Field Of Surgical Pathology Research Articles

A clinico-histopathological study of skin appendageal tumours in a tertiary health care centre in western Odisha– A case series

Skin appendageal tumours (SATs) are those neoplasms that arise from pilosebaceous, apocrine, or eccrine sweat glands. These are a diverse group of tumours with both benign and malignant counterparts. They can be single, multiple, or have a syndromic association with internal malignancies. Benign adnexal tumours are more common, while malignant adnexal tumours are rare, usually locally aggressive, and have the potential for nodal involvement and distant metastasis with a poor clinical outcome. Therefore, proper diagnosis of SATs is important for therapeutic and prognostic reasons.This study aims to determine the clinico-histopathological correlation in cases of SATs in our hospital. It is a case series conducted over a one-and-a-half year period from January 2021 to July 2022. All clinically suspected cases of SATs were examined, biopsied, and subjected to histopathological examination. Histopathologically confirmed cases of SATs were finally analysed. Among twenty-four thousand two hundred twenty-four new patients attending OPD, 30 suspected cases of ATs underwent histopathological examination. Histopathology was confirmatory in only 12 cases (40%). 10 cases were benign, and two were malignant. Out of 10 benign cases, hidradenoma was noted in 3 (25%), trichoepithelioma in 2 (16%), proliferating pilar tumour, apocrine hidrocystoma, steatocystoma multiplex, hidradenoma papilliferum, and pilomatrixoma were seen in one each. Females (75%) outnumbered males (25%) in our study population.: SATs are infrequent and are not frequently observed in the field of surgical pathology. Histopathology is the gold standard for diagnosis.

Role of immunohistochemistry as a real mentor in diagnostic histopathology

: The goals and objectives of this study are to find out the number of cases where IHC was used to solve discrepant cases of histopathology. This gives an idea as to what percentage of cases required IHC for diagnostic evaluation. : This research is a combined retrospective and prospective analysis of a three-year time frame, beginning in January 2017 and ending in December 2019. Only those cases of benign and malignant neoplasms which have undergone IHC in our department are part of this study. Total of 67 cases were studied using routine H&E and IHC stain. Slides were evaluated by light microscopy. Using specific monoclonal or polyclonal antibodies, paraffin sections were stained immunohistochemically (IHC) using a Peroxidase antiperoxidase (PAP) technique.: There were a total of 23,558 biopsy reports made in the field of surgical pathology. Out of a total of 67 cases requested for IHC, 36 cases (53.7%) had histopathological diagnosis concordant with IHC diagnosis. While in 25 cases (37.31%) histopathological diagnosis was discordant with IHC diagnosis. In 6 cases (8.95%) conclusive diagnosis could not be derived.: From this study, we concluded that IHC plays a significant role in the definitive typing and grading of tumours. When trying to characterise a tumour, it's best to use an antigenic profile of both positive and negative markers, which may be achieved by a panel method consisting of well-chosen antibodies. It also brings about the conclusion that internal and external quality control plays an important part in routine Histopathology, which should not be undermined. Both QC and IHC must be made a routine part of Histopathology. Since we began comparing histology and IHC diagnosis three years ago, we've seen a significant uptick in the quality of our performance evaluations, patient care, and general laboratory practises.

Ozone therapy, applications in surgical pathology.

The paper deals with a series of cases in the field of surgical pathology, surgically and non-surgically solved in the first private clinic with continuous hospitalisation in Oltenia region.
 
