Book review

Flow Cytometry in Neoplastic HematologyWojciech GorczycaTaylor and Francis, London UK, 2006, 280 pp.ISBN 1841845655.

A picture is worth a thousand words. The familiarmaxim was apparently the brainchild of a 1920s-eraadvertiser, Fred Barnard. Pathology texts can beBarnardian: the images make the book by captiva-ting the reader. Poor quality pictures are akin toexamining the tissue sections through anout-of focusmicroscope, severely impairing the delivery of thetextual message regardless of the eloquence ofthe author. Diagnostic flow cytometry is also ahighly visual medium. Pathologists rely on thepictorial graphic display of the electronically ac-quired immunologic and light scatter data for inter-pretation. So, it comes as a pleasant surprise thatGorczyca’sFlowCytometry inNeoplasticHematologyhas more than 200 handsome and colorful dot-plotdisplays. The diagrams serve as crucial illustrators ofthe concepts presented within the book and are thehighlight of this Taylor and Francis publication.

Regardless of Mr Barnard, articulate delivery ofknowledge on the page is paramount. Dr Gorczycahas a simple and straightforward writing style,notwithstanding a few grammatical faux pas. Thebook, however, did not satisfy my desire for acomprehensive treatise on neoplastic cell pheno-types and cell markers.

The attractive 266-page volume is well organized.It covers the practical aspects of flow cytometry forthe diagnosis of hematologic malignancies in 11chapters with an atlas-like feel. It is organized intothree main unmarked sections: the identification ofabnormal cells, a discussion on phenotypic mark-ers, and flow cytometry findings in specific hema-tologic disorders.

The introductory chapter covering basic flowcytometry concepts is too brief; a more detaileddescription of the phenotypic findings of normalblood, marrow, and tissue elements would bewelcomed. For instance, basophils are ignoredand are without an entry in the index. This isunfortunate, as basophils can be confused withblasts on flow cytometry because of their lightscatter characteristics and an understanding of theirunique phenotype helps avoid this mis-step.

The following four chapters on abnormal cellidentification broken out into sections on B cells, T

cells, blasts and dysplasia are enjoyable, althoughsomewhat redundant with later discussions ofindividual neoplastic disorders. A brief chapter onflow cytomerty limitations is then followed by a 30-page discussion on phenotypic markers. Thissection is disappointing in its lack of depth. Betterover-views are available in other texts. Severalmarkers are lumped together (CD4 and CD8,CD13, and CD33), while other important antigensare ignored (e.g. CD26 and CD58). The significanceof ZAP-70 in CLL is succinctly reviewed, but nomention is given to the technical difficulties ofanalyzing this labile intracellular protein. Theseoversights may be due to constraints by thepublisher, but limit the effectiveness of thepublication.

The final four chapters on the flow cytometricfindings of specific disorders are also somewhat thinon details. More extensive discussions particularlyon acute lymphoblastic leukemia (ALL) subtypesand Sezary cells among other things seem pertinent.Emphasis is appropriately placed on each diseaseprocess although an unusually large full-page tableon the phenotypic features of the rare blasticnatural killer (NK)-cell lymphoma/leukemia ispresented and the possible occurrence of aberrantCD3 expression in the equally rare primary effusionlymphoma is mentioned no less than three timesthroughout the book.

Several other points should be made. Althoughsharply fashioned, the figures do have severaldrawbacks. Firstly, the histologic images are occa-sionally small and therefore of limited utility.Secondly, many of the figures are presented inlandscape view, rather than portrait style, requiringthe reader to rotate the book 90� to view theillustrations correctly. Thirdly, the figure legendsare often brief and inadequate to explain thecomplex graphs. Finally, the text appears mostappropriate for pathology residents, hematopatho-logy trainees, and practicing hematopathologists,best serving as an introductory guide for trainees. Itis hard to conceive the utility of the publication tonon-laboratorians.

The subtitle of Gorczyca’s book Morphologic-Immunophenotypic Correlation is apt. Flow cyto-metry has become an indispensable tool to aid inthe diagnosis and classification of hematologicdisorders. These instruments have solidifiedthemselves as essential elements of the clinical

Eur J Haematol 2006: 77: 542–543doi:10.1111/j.1600-0609.2006.00749.xAll rights reserved

� 2006 The AuthorJournal compilation � 2006 Blackwell Munksgaard

EUROPEAN JOURNAL OF HAEMATOLOGY

542

hematology laboratory but are currently unable todecipher the morphologic qualities that are thebackbone of diagnostic pathology. The carefuldiagnostician, therefore, must always correlate theimmunologic and light scatter data accrued fromthe device with the architecture of the lesion. Aninformation guide on diagnostic flow cytometryneeds to heed these realities. Dr Gorczyca appearskeenly aware of this fact through his carefullycrafted collages of histologic images and dot plots.

Further enhancements are needed, however, tomake this an obligatory addition to the pathologylibrary.

Howard J. MeyersonDepartment of Pathology

University Hospitals of Cleveland11100 Euclid Avenue

Cleveland, Ohio, USA 44106e-mail: howard.meyerson@uhhs.com

Book review

543