovial sarcomas from mesotheliomas. How many synovial sarcomas are misdiagnosed as mesotheliomas? Nobody knows, but certainly I have found a few. This is an important issue in diagnostic pathology, because synovial sarcomas are more susceptible to therapy compared with sarcomatoid or biphasic mesotheliomas. This topic is dealt with in a few sentences. A more extensive discussion, one that provides information on the performance of the molecular tests, the precautions that should be taken, the handling of the tissue for these tests, and the correct interpretation of the results of such tests, would have been useful and would have helped justify this second edition. Moreover, numerous additional genetic translocations have been identified and allow the molecular pathologist to provide information that is useful to distinguish different types of sarcomas from sarcomatoid mesotheliomas. Such a differential diagnosis is often difficult when molecular tests are not available and the tumor seems to arise from the pleura or the peritoneum. Extensive discussion of these topics would have been justified and useful for practicing pathologists not familiar with pleural diseases, who sometimes assume that any spindle cell tumor of the pleura must be a mesothelioma.Numerous immunohistochemical markers have been developed in the past years. Some of these are discussed in chapter 5 and some are not, and it is unclear why. For example, WT-1 is often used as a positive marker for mesothelioma and Moc-31 as a negative marker. Does the fact that the authors do not mention these markers indicate they do not believe their reliability? If so, this information would be useful. If not, why were these markers not included in the discussion?