Chemical Pathology and the Sick Child

sion surprise is the inclusion of HMR in the group of T-zone histiocyte disorders and one is perhrps entitled to enquire what criteria the authors used in establishing the diagnosis of HMR-especially as there appear to have been some exceptions to the general rule of a T-zone histiocytic origin. One of the chief problems in investigating proliferative disorders of histiocytes is the rarity of some of these conditions and uncertainty as to how many separate entities exist. The authors freely acknowledge this and repeatedly stress the necessity of studying more cases. Another interesting problem concerns the distinction between certain malignant lymphomas of T-cell origin and primary neoplasms of T-zone histiocytes-a distinction which may not be easy to make. The third chapter is entitled Symposium on Histiocytic or Large Cell Lymphomas and in this, seven contributors, mostly working in pairs, attempt to answer ten different questions posed by an imaginary chairman. It is difficult to believe that this was a real symposium in which the participants actually met to discuss these topics, since the replies to the questions from pairs of contributors often cover the same ground and there is much tedious repetition. Furthermore, some of the questions are interpreted quite differently by different authors and much confusion arises over the use of the term "histiocytic lymphoma". The four North American participants understand the term to mean any large-cell lymphoma, as implied in the Rappaport classification, while the Japanese and British participants apply the term only in the strict sense of a neoplasm of histiocytic derivation. Imagine what a garment would look like if knitted by four different people, each choosing their own pattern, their own wool, and different sized needles, and some idea can be gained of how this symposium hangs together. A lengthy essay on plasma cell disorders is contributed by TR Callihan, JM Holbert and CW Berard under the verbose title "Neoplasms of terminal B-cell differentiation-the morphologic basis of functional diversity" which runs to 99 pages and includes 428 references. This valuable and comprehensive review discusses first the development of B and T lymphocytes and their interactions before going on to the immunoglobulins and the occurrence of monoclonal gammopathy. Guidance is given on the differentiation of "benign" gammopathy from that associated with neoplasms. A detailed account of multiple myeloma and solitary plasmacytoma follows and then sections on Waldenstrom' s macroglobulinaemia, the various heavy chain diseases, and finally amyloidosis. The lymphoplasmacytoid immunocytomas of the Kiel classification are here dealt with under "Waldenstrom' s macroglobulinaemia" despite the fact that a majority of such cases are not associated with a detectable paraprotein in the serum, as Lennert has pointed out. It is perhaps significant that not one single mention is made of the work of Lennert and his coworkers in clarifying this group of lymphoid neoplasms. The fifth and sixth articles in this volume are both much briefer. P Haghighi has written on "Primary Small Intestinal Lymphoma and Immuno-proliferative Small Intestinal Disease: an update". Readers who are not already familiar with the subject may find this paper confusing and even to the initiated it makes difficult reading, partly owing to the wealth of abbreviations in the text. In the discussion of alpha chain disease there is of course some overlap with the previous article, just as there is between the second and third articles in the book on the subject of "true" histiocytic neoplasms (S Watanabe contributes to both chapters). In the final article, MH Zarrabi and SB Chandor have written on the "relationship of Hodgkin's disease and the nonHodgkin's lymphomas". The approach is initially historical, outlining the evolution of ideas on this relationship, on the nature of the Reed-Sternberg cell, and the continuing uncertainty surrounding its origins. One of the several quotations in this section is wrongly ascribed to van den Tweel et al. It should have been attributed to Willis (RA Willis, Pathology of Tumours, 1960, 3rd edition, Butterworth p 785). After concluding that our ignorance of the nature of the Reed-Sternberg cell alone justifies the separation of Hodgkin's disease from the "non-Hodgkin' s lymphomas", the authors go on to discuss the occasional occurrence of the two disorders in the same patient and the significance of this observation. Although there is much to criticize in this collection of papers there is also some merit, and the volume can be commended to those wishing to keep abreast of current thinking in the difficult field of malignant lymphomas. The book is beautifully produced and there are admirably few spelling mistakes.