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Intra-Operative Diagnosis of CNS Tumours.
  1. MARGARET ESIRI

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    Intra-Operative Diagnosis of CNS Tumours. Edited by tim h moss, james a r nicoll, james w ironside. (Pp193 £99.00). London: Arnold, 1997. ISBN 0-340-67737-6.

    This is a handsome and liberally illustrated guide to smear and frozen section diagnosis in neuropathology. This aspect of practice remains a central part of a clinical neuropathologist’s role and this book can be recommended to trainees and practitioners for its wealth of illustration and practically oriented text. It is particularly useful to see a wide range of appearances for each tumour illustrated—for example, 20 figures illustrating metastatic tumours, 13 illustrating pituitary adenomas, and 38 illustrating various grades of astrocytic tumours. This enables the less readily diagnosed examples to be considered as well as more typical varieties. Typical varieties tend to be the only ones illustrated in a less specialised text. There are 18 chapters that cover each of the main types of tumour encountered as well as providing advice on making and interpreting smears and dealing with lesions that do not smear well. The emphasis is on using smears as standard preparations with frozen sections as back up when required—a procedure that is probably adopted in most neuropathology departments.

    The success of a book like this depends crucially on the quality of the photographs. These are, appropriately, all in colour. Many are of excellent quality. Some are intentionally obscure—for example, to make the point that desmoplastic carcinomas may be too tough to examine in smears (fig 18.1). A few have rather poorly defined features and these tend to be illustrations of frozen sections which inevitably lack the crispness of smears. However, even these illustrate the points intended. The legends to the figures are full enough to avoid the need for arrows that might otherwise have obscured the images. There is a useful index, but the book would have benefited from more references—I found only six.

    Smear diagnosis is best learnt by doing it, with a sympathetic, experienced colleague at one’s elbow. Often this condition cannot be fulfilled and I would strongly recommend this book as a very valuable alternative or adjunct.

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