Atlas of Liver Pathology

Current Histopathology

Consultant Editor Professor G. Austin Gresham, TD, ScD, MD, FRCPath. Emeritus Professor of Morbid Anatomy and Histopathology, University of Cambridge

Volume Twenty-three

LIVER PATHOLOGY SECOND EDITION

By D. G. D. WIGHT Department of Histopathology University of Cambridge Addenbrooke's Hospital Cambridge, UK

Springer-Science+Business Media, B.V.

Copyright

A catalogue record for this book is available from the British Library.

ISBN 978-94-010-4980-1 ISBN 978-94-011-2212-2 (eBook) DOI 10.1007/978-94-011-2212-2

Library of Congress Cataloging-in-Publication Data

© 1993 by D. G. D. Wight Originally published by Kluwer Academic Publishers in 1993 First edition published 1982 as volume 4 in