Due to its rapid development in recent years, hematopathology has become a very complicated discipline. The current development is mainly in two aspects: the new classification of lymphomas and leukemias and the new techniques. The Revised European-American Classification of Lymphoid Neoplasms (REAL classification) and the World Health Organization (WHO) classification of hematologic neoplasms require not only morphologic criteria but also immunophenotyping and molecular genetics for the diagnosis of hematologic tumors. Immunophenotyping is performed by either flow cytometry or immunohistochemistry. There are many new monoclonal antibodies and new equipments accumulated in recent years that make immunophenotyping more or more accurate and helpful. There are even more new techniques invented in recent years in the field of molecular genetics. In cytogenetics, the conventional karyotype is supplemented and partly replaced by the fluorescence in situ hybridization (FISH) technique. The current development of gene expression profiling is even more powerful in terms of subtyping the hematologic tumors, which may help guiding the treatment and predict the prognosis. In molecular biology, the tedious Southern blotting technique is largely replaced by polymerase chain reaction (PCR). The recent development in reverse-transcriptase PCR and quantitative PCR makes these techniques even more versatile. Because of these new developments, hematopathology has become too complicated to handle by a general pathologist. Many hospitals have to hire a newly trained hematopathologist to oversee peripheral blood, bone marrow and lymph node examinations. These young hematopathologists are geared to the new techniques, but most of them are inexperienced in morphology. No matter how well-trained a hematopathologist is, he or she still needs to see enough cases so that they can recognize the morphology and use the new techniques to substantiate the diagnosis. In other words, morphology is still the basis for the diagnosis of lymphomas and leukemias. Therefore, a good color atlas is the most helpful tool for these young hematopathologists and for the surgical pathologists who may encounter a few cases of hematologic tumors from time to time. In a busy daily practice, it is difficult to refer to a comprehensive hematologic textbook all the time. There are a few hematologic color atlases on the market to show the morphology of the normal blood cells and hematologic tumor cells. These books are helpful but not enough, because tumor cell morphology is variable from case to case and different kinds of tumor cells may look alike and need to be differentiated by other parameters. The best way to learn morphology is through the format of clinical case study. This format is also consistent with the daily practice of hematopathologists and with the pattern in all the specialty board examinations. Therefore, it is a good learning tool for the pathology residents, hematology fellows as well as medical students. This proposed book will present 83 clinical cases with clinical history, morphology of the original specimen and a list of differential diagnoses. This is followed by further testing with pictures to show the test results. At the end, a correct diagnosis is rendered with subsequent brief discussion on how the diagnosis is achieved. A few useful references will be cited and a table will be provided for differential diagnosis in some cases. The major emphasis is the provision of 500 color photos of peripheral blood smears, bone marrow aspirates, core biopsy, lymph node biopsy and biopsies of other solid organs that are involved with lymphomas and leukemias. Pictures of other diagnostic parameters, such as flow cytometric histograms, immunohistochemical stains, cytogenetic karyotypes, fluorescence in situ hybridization and polymerase chain reaction, will also be included. A comprehensive approach with consideration of clinical, morphologic, immunophenotypic and molecular genetic aspects is the best way to achieve a correct diagnosis. After reading this book, the reader will learn to make a diagnosis not only based on the morphology alone but also in conjunction with other parameters.
