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The seven years that have elapsed between the current and the previous editions of this book have seen momentous changes taking place in the practice of surgical pathology.
Immunohistochemistry has continued its notable expansion and has become an indispensable adjunct for the practice of the specialty. It has truly transformed the practice of surgical pathology in a fashion that no other technique has done before or after. Newcomers to the specialty take it for granted when ordering their panels, without pausing to think that only forty years ago none of this was available to the brave pathologists who based all of their diagnoses and other considerations on patterns of growth and cellular features seen in hematoxylin-stained slides, with the occasional modest help provided by one or another ‘special stain’.
We are now in the midst of another transformation, resulting from the application to surgical pathology specimens of the enormous amount of new knowledge derived from the molecular genetic revolution. The potential and – in some instances – the already tangible benefits of this technology are too obvious to be emphasized. It may instead be instructive to reflect on the effect that this barrage of new information is having on the approach to surgical pathology by the new generation of practitioners, and the danger that the tradition of meticulous gross and microscopic examination upon which surgical pathology has been built may be gradually eroding. Some of this may be inevitable and is perhaps not altogether undesirable, yet the amount of information that this timehonored examination can still provide is so rich and dependable that one recoils at the thought of it being belittled or altogether ignored. With that caveat in mind, this edition dutifully incorporates the many promising results reached with the new technologies (emphasizing those in which a clinical validation has occurred), but always matching them against the results and conclusions derived from the morphology-based approach that has served pathologists so well for so long.
This difficult integration task has been carried out in most chapters by Dr John KC Chan, a brilliant representative of that emerging and still sparse cadre of surgical pathologists who combine a superb knowledge of conventional pathology with an understanding of the principles, possible applications and potential pitfalls of molecular genetic techniques.
Another important change that has taken place during this period concerns the increasing demands for standardization, compliance with regulatory controls and legal accountability, which have prompted various pathology organizations to produce sets of guidelines to help us navigate through an increasingly complicated terrain.
Yet another significant development concerns the pervasive influence acquired by electronic information systems in practically all activities that take place in the surgical pathology laboratory, rendering some degree of computer literacy indispensable to those wishing to practice the specialty.
It has not been easy to accommodate this rapidly changing and continuously expanding universe within the confines of the covers of this book. The amount of information that had to be reviewed, even if often of a merely confirmatory or plainly repetitive nature, was daunting, and the trend for the establishment of subspecialties in surgical pathology – each with its own rites and lingo – has accelerated. The sum of these factors has made the production of this book a heavy burden, to the point of making one wonder on more than one occasion whether it had grown beyond the capabilities of an individual. Yet, as you can see, despite it all, another edition has been completed, once again for the most part written by one author, in the continuing hope that whatever expertise is inevitably missing as a result may be compensated by what somebody in a related context referred to as ‘the ultimate simplicity of one voice speaking’. Along those lines, a constant attempt has been made to preserve as much as possible the pragmatic flavor initially given to this work by its peerless begetter, Dr Lauren V Ackerman (1905-1993).
This goal of coherence notwithstanding, it became increasingly obvious that there were highly specialized areas (mainly but not exclusively in the non-neoplastic field) that could not have been covered adequately without the contribution of experts. I was fortunate in being able to secure once again the collaboration of outstanding individuals (listed on the contributors’ page) for this purpose, and I am extremely grateful to them for their willingness in lending their considerable expertise to this effort.
A book that has gone through so many editions is bound to contain strata of text and illustrative material that have been contributed by somebody at some point, to subsequently being covered by other strata from somebody else, but whose original source will still be identifiable to the initiated. Among the several past contributors
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