 THE RELATIONSHIP BETWEEN SURGERY AND OZONE THERAPY.
 The benefits are particularly seen in the postoperative period. A special category is wounds, as follows:
 A) Chronic, non-healing, refractory to conventional treatments or special dressings.
 - Local causes: resistant germs, circulatory disorders.
 - General causes: diabetes, neoplasia, immunosuppressed patients.
 B) Infected ulcerated mammary neoplasms
 C) Postoperative infiltration, before reaching the stage of suppuration
 D) Speeding up wound healing with high substance deficiency
 E) Post-operative wounds defectively healed
 A retrospective study conducted on 55 patients with various surgical pathologies treated with ozone for 20-40 days demonstrates the positive effect of the treatment, with an obvious improvement of symptoms and accelerated healing of postoperative wounds.
 The paper will detail cases with certain particularities: age, patient’s medical background, lesion itself, evolution under treatment.
 This work should awaken and propel medical specialists to reconsider ozone therapy more carefully.

WT1 and Cyclin D1 Immunohistochemistry: A Useful Adjunct for Diagnosis of Pediatric Small Round Blue Cell Tumors on Small Biopsies

Pediatric small round blue cell tumors (SRBCTs) are a heterogeneous group of neoplasms with overlapping morphological appearance. Accordingly, their diagnosis is one of the most difficult in the field of surgical pathology. The most common tumors include rhabdomyosarcoma, Ewing’s sarcoma, neuroblastoma, lymphoblastic lymphoma and Wilms’ tumor (the blastemal component). Over time their diagnosis has become more difficult due to the increasing use of small biopsies. However, the advent of immunohistochemistry has improved the quality of diagnosis in most cases by the application of an adequate panel of immunomarkers. Recently, WT1 and Cyclin D1 have been shown to be useful in the differential diagnosis of SRBCTs on surgically-resected specimens, showing a diffuse cytoplasmic positivity of the former in all RMSs and a diffuse nuclear staining of the latter in both EWS and NB. The aim of the present study was to investigate the expression of WT1 and Cyclin D1 on small biopsies from a series of 105 pediatric SRBCTs to evaluate their diagnostic utility. Both immunomarkers were differentially expressed, with a diffuse and strong cytoplasmic staining for WT1 limited to all cases of RMS, and a diffuse nuclear staining for cyclin D1 restricted to all cases of EWS and NB. Notably, the expression of WT1 and cyclin D1 was also retained in those cases in which the conventional tumor markers (myogenin, desmin and MyoD1 for RMS; CD99 for EWS; NB84 for NB) were focally expressed or more rarely absent. The present study shows that WT1 and Cyclin D1 are helpful immunomarkers exploitable in the differential diagnosis of pediatric SRBCTs on small biopsies, suggesting their applicability in routine practice.

Digital teaching in pathology: experiences from Mainz

Due to the corona pandemic, digital teaching has become especially important in education and has led to arestructuring of teaching, not only in the subject of surgical pathology. In this article, different forms of e‑learning are presented and illustrated using the example of teaching surgical pathology and neuropathology at the University Medical Center Mainz. Before the onset of the corona pandemic in spring 2020, digitization had already assumed great importance for teaching in the technology- and method-oriented subject of surgical pathology. In particular, the possibility of virtual microscopy via scanned slides with adigital slide server has been used in many pathology institutes. Virtual microscopy often partially or completely replaced conventional microscopy of histologic slide collections. Complementary virtual learning offers are becoming more and more important. These include asynchronously provided lectures or macroscopy videos, video conferences, scripts and communication via learning platforms. In addition, electronic exams have become an indispensable part of teaching. Nevertheless, the corona pandemic revealed how important personal contact with students is to achieve optimal learning success; learning forms with acombination of face-to-face teaching and e‑learning in the sense of blended learning are of particular importance. As part of blended learning, digital teaching is an ideal complement to face-to-face teaching and is changing teaching in the longer term, not only in the field of surgical pathology. Digital learning formats will remain in the future and will at least partially replace classroom formats such as lectures.

Clear cell lesions in pathology: Histomorphologic approach to diagnosis.