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我带着一种近乎朝圣的心情打开了这本图集,期望它能解答我心中所有关于血癌异质性的疑惑。它确实没有让我失望,特别是关于急性髓系白血病(AML)中,不同FLT3或NPM1突变下的原始细胞形态微妙差异的展示,简直是艺术品级别的呈现。作者似乎倾尽毕生心血,将数十年积累的诊断经验浓缩在了这些高分辨率的图像之中。阅读过程中,我不得不频繁地停下来,对照我自己的病理切片进行“盲审”,这种沉浸式的对比学习效率极高。然而,这本书的阅读体验是极其消耗精力的,它不适合碎片化时间阅读。你需要一个完全安静、不受打扰的环境,最好是搭配一台高精度显示器来辅助查看那些需要放大观察的细胞核结构细节。总而言之,它无疑是血液病理和诊断学领域的一座丰碑,其深度和广度无人能及,但它同时也是一扇需要极高门票才能进入的知识殿堂,需要学习者付出巨大的努力和时间成本才能真正掌握其精髓。
评分这本厚重的书,光是掂在手里就觉得沉甸甸的,光是翻阅目录就能感受到它内容的广度和深度。我本是血液科领域的新手,初次接触这般详尽的图集,心中不免有些敬畏。它并非那种轻描淡写、仅做宏观介绍的入门读物,更像是一份需要细心研读、反复查阅的专业工具书。我尤其欣赏其中对各种罕见病例的详尽描绘,那些在日常临床中可能仅出现一两次的病理形态,在这里都有极其精细的彩色图谱作为佐证。阅读体验上,它要求读者具备一定的基础知识背景,否则那些密集的术语和复杂的分类体系可能会让人望而却步。我花了大量时间去消化其中关于免疫分型和分子遗传学异常的章节,那些复杂的图表和流程图,虽然烧脑,但一旦理解,对疾病的认知水平瞬间拔高了一个层次。它迫使你跳出教科书上对疾病的刻板印象,真正进入到细胞和分子层面去理解肿瘤的异质性。这本书的价值在于其无可替代的视觉参考性,是临床实践和科研工作者案头必备的“百科全鉴”,它提供的不仅仅是知识,更是一种面对复杂血液肿瘤时的信心支撑。
评分这本书的出版时间信息给我留下了深刻的印象,它似乎囊括了近些年血液学领域内最前沿的分子生物学发现,并努力将其整合到传统的形态学框架中去。我尤其欣赏其中关于浆细胞肿瘤部分的处理方式,那几乎就是一张分子标志物的星图,清晰地标明了哪些基因突变与哪种预后相关联。然而,我发现一个小小的问题,或许是由于图集本身的性质所限,一些快速发展的治疗方式,比如CAR-T疗法或新型靶向药物对病理形态的长期影响,在图谱中体现得还不够充分,更多的是基于既往的治疗模式下的形态描述。换句话说,它在描述“静止”的肿瘤特征方面达到了极致,但在描述“动态”的治疗反应和耐药后的表型漂移方面,尚有拓展的空间。这使得它在面对一个正在接受新疗法的患者时,提供的指导性略显滞后,当然,这也许是所有依赖视觉固化材料的专业书籍的通病。
评分翻开书页,首先扑面而来的是那种老派医学图谱特有的严谨与考究,装帧精美,纸张质量极佳,显然是为了长期保存和频繁翻阅而设计。我最感兴趣的是它对于慢性淋巴细胞白血病(CLL)不同亚型的影像学和细胞形态学演变的对比分析。作者在描述每一种病变时,都极力避免使用过于主观的形容词,而是用极其客观、精确的医学语言进行陈述,这种克制的叙事风格,反而更显出内容的权威性。例如,对骨髓活检中淋巴细胞浸润模式的分类,细致到令人发指,不同区域的浸润密度如何影响后续治疗反应,都被图文并茂地展示出来。我尝试将其作为辅助诊断的工具,发现它在鉴别一些形态学上非常相似但预后截然不同的疾病时,提供了关键的线索。这本书的排版布局也非常用心,关键的诊断标准和最新的WHO分类节点被高亮显示,使得快速定位信息成为可能,尽管内容本身密度极大,但阅读路径的设计却非常清晰,体现了编纂者对临床需求的深刻理解。
评分说实话,这本图集更像是一本“视觉词典”,而非传统意义上的“故事书”。我希望在阅读过程中能有一些更具启发性的临床思维导图或者诊断路径的建议,但它似乎更专注于对“已确诊”或“待确定”病理形态的穷尽式记录。对于刚刚开始学习血液肿瘤学的住院医师来说,它更像是图书馆里一本需要“膜拜”的参考书,而不是床边快速查询的指南。我尝试用它来指导一个复杂的骨髓增生异常综合征(MDS)病例的诊断,发现虽然图谱展示了所有可能的细胞形态变异,但关于如何将这些形态学发现与FISH或NGS的结果进行整合分析,书中的引导相对较少,更多的是对形态本身的呈现。这或许是其定位的局限性,它是一部现象学的巨著,专注于“是什么样”,而非“该怎么办”。因此,它更适合作为高级病理学家或科研人员深入研究某一特定细胞谱系演化历程时的深度参考资料,而不是一个急于寻求即时决策支持的临床医生手中的首选。
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