lit patan tsvetnoy atlas robin cook/Colour Atlas of Anatomical Pathology

Патологическая анатомия
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FOREWORD TO THE THIRD EDITION

It has often been stated that pathology is primarily a visual discipline. The observation, not always
meant as a compliment, has a component of truth, in the sense that a large segment of pathology
practice consists in the interpretation of images of one type or another. The magnification range of

the images that the pathologist has been asked to evaluate has increased exponentially over the
years, from the gross to the microscopic, down to the ultrastructural and cytogenetic; but the basic

purpose has remained the same: to extract from the visible structural features all the necessary
information in an attempt to ascertain the nature and mechanism of formation of the abnormalities
present.

In its beginning, the imagery of pathology was exclusively of a macroscopic nature, and the

expertise of the pathologists was once judged on the basis of their acumen in predicting the
histology on the basis of the gross appearance of the specimens. Legends were built around this
prowess, like the story of Karl Rokitansky looking at a cross-section of a pneumonia and being able

to indicate which foci were composed of neutrophils and of histiocytes. A good measure of the

importance given at one time to gross pathology is the fact that an integral component of every
major department of pathology was the museum, in which a formally appointed curator (none more

famous than Thomas Hodgkin) supervised all the activities leading to the selection, processing,

identification and displaying of selected specimens.

1

A related activity, which has progressively replaced the actual museums, has been the production

and publication of atlases of gross pathology. Some of these were based on the museum pieces
and others on fresh specimens, the latter having the obvious advantage of rendering a more faithful
representation of the appearance of the 'live' lesion. The importance of this material in the teaching
of anatomic pathology at both the undergraduate and postgraduate level cannot be
overemphasized, particularly at a time when the attitude is gradually taking hold that the
examination of a gross specimen is simply the technical step required for the acquisition of the
microscopic slides. Nothing can be further from the truth, either in surgical pathology or autopsy
pathology. As stated in an editorial appropriately titled 'In praise of the gross examination', it is the
gross aspect of the specimen that shows the size, form and nature of the process so that it can be
understood both in a structural sense and in a clinical context.

2

For some specimens, a careful

gross examination is infinitely superior to the examination of random microscopic sections taken
from that specimen. Therefore, books and atlases that display in an optimal fashion the features of
these specimens are crucial to the specialty, and I dare say they will remain so long after the genetic

background of all human diseases has been determined. Alas, it is not easy to produce such a

work. First of all, it takes a place that handles a wide range of specimens in order to select those
that are most representative of the conditions being depicted. Secondly, it needs a prosecutor who

handles those specimens, as Arthur Hertig once put it, 'with loving care'. Thirdly, it takes a
photographer who is not only technically skilled but who also has an aesthetic feeling for those

specimens. Unfortunately, these desiderata are rarely found together. Regarding the latter aspect, it

has been stated in frustration that '[gross] photographs are often not taken, or, when taken, they are
[often] not useful because of underexposure, overexposure, inappropriate lighting, poor selection of
background, or blood-stained or blood-smeared backgrounds'.

3I

have learned the truth of this

statement the hard way when searching the photography archives of one pathology department or
another for good pictures for my Surgical Pathology book, only to discard nine out of ten of those

pictures because of those very reasons.

It was therefore with great pleasure, admiration and a touch of envy that I looked at the remarkable

collection of photographs that Dr Robin Cooke has been able to assemble in this Atlas. The

V


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