There has been remarkable progress in the field of surgical pathology; however, histomorphology has remained the most important and essential tool of the surgical pathologist in everyday practice till now. It is surprising that the hematoxylin-eosin (H and E) stain, introduced more than a century ago, has still remained the gold standard stain for histological examination and diagnosis of human diseases. Besides different findings or clues observed in histopathology sections like inclusions, granules, grooving, globules, halo, or clearing, which would enable the pathologist to provide a precise and accurate diagnosis; observation of clear cells is one of the important findings and clue for reporting. It may also sometimes lead to difficulties and delays in establishing the diagnosis. It can be focal or extensive and primary or rarely it may be secondary. Clear cell changes may be observed in many non-neoplastic, benign, or malignant tumors of diverse origin. Clear cell tumors contain a preponderance of clear cells. It can be seen in almost all the organs of human body and can be classified according to location or biological behavior. Commonly seen clear-cell tumors are usually malignant and common organs involved are female genital tract, urogenital tract, head and neck areas, central nervous system, skin, and rarely in bone and soft tissues. For approach to clear cell lesions, one has to decide if the change is artifactual, a mimic of clear cell tumors, or a clear cell tumor in reality. Once the mimics and artifactual/degenerative changes have been ruled out, a tumor either primarily of clear cell origin or showing secondary change has to be decided. The tumor next is to be diagnosed as benign/malignant and epithelial/mesenchymal based on morphology.

Prognostic Role of ki-67 Immunohistochemistry in Soft Tissue Sarcoma: Review and Meta-Analysis

Malignant soft tissue tumors or soft tissue sarcomas accounts for less than one percent of all malignant neoplasms affecting mankind; however, they include more than 50 types of mesenchymal tumors based on histological. The number of articles dealing with the subject of Ki-67 immunohistocehmistry in soft tissue sarcoma is relatively great since the administration of this marker in the field of surgical pathology; however, the big picture about the definite role of Ki-67 in soft tissue sarcoma requires the collection of these data in a single meta-analysis study. Thus, the aim of present study is to review the role of Ki-67 immunohistochemical expression in soft tissue sarcoma using meta-analysis design Google search engine was used and the following key words were used in a variety of combination: Ki-67, immunohistochemistry, soft tissue sarcoma, prognosis, grading, role of and survival. Inclusion criteria included any article dealing with the immunohistochemical role of Ki-67 in soft tissue sarcoma of any histological subtype or as a group In the present study we found that moderate and strong ki-67 expression is associated with 50% survival.

Completeness and adequacy of clinical and demographic information in non- gynaecologic surgical pathology requisition forms: An analysis of 1046 cases

Background: An important cornerstone in health care delivery is the field of surgical pathology and one of its major aims is to provide a complete, precise and comprehensive diagnosis within a short period of time. In achieving this, the clinician needs to properly fill a surgical pathology requisition form.Method: All the consecutive requisition forms from January 1, 2018 to April 30, 2018, totaling 1046 were evaluated for completeness of the information. The requesting clinicians were unaware and cytologic smears were excluded. Patient confidentiality was maintained as no names were recorded. All the Information on the forms was recorded as being present or absent. Analysis was done using the Statistical Package for Social Science version 20.Results: Altogether 1046 forms were evaluated and (100%) of the sample population bore the surnames and first names. Ages were recorded in 93.7%. Similarly, 68.2% of the forms did not bear the hospital number. Clinical summary and date of request were absent in 42.9% and 35.4% of the forms respectively. Clinicians name/ signature and investigation required were absent in 25.1% and 21.1% of the forms respectively. Overall, 77.6% of information was provided while 22.4% not provided.Conclusion: The names were completely filled in all the requisition forms. Others were incompletely filled. These findings should be communicated to Clinicians and the recurring attitude of allowing House Officers to fill the requisition forms should be discouraged. Efforts should also be made to let Clinicians appreciate the importance of good clinical information since this determines to a large extent the output of laboratory results.Keywords: Surgical pathology, requisite form, laboratory result

The Effect of Mental Rotation on Surgical Pathological Diagnosis.

