Ramon L Font, J Oscar Croxatto, Narsing A Rao

The American Registry of Pathology in collaboration with the Armed Forces Institute of Pathology, 2006. ISBN Number 1-881041-99-9

All would agree how vitally important it is for pathologists and other specialists to speak a common language when describing and discussing tumours. This is why, in 1947, the US Armed Forces Institute of Pathology (AFIP) published its Atlas of Tumor Pathology. The atlas, which comprised nearly 40 volumes or ‘fascicles’, was a great success. Second and third editions or ‘series’ were subsequently published to improve the atlas and keep it up to date.

Tumors of the Eye and Ocular Adnexa by Font, Croxatto, and Rao is the fifth volume (or Fascicle) of the fourth series of the AFIP Atlas of Tumor Pathology.

The chapters are organised anatomically as follows: conjunctiva and caruncle, uveal tract, retina, optic nerve and optic nerve head, eyelids, lacrimal gland and lacrimal drainage system, and orbit. The final chapter is dedicated to the pathologic examination of ocular specimens, detailing the techniques to be applied in the gross description and preparation of a variety of ocular specimens.

Each chapter starts with a brief description of the anatomy and histology of the relevant tissues, before providing a detailed account of all the benign and malignant tumours involving that site. Most entities are described under the following subheadings: definition of the tumour, general features, pathogenesis and epidemiological observations, clinical features, macroscopic and microscopic findings, cytology (if applicable), differential diagnosis, and special studies (eg immunohistochemistry, polymerase chain reaction, gene translocations).

All chapters contain a large number of beautiful colour illustrations, arising not only from the files of the Ophthalmic Pathology Laboratory of the AFIP, but also from the Cullen Eye Institute (Baylor College of Medicine) and the Doheny Eye Institute (Keck School of Medicine). These indeed represent the highlight of this Fascicle series. Key information is helpfully summarised in pastel-coloured tables. Each chapter is accompanied by a reasonably updated list of references, which are subdivided for convenience according to subheading (eg classification and frequency) and then tumour subtype. Finally, the book is concluded with a concise and accurate index.

I have a few quibbles. Some of the references are not as up to date as one might expect. For example, the ‘TNM/AJCC Tumor Staging System’ has been provided for most neoplasms; however, it not clear why the fifth version of this classification system was chosen as a reference rather than the sixth (particularly considering the imminent publication of the seventh edition).1 With regard to special studies in choroidal melanoma, there is no mention of the prognostic significance of chromosomal abnormalities, such as monosomy 3. Further, I hope that future Fascicle series will discourage the use of the term ‘Primary Intraocular Lymphoma’, which is often secondary to central nervous system disease. The authors correctly distinguish primary ‘retinal’ from primary ‘uveal’ lymphomas. However, they still refer to ‘reactive uveal lymphoid hyperplasia’, despite convincing evidence that these lesions indeed are low-grade malignant B-cell lymphomas of mucosa-associated lymphoid tissue type.2

In summary, I can thoroughly recommend The Fourth Series AFIP Fascicle of the Tumors of the Eye and Ocular Adnexa as an educational tool and especially as a standard reference text for both general and specialised surgical pathologists interested in the neoplasms of the eye and the ocular adnexa.