Familial gliomas

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Familial Gliomas

these two tumours were very similar, with gemistiocytic and fibrillary tumour cells. The mother proceeded to receive 6200 cGy in 39 fractions over seven weeks. Although an increased risk of gliomas in relatives of affected patients has been proposed, familial astrocytomas are rare, with only about 20 cases reported and none with such a long latency of 14-15 years. This makes an environmental causation less likely than genetic factors. Understanding how such families are predisposed may prove an effective way of finding out more about the causes of cancer in general and provide information about the relative roles of environmental and genetic causation of gliomas in particular.

SIR - The occurrence of brain tumours in more than one member of a family is rare. We would like to report the instance of highgrade gliomas in a mother and daughter with an interval of 14 years between presentations. In 1975 a 15-year-old girl presented with focal epilepsy and raised intracranial pressure associated with a mild left hemiparesis. A CT scan demonstrated an infiltrative tumour in the region of the corpus callosum extending into the frontal lobes and right hemisphere. This was debulked and proved to be a grade III astrocytoma. Postoperatively she received 4500 R in 18 fractions over 42 days but she soon deteriorated and died within 6 months. In 1989 the girl's mother presented with ataxia and vertigo and acutely with meningism. CSF was haemorraghic and CT showed a cerebellar tumour which had bled into the ventricles and was associated with a haematoma. A complete removal of a grade III glioma was performed. Histologically the appearances of

C. P. LOWDELL M. QUIGLEY M. G. GLASER

Department of Radiotherapy Charing 'Cross Hospital Fulham Palace Road London W6 8RF

Book Reviews

Tumour of the Female Lower Genital Tract by Ranadhir Barua.

Springer-Verlag, Heidelberg, 1990. Pages: 409, Illustrations: 141, Price: DM298.00. This book has an unusual approach in that it aims to provide a comprehensive classification and description of the pathological and related clinical features of all benign, pseudomalignant and malignant tumours of the vulva, vagina and female urethra. Thus for the vulva, which comprises two-thirds of the book, sections include cysts of epidermis and adnexa, developmental cysts and tumours, lymphomas, neuroendocrine tumours, germ cell tumours and inflammatory conditions which may simulate tumours. The section on vagina occupies most of the remaining one-third, with 16 pages on urethral tumours. The information is presented systematically within numbered sections and subsections, and the style is concise and factual, but without critical analysis. The accounts of each tumour, including the rarest, are detailed and comprehensively referenced, and information on staging, grading, prognostic factors, survival and management is given for major tumour types. The references mostly go up to 1986, with a few from 1987, but some sections quote only earlier literature, and overall the book is a little out of date since so many developments in pathology have taken place in the last five years; this may reflect the difficulties of sole authorship. Although the section subnumbering becomes focally complex, the system is usuble and the text is clear with few printing errors. There is no separate alphabetical index, so the reader must become familiar with the sequence of the book as detailed in the contents. For the diagnostic histopathologist the photomicrographs are not of the best quality and there is insufficient discussion of differential diagnosis, particularly for pseudomalignant lesions, so that the larger textbooks of gynaeeological pathology will still be required. These are, however, relatively inaccessible (and perhaps user-unfriendly) to the clinical oncologist and gynaecologist who need a convenient summary of the nature of the often rare tumours which they will occasionally encounter, particularly in referral centres. In this book, a considerable amount of practical information has been brought together in an organized way, and it should prove of value to those who manage tumours of this area, including dermatologists and urologists. C. FISHER

Surgical Oncoiogy Edited by C. S. McArdle. Butterworths, London, 1990. Pages: 332. £55.00. This book provides a well written, comprehensive review of major problems in surgical oncology. The individual reviews are balanced, well referenced and up to date. The book would be very useful to the surgeon in training and also to the trained surgical oncologist as a source of reference. The balance of the book may have been helped by inclusion of a section on terminal care. Rightly the author includes sections on chemotherapy and recent advances but since sadly over 50% of patients with 'surgical' cancers die of their cancer and the majority of these deaths occur in hospital terminal care is very much an every day duty of the surgical oncologist. A small section to talk about the training of the surgical oncologist to include details of relevant societies, clinical trial centres and future Royal College plans for specialist training would have been useful if perhaps a little controversial. In the very detailed review of gastric cancer the contributor does not acknowledge that the majority of patients in the United Kingdom are elderly and most operations palliative. The chapter on breast cancer does not include or emphasize the role of the surgeon in the national breast screening programme. Details concerning needle localization, assessment clinics, quality control and amount of time required would have been useful. There is no mention of hormone replacement therapy - a currently much discussed topic and one which patients often ask advice on. The melanoma chapter fails to include reference to the role of education. I was disappointed to see little reference to paediatric orthopaedics in the long section on bone and soft tissue. I welcome a textbook on surgical oncology a sadly neglected area. R. KINGSTON

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