PurposePathological diagnosis involves very delicate and complex consequent processing that is conducted by a pathologist. The recognition of false patterns might be an important cause of misdiagnosis in the field of surgical pathology. In this study, we evaluated the influence of visual and cognitive bias in surgical pathologic diagnosis, focusing on the influence of “mental rotation.”Materials and MethodsWe designed three sets of the same images of uterine cervix biopsied specimens (original, left to right mirror images, and 180-degree rotated images), and recruited 32 pathologists to diagnose the 3 set items individually.ResultsFirst, the items found to be adequate for analysis by classical test theory, Generalizability theory, and item response theory. The results showed statistically no differences in difficulty, discrimination indices, and response duration time between the image sets.ConclusionMental rotation did not influence the pathologists' diagnosis in practice. Interestingly, outliers were more frequent in rotated image sets, suggesting that the mental rotation process may influence the pathological diagnoses of a few individual pathologists.

Microfluidics for rapid cytokeratin immunohistochemical staining in frozen sections

Frozen sections (FS) of tumor samples represent a cornerstone of pathological intraoperative consultation and have an important role in the microscopic analysis of specimens during surgery. So far, immunohistochemical (IHC) stainings on FS have been demonstrated for a few markers using manual methods. Microfluidic technologies have proven to bring substantial improvement in many fields of diagnostics, though only a few microfluidic devices have been designed to improve the performance of IHC assays. In this work, we show optimization of a complete pan-cytokeratin chromogenic immunostaining protocol on FS using a microfluidic tissue processor into a protocol taking <12 min. Our results showed specificity and low levels of background. The dimensions of the microfluidic prototype device are compatible with the space constraints of an intraoperative pathology laboratory. We therefore anticipate that the adoption of microfluidic technologies in the field of surgical pathology can significantly improve the way FSs influence surgical procedures.

Automated histological classification of whole-slide images of gastric biopsy specimens.

Automated image analysis has been developed currently in the field of surgical pathology. The aim of the present study was to evaluate the classification accuracy of the e-Pathologist image analysis software. A total of 3062 gastric biopsy specimens were consecutively obtained and stained. The specimen slides were anonymized and digitized. At least two experienced gastrointestinal pathologists evaluated each slide for pathological diagnosis. We compared the three-tier (positive for carcinoma or suspicion of carcinoma; caution for adenoma or suspicion of a neoplastic lesion; or negative for a neoplastic lesion) or two-tier (negative or non-negative) classification results of human pathologists and of the e-Pathologist. Of 3062 cases, 33.4% showed an abnormal finding. For the three-tier classification, the overall concordance rate was 55.6% (1702/3062). The kappa coefficient was 0.28 (95% CI, 0.26-0.30; fair agreement). For the negative biopsy specimens, the concordance rate was 90.6% (1033/1140), but for the positive biopsy specimens, the concordance rate was less than 50%. For the two-tier classification, the sensitivity, specificity, positive predictive value, and negative predictive value were 89.5% (95% CI, 87.5-91.4%), 50.7% (95% CI, 48.5-52.9%), 47.7% (95% CI, 45.4-49.9%), and 90.6% (95% CI, 88.8-92.2%), respectively. Although there are limitations and requirements for applying automated histopathological classification of gastric biopsy specimens in the clinical setting, the results of the present study are promising.

An immunohistochemical study of androgen receptor in carcinoma arising in pleomorphic salivary adenoma

Carcinoma originating within a pre-existing in pleomorphic adenoma is well-known phenomena and is occasionally debated in the field of surgical pathology. The use of the hormone treatment in salivary gland cancers is controversial. The management of patients who show positive reactivity to androgen receptor in prostate carcinomas has guided the researchers to assess the expression of this receptor in a variety of other tumors, including those arising in the salivary glands and particularly in carcinoma ex pleomorphic adenoma. Our study aimed to characterize alteration in the immunohistochemical expression of androgen receptor in the tumor cells of carcinoma arising in pleomorphic adenoma. 20 cases of carcinoma arising in pleomorphic adenoma (undifferentiated and adenocarcinoma types) were examined. The results showed that 10 (50%) of 20 cases had negative nuclear staining, whereas 10 (50%) of 20 cases had positive nuclear staining for androgen receptor. Our data suggest that carcinoma arising in pleomorphic adenoma may be dependent on endocrine function.

