Table Of ContentAnthony W.H. Chan
Alberto Quaglia
Beate Haugk
Alastair Burt
Atlas of
Liver Pathology
123
Atlas of Anatomic Pathology
Series Editor
Liang Cheng
For further volumes:
http://www.springer.com/series/10144
Anthony W.H. Chan (cid:129) Alberto Quaglia
Beate Haugk (cid:129) Alastair Burt
Atlas of Liver Pathology
Anthony W.H. Chan, BMedSc, MBChB, FRCPA, Alberto Quaglia, MD, PhD, FRCPath
FHKCPath, FHKAM (Pathology) Institute of Liver Studies
Prince of Wales Hospital King’s College Hospital
The Chinese University of Hong Kong Denmark Hill, London
Hong Kong UK
Beate Haugk, MD, FRCPath Alastair Burt, BSc(Hons), MBChB, MD(Hons),
Department of Cellular Pathology FRCP, FSB
Royal Victoria Infi rmary School of Medicine
Newcastle upon Tyne The University of Adelaide
UK Adelaide
Australia
ISBN 978-1-4614-9113-2 ISBN 978-1-4614-9114-9 (eBook)
DOI 10.1007/978-1-4614-9114-9
Springer New York Heidelberg Dordrecht London
© Springer Science+Business Media New York 2014
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Series Preface
One Picture Is Worth Ten Thousand Words
– Frederick Barnard, 1927
Remarkable progress has been made in anatomic and surgical pathology during the last 10
years. The ability of surgical pathologists to reach a defi nite diagnosis is now enhanced by
immunohistochemical and molecular techniques. Many new clinically important histopatho-
logic entities and variants have been described using these techniques. Established diagnostic
entities are more fully defi ned for virtually every organ system. The emergence of personalized
medicine has also created a paradigm shift in surgical pathology. Both promptness and preci-
sion are required of modern pathologists. Newer diagnostic tests in anatomic pathology, how-
ever, cannot benefi t the patient unless the pathologist recognizes the lesion and requests the
necessary special studies. An up-to-date Atlas encompassing the full spectrum of benign and
malignant lesions, their variants, and evidence-based diagnostic criteria for each organ system
is needed. This Atlas is not intended as a comprehensive source of detailed clinical information
concerning the entities shown. Clinical and therapeutic guidelines are served admirably by a
large number of excellent textbooks. This Atlas, however, is intended as a “fi rst knowledge
base” in the quest for defi nitive and effi cient diagnosis of both usual and unusual diseases.
The Atlas of Anatomic Pathology is presented to the reader as a quick reference guide for
diagnosis and classifi cation of benign, congenital, infl ammatory, nonneoplastic, and neoplastic
lesions organized by organ systems. Normal and variations of “normal” histology are illus-
trated for each organ. The Atlas focuses on visual diagnostic criteria and differential diagnosis.
The organization is intended to provide quick access to images and confi rmatory tests for each
specifi c organ or site. The Atlas adopts the well-known and widely accepted terminology,
nomenclature, classifi cation schemes, and staging algorithms.
This book Series is intended chiefl y for use by pathologists in training and practicing surgi-
cal pathologists in their daily practice. It is also a useful resource for medical students, cyto-
technologists, pathologist assistants, and other medical professionals with special interest in
anatomic pathology. We hope that our trainees, students, and readers at all levels of expertise
will learn, understand, and gain insight into the pathophysiology of disease processes through
this comprehensive resource. Macroscopic and histological images are aesthetically pleasing
in many ways. We hope that the new Series will serve as a virtual pathology museum for the
edifi cation of our readers.
Liang Cheng , MD, Series Editor
v
Pref ace
This atlas is designed to be a primer for students and residents and for general pathologists in
the interpretation of liver biopsy histology. The liver is subjected to a wide range of insults but
has a relatively limited repertoire of histopathological changes. Optimal interpretation of liver
biopsy specimens requires accurate recognition of the morphological abnormalities and an
ability to put these into the appropriate clinical context.
We have deliberately not tried to be comprehensive in this atlas but rather sought to cover
an approach to the most common forms of liver disease in which biopsy interpretation remains
an important part of the diagnostic workup or indeed in prognostication. We set the scene with
the fi rst two chapters by covering normal liver and variants and basic patterns of injury. This
forms a basis for a greater understanding of the impact of different disease processes on liver
microarchitecture described in the remaining chapters.
All four of the authors remain fascinated by the changes that can be seen by microscopy in
liver tissues; we hope that our enthusiasm for the subject will rub off on those who read and
use this book. We are each indebted to our respective mentors and to histopathological and
hepatological colleagues who continue to share their interesting and challenging cases with us.
Finally all four authors would like to acknowledge the incredible support of their respective
families during the preparation of this atlas.
Hong Kong Anthony W.H. Chan
London Alberto Quaglia
Newcastle Beate Haugk
Adelaide Alastair Burt
vii
Contents
1 Normal, Variants, and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Normal Liver Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Normal Variants and Artefacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3 Routine Handling and Histochemical Staining. . . . . . . . . . . . . . . . . . . . . . . . . 8
1.4 Ancillary Tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2 General Processes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.1 Infl ammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2 Cellular Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.3 Intracellular/Extracellular Accumulations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.4 Regeneration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.5 Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3 Developmental Abnormalities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.1 Normal Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.2 Fibrocystic Liver Disease and Choledochal Cyst . . . . . . . . . . . . . . . . . . . . . . . 41
3.3 Paucity of Intrahepatic Bile Ducts and Biliary Atresia. . . . . . . . . . . . . . . . . . . 46
3.4 Miscellaneous Anatomic and Vascular Anomalies. . . . . . . . . . . . . . . . . . . . . . 47
4 Metabolic Liver Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.1 Disorders of Iron Metabolism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
4.2 Disorders of Copper Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
4.3 Disorders of Carbohydrate Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
4.4 Endoplasmic Reticulum Storage Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
4.5 Disorders of Amino Acid Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
4.6 Lysosomal Storage Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
4.7 Primary Mitochondrial Hepatopathy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4.8 Disorders of Bile Acid and Bilirubin Metabolism . . . . . . . . . . . . . . . . . . . . . . 66
4.9 Miscellaneous Metabolic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
5 Fatty Liver Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
5.1 Alcoholic Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
5.2 Nonalcoholic Fatty Liver Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
5.3 Focal Fatty Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
6 Viral Liver Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
6.1 Hepatotropic Viral Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
6.2 Grading and Staging of Chronic Viral Hepatitis. . . . . . . . . . . . . . . . . . . . . . . . 91
6.3 Nonhepatotropic Viral Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
7 Nonviral Infectious Liver Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
7.1 Bacterial Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
7.2 Mycobacterial Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
7.3 Rickettsial Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
7.4 Fungal Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
ix
