Enzinger and Weiss’s Soft Tissue Tumors

Cancer has enormous diversity and behaves differently: it’s highly mutable, the evolutionary principles are very complicated and often its capacity to be constantly mystifying comes as a big challenge. —Siddhartha Mukherjee in The Emperor of All Maladies Perhaps cancer of no other site is more mystifying or challenging to pathologists than that of the soft tissues. Over the least 4 decades, through 6 earlier editions, pathologists (and clinicians) have turned to Enzinger and Weiss’s Soft Tissue Tumors to demystify the extensive and evolving spectrum of soft tissue tumors. The latest iteration of this opus is more than likely to remain the most comprehensive and authoritative salve available on the topic. Of course, only comprehensive and authoritative textbooks can be trusted with soft tissue tumors. Per conventional wisdom, only a few such tumors are facile, plenty are perplexing, and some are impossible. Enzinger and Weiss’s Soft Tissue Tumors describes key facts in simple memorable nuggets, for example, “some vascular tumors do not have a hemorrhagic appearance,” “sarcomas lack a true capsule,” and so forth. Even significant points are elaborated upon in plain language—for example, regarding reactive lesions, “although mitotic figures may be numerous, important negative observations include absence of atypical mitotic figures or nuclear atypia, as one would expect in a sarcoma,” and “there are no markers or combinations of markers that will reliably distinguish benign from malignant tumors (for example nodular fasciitis from leiomyosarcoma).” Complex concepts such as those of “ungradable” sarcomas and “managerial” management are deftly described. Little-known pointers are abundantly shared (eg, “lymphoblastic lymphomas may be CD45 negative”). Useful practical caveats are shared: “CD31 is the single best screening marker to assess for endothelial differentiation in tumors,” “embryonal rhabdomyosarcoma occurs almost exclusively in young individuals,” and the like. One is alerted to pitfalls such as “punctate keratin staining from exogenous keratin (dandruff).” Updated therapeutic practices are plainly outlined, such as “treatment of primary GIST is surgical, and treatment of recurrent/metastatic GIST is primarily based on targeting oncogenic KIT and PDGFRA mutant proteins.” Intriguing lesions such as “biker’s nodule” are incorporated. Genetic characterization (commonly known as molecular pathology) of tumors, an area that is growing exponentially, is as updated as possible in a published book. In sum, this book is all-inclusive. Enzinger and Weiss’s Soft Tissue Tumors is now authored by an academically formidable team of a dozen or so authorities, led by Drs. Goldblum, Folpe, and (the eponymous) Weiss. The introductory chapter to this edition states, “There seems to be an upward trend in the incidence of soft tissue sarcomas, but it is not clear whether this represents a true increase or reflects better diagnostic capabilities and greater interest in this type of tumor.” It would be safe to say that the authors have only themselves to blame if there is any truth to the latter 2 possibilities.