Immunohistochemical expression of oestrogens and progesterone receptors in carcinoma ex pleomorphic adenoma- undifferentiated and adenocarcinoma types

Cancer of the salivary gland is one of the common cancers in the head and the neck regions. This type of cancer develops in the minor and the major salivary glands, and it sometimes metastasizes to other organs, particularly the lung. Morphologic mimicry and similarity in the expression of steroid hormone receptors between salivary gland tumours and breast tumours are well-known phenomena and are occasionally debated in the field of surgical pathology. The expression of sex hormone receptors in some tumours suggests a role for these receptors in tumor pathogenesis and therapy. Previous studies of the expression of estrogens and progesterone receptors in salivary gland tumours have reported conflicting results. Our study aimed to characterize alteration in the immunohistochemical expression of oestrogens receptor and progesterone receptor in the tumour cells of carcinoma arising in pleomorphic adenoma. 27 cases of carcinoma arising in pleomorphic adenoma (undifferentiated and adenocarcinoma types) were examined. The results showed that 27 (100 %) of 27 cases had negative nuclear staining for either oestrogens or progesterone receptors. Our data suggest that carcinomas arising in pleomorphic adenoma were not dependent on endocrine function.

Growth inhibition of human salivary gland tumor cells by introduction of progesterone (Pg) receptor and Pg treatment

Cancer of the salivary gland is one of the common cancers in the head and the neck regions. This type of cancer develops in the minor and the major salivary glands, and it sometimes metastasizes to other organs, particularly the lung. Morphologic mimicry and similarity in the expression of steroid hormone receptors between salivary gland tumors (SGTs) and breast tumors are well-known phenomena and are occasionally debated in the field of surgical pathology. Progesterone (Pg), one of the female sex steroid hormone, is intimately involved in the development of the mammary gland. Further, it is believed that Pg plays a role in breast cancer progression. However, little is known regarding its role in SGTs. In this study, we used ACCM, a human adenoid cystic carcinoma cell line established from the salivary gland, in order to clarify the role of the Pg receptor (PR) on cell proliferation. No effect of Pg on cell proliferation was observed in the PR-deficient aggressive ACCM cells. However, after introducing PR into the ACCM cells, Pg markedly inhibited the proliferative activity of the cells. This inhibitory effect on cell proliferation was accompanied by p21 upregulation, and Id1 and c-myc downregulation. Moreover, Pg-treated PR transfectants showed significant morphological change; they appeared more flattened and spread out when compared with the ethanol-treated control cells. Our results provided significant insights into the mechanism of suppression of the proliferative property of the cells via the function of PR, and suggested that PR reintroduction therapy might be a viable method of inhibiting human SGT progression.

Beyond Hematoxylin and Eosin—The Role of Immunohistochemistry in Surgical Pathology

Immunohistochemistry, a technique that microscopically detects cellular constituents via specific antibodies, has revolutionized the field of surgical pathology by tremendously empowering the hematoxylin and eosin (H&E) slide. In the investigation of the unknown primary, it enables detecting the origin of the tumor by use of tissue- or organ-specific antibodies as well as antibodies associated with minimal histogenetic differentiation. It has almost perfected the pathologist's ability to make specific diagnoses such as those of mesothelioma, melanoma, and neuroendocrine tumors. These diagnoses should be reached by interpreting the immunohistochemical results in the context of a detailed morphological analysis and differential diagnosis based on the H&E. Other important uses include detection of microinvasive and micrometastatic disease. Through the use of prognostic markers, immunohistochemistry can provide valuable information regarding tumor behavior and therapy. Lastly, immunohistochemistry serves a small but valuable role in highlighting microorganisms, particularly viruses.

