The Granulomatous Disorders

The editors of this impressive new book indicate in their preface that this text was compiled to give "undivided attention" to granulomatous disorders other than sarcoidosis. Toward that end, they have assembled an impressive array of experts from around the world as chapter editors. In turn, the editors had most chapters jointly authored by a pathologist and a clinician in an effort to provide the reader with, as they put it, "an insight into increasing knowledge on the pathogenesis and clinico-pathologic correlates of granulomatous diseases." For the most part, they succeed admirably in attaining their goals.

The book is organized into four parts: Biology of Granulomas, Infectious Granulomas, Granulomas and Disease, and Granulomas and Body Systems. These large sections provide the reader with extended discussions and insights into our current understanding of, respectively, basic biology as applied to pathogenesis, diagnosis, and taxonomy; infectious etiologies; "syndromes" (eg, sarcoidosis, cancer-related syndromes, bone marrow involvement); and specific organ system involvement (eg, heart, eye, gastrointestinal) of granulomatous disease.

The sections and their constituent chapters are thorough in the treatment of their assigned topics and are generally quite current in terms of the exhaustive list of references provided with each chapter. The editors themselves credit the book with being "eminently readable and extensively illustrated," and they are correct. The text is uniformly lucid and the type font is large and easy on the eyes. The illustrations and tables are particularly worth noting, both for their quantity and quality.

Medical texts always risk becoming ponderous tomes with endless fact-laden text, but that is not a problem with The Granulomatous Disorders. Here, the clear writing is abundantly supplemented by well-organized tables and excellent reproductions of histopathology, patient photographs (including some in color), and various imaging studies. This material substantially adds to the text and augments the reader’s understanding of the topic. Those who have occasion to teach this subject will find that many of the tables provide useful teaching summaries.

As noted, this is an extraordinarily comprehensive work. I can think of no other book in which one might find mention-let alone discussion-of entities such as Blau’s syndrome (a pediatric granulomatous condition) or Kikuchi’s disease (a condition of young women that is often associated with autoimmune disorders) as well as an extended analysis of the often vexing relationship between granuloma formation and various cancers.

However, there are some instances where this level of detail becomes somewhat excessive-for example, the nearly two-page discussion of the Kveim-Stilzbach test for sarcoidosis, including the preparation of the test antigen. Likewise, a full chapter on the electron microscopy of granulomas (an approach that, by the author’s declaration, has been largely superseded by other tools) may be of interest mostly for historic purposes.

On the other hand, the chapter on sarcoidosis does not provide nearly as much information on the application of serum angiotensin-converting enzyme to that condition as many readers might like. Furthermore, the section dealing with the heart does not provide guidance on the role of newer imaging modalities such as magnetic resonance imaging in evaluating possible granulomatous involvement of that organ.

However, these and similar relatively modest shortcomings are more than made up for, particularly by parts I and IV of the book. The early chapters that address the biology and immunology of the granuloma and the mechanisms that interrelate granuloma formation and fibrosis are especially effective at providing an understanding of the complex interaction between T helper (Th1/Th2) lymphocytes, the lymphokines they produce, macrophages, and an array of chemokines, cytokines, and growth factors at work in the pathogenesis of these disorders. Likewise, the chapter on the classification of granulomatous disorders provides a very helpful organization for categorizing and distinguishing these from one another and from related conditions.

The chapters on specific organ involvement in granulomatous disease are also distinctive and useful. In addition, a chapter on granulomatous lesions of unknown significance (the GLUS syndrome) is thoughtfully included. This is a common clinical problem, and readers will appreciate the thorough and practical treatment it is given in the text.

While biologists and immunologists will find different aspects of this text to interest them, this clearly seems to be a book written for clinicians. As already noted, this is a generally excellent text, in large part due to its comprehensive nature. That said, who exactly will have sufficient use for a detailed work on such a circumscribed topic?

Although many internists, pediatricians, pathologists, and others involved in clinical medicine will encounter granulomatous diseases, most will not do so often. Subspecialists of various types may be the most frequent users of this text. It will be a comforting resource for some of the more difficult issues related to granulomatous disease. For that reason alone, many will want a copy of this book available to them in their hospital or medical school library. It is less clear how many will want this book on the shelf of their personal book collection. That’s a shame, as this is a well-written and unique text.