Pathology of Liver Diseases

Book Preface

With all of the advancements in hepatology, including invasive and non-invasive imaging, laboratory tests targeting specific diseases, molecular biology, and genomics, one might think that liver biopsy material in patients with suspected acute or chronic liver diseases or hepatic tumors may not be as necessary in arriving at a specific diagnosis as it was in the past; however, what still persists is an inconsistency oftentimes in the way patients clinically present with laboratory tests and what in fact the biopsy shows. This therefore leads to the continued importance of liver biopsy interpretation. The settings where liver biopsies are especially crucial tools in patient care are numerous, are discussed in more detail in Chapter 1, and include assessing patients who present with clinical signs of acute or chronic liver disease but with normal liver tests, patients with abnormal liver tests inconsistent with the suspected diagnosis (e.g., clinical diagnosis of acute viral hepatitis with an unexpectedly high alkaline phosphatase value), and patients in acute liver failure and those with transaminitis of no known cause. Biopsies are often warranted in the evaluation of various space-occupying lesions when imaging, cultures or fine needle aspirates are not conclusive. Biopsies are often critical in specifically evaluating liver transplant patients where the clinical presentation and liver test abnormalities can hint at any of a whole range of possibilities including acute or chronic rejection, biliary strictures, infections, or recurrent disease, all of which necessitate different treatment approaches. Lastly biopsies also remain the gold standard in the staging and grading of chronic liver diseases to determine the appropriate individual therapies. For all of these reasons, useful reference material, as presented in this book Pathology of Liver Diseases, is most helpful to the pathologist and the patients’ attending physicians in arriving at the diagnosis or best possibilities that fit each individual patient.

Pathology of Liver Diseases uses both book and online material in the presentation of the whole range of liver diseases seen in both the community hospitals as well as academic medical centers. The book in fifteen chapters emphasizes not only the pathology seen in biopsy and surgically resected or transplanted and autopsy material, but also the most pertinent clinical and laboratory findings including epidemiology and the various etiologic and pathophysiologic concepts, imaging when appropriate, and the differential diagnostic possibilities with references.

Furthermore, what significantly adds to the overall usefulness of the book is the online material. An online Library Images that contains over 850 images of the various liver diseases is offered that significantly adds to the over 540 images already in the book. Additional online Tables to those already in the book are added so that the reader can have a more detailed reference to the grading and staging systems of fatty liver diseases, viral and autoimmune hepatitis, and liver transplant rejection. In addition 140 Case Examples from patients seen at the Keck Medical Center of USC as well as from consult case material are presented in PowerPoint format that demonstrate the various ways many of these disease entities present clinically and the pathology seen, including both classic and common examples such as alcoholic hepatitis as well as cases infrequently seen such as progressive familiar intrahepatic cholestasis. Finally, courtesy of Dr. Rick Selby, Professor of Surgery and Chief of Hepatobiliary, Pancreatic Surgery and Abdominal Organ Transplantation at the Keck Medical Center of USC, the PowerPoint presentation Liver Transplantation – Surgical Procedure is also included with photographs from the operating table of the step-by-step process in liver transplantation.

The amount of information targeting the numerous fields of medicine has exponentially increased over recent years. The addition of this book and online material will not only be most valuable in enabling the viewer to have access to the wealth of material in diagnostics but also in gaining a better overall understanding of these hepatic and hepatobiliary disorders.

Gary C. Kanel,
Los Angeles, 2017

Contents
Preface vi
About the companion website viii
Chapter 1 Normal Liver 1
Chapter 2 Viral Hepatitis 24
Chapter 3 Fatty Liver Diseases 50
Chapter 4 Diseases of the Biliary Tract 72
Chapter 5 Non-Viral Infectious Diseases 95
Chapter 6 Granulomatous Hepatitis 123
Chapter 7 Autoimmune Hepatitis 131
Chapter 8 Vascular Disorders 143
Chapter 9 Genetic and Metabolic Hepatic Diseases 162
Chapter 10 Developmental Hepatobiliary Disorders and Cystic Diseases 198
Chapter 11 Drug- and Toxin-Induced Liver Diseases 215
Chapter 12 Liver Transplantation 231
Chapter 13 Hepatic Tumors, Benign 266
Chapter 14 Hepatic Tumors, Malignant 289
Chapter 15 Miscellaneous Hepatic Disorders 337