RT in situ PCR for VEGF mRNA in Sclerosing Stromal Tumor

To the Editor: It is sometimes difficult to obtain satisfactory results in in situ hybridization for mRNA using the archival formalin-fixed paraffin-embedded tissues, because RNA is easily degraded by RNase in tissues handled by routine methods. Reverse transcriptase in situ polymerase chain reaction (RT in situ PCR) 1 is a newly developed technique that allows in situ amplification of reverse-transcribed complementary DNA (cDNA) originating from mRNA. 1–3 The technique is thus considered to be more suitable for in situ detection of target mRNA in routinely processed formalin-fixed paraffin-embedded tissue sections than in situ hybridization. In a previous article in this journal, 4 we immunohistochemically examined the localization of vascular endothelial growth factor (VEGF) in sclerosing stromal tumor, a rare benign ovarian tumor histologically characterized by a unique morphology and marked vasculature. VEGF was predominantly positive in luteinized theca-like cells, a distinct component of cellular pseudolobules of sclerosing stromal tumors, and ordinary reverse transcription-polymerase chain reaction (RT-PCR) confirmed the expression of VEGF mRNA. In addition, we also detected an immunohistochemically positive endothelial cell-specific VEGF receptor in the endothelium of small to capillary-sized blood vessels of sclerosing stromal tumor. We thus concluded that the expression of VEGF in the luteinized theca-like cells of sclerosing stromal tumor was probably involved in the morphogenesis of this tumor. To confirm VEGF expression in the luteinized theca-like cells, we used the RT in situ PCR for VEGF mRNA using formalin-fixed paraffin-embedded tissue sections of sclerosing stromal tumor. RT in situ PCR was performed using the method described by Nuovo 3 with some modifications, including the addition of a hot start procedure, microwave pretreatment to retrieve the reactivity of mRNA, 5 and improvement of the visualization method. The primer sequences and reaction conditions were almost similar to those of the previous RT-PCR for VEGF mRNA, 4 and appropriate negative and positive controls were included in the experiment. The integrity of RNA in the paraffin-embedded tissues was confirmed by in situ hybridization of 28S ribosomal RNA. 6 The signals corresponding to VEGF mRNA were found predominantly in the cytoplasm of luteinized theca-like cells (Fig. 1). Nonspecific background staining was minimal. Although a degree of nuclear labeling, probably resulting from genomic DNA amplification and repair, 3 was observed, the result confirmed the expression of VEGF mRNA in the luteinized theca-like cells as well as our hypothesis concerning the morphogenesis of sclerosing stromal tumor.FIG. 1.: Labeling for amplified VEGF cDNA is observed in the cytoplasm of epithelioid cells corresponding to luteinized theca-like cells.One of the reasons why immunohistochemical staining has become universally used as a diagnostic and research tool in the field of surgical pathology is that it allows easy and reliable detection of a specific antigen using formalin-fixed, paraffin-embedded tissue sections. In the present experiment, RT in situ PCR was considered as a suitable and convenient tool for surgical pathologists to detect target mRNA with the archival formalin-fixed, paraffin-embedded tissue. However, there are a number of problems that have to be resolved before the method is widely used. These include procedural improvement of mRNA preservation in the formalin-fixed, paraffin-embedded tissues, standardization of RT in situ PCR procedure, reduction of nonspecific labeling, and inhibition of genomic DNA amplification and repair. In conclusion, RT in situ PCR on formalin-fixed, paraffin-embedded tissue sections of sclerosing stromal tumor confirmed the expression of VEGF mRNA. We think RT in situ PCR could be potentially useful for the detection of mRNA in formalin-fixed paraffin-embedded tissues. Shigeto Kawauchi M.D. Toshiro Fukuda M.D. Masazumi Tsuneyoshi M.D.

Arthur Purdy Stout (1885-1967), a pioneer of surgical pathology: a survey of his Notes on the Education of an "Oncological" Surgical Pathologist.

Arthur Purdy Stout (1885-1967) started his medical career as a surgical intern and house surgeon at institutions that were to join the Columbia-Presbyterian Medical Center. With virtualy no formal training in pathology and little supervision, he was given the opportunity to work in a laboratory of surgical pathology. He focused his attention on neoplasms and tumor-like conditions, and authored Human Cancer in 1932. This book was organized according to topography of lesions and set a model for the Atlas of Tumor Pathology project. In addition to his many articles and slide seminars, Stout embarked during his "postretirement" years, with the help of residents and fellows, on a systematic study of soft tissue tumors in children. In 1950, he also began his Notes on the Education of an "Oncological" Surgical Pathologist. This manuscript of 427 typewritten pages offers candid details on his development as a surgical pathologist from rather primitive and chaotic beginnings, and on the post-World War II rise of surgical pathology. Notes provides interesting glimpses of his rapidly changing world, particularly of New York, the College of Physicians and Surgeons of Columbia University, and other pathologists. It also portrays an individual absorbed by his work and intent on leaving behind the legacy of a pioneer in the field of surgical pathology.

Ackerman's Surgical Pathology

'Monomania' from Karl Heinrich Baumgartner's Kranken-Physiognomik (Stuttgart: L. F. Rieger, 1842). From Seeing the Insane , by Sander L. Gilman, 252 pp, with illus, paper, $30, ISBN 0-8032-7064-X, Lincoln, Neb, University of Nebraska Press, 1982, 1996. The publication of the eighth edition of Ackerman's Surgical Pathology , the third under the aegis of Juan Rosai, is a welcome event for surgical pathologists. Since the last edition in 1989, the field of surgical pathology has continued to expand at an exponential rate. To reflect these advances, the new edition has been completely revised and updated. Dr Rosai again has succeeded in condensing the new information into a concise but comprehensive and readable text, maintaining the standard of excellence and uniformly high quality he achieved in the two prior editions. Six collaborators have written on the following subjects: Drs K. W. Barwick (liver—nonneoplastic diseases), N. G. Ordonez (kidney—nonneoplastic diseases), R. D. Brunning (bone marrow),

The Difficult Diagnosis in Surgical Pathology

The editor of The Difficult Diagnosis in Surgical Pathology has successfully gathered a group of surgical pathologists to contribute to this new book. The contributing pathologists are all well-recognized experts in their fields of specialization. There is a danger that such authors would rediscover the wheel and rewrite the entire field of surgical pathology. Instead, they have written chapters utilizing their personal experience and turning their attention to the diagnosis of the difficult case in surgical pathology, without undue repetition of what is already in the standard texts. Lesions that mimic other lesions, variants of lesions, unusual and uncommon conditions, and newly described entities are all discussed in great detail, with an extensive and up-to-date bibliography and with reference to all the recent advances in the use of immunohistochemistry in surgical pathology. In a book of this nature, not only is the text of importance, but the standard of

French Keller Hansel and the history of allergy.

The death of French Keller Hansel, MD, at the age of 88 years, on Aug 29, 1981, brought to an end the career of a great man and an exciting era in our specialty of otolaryngology. A brilliant scientist and an enterprising innovator, Hansel was born in 1893, in Fidelity, Ill. He graduated from the St Louis School of Medicine and served as an intern and medical resident at the Missouri Baptist Hospital, St Louis. In 1921, he went to the Mayo Clinic, Rochester, Minn, first in the field of surgical pathology and then as a Fellow in otolaryngology under H. I. Lillie, MD. His examination of pathologic sections from surgical specimens called to the attention of his inquiring mind the unusual eosinophilic infiltration of the subepithelial tissues of numerous specimens of nasal and sinus mucosa removed at surgery on the nose and nasal accessory sinuses. He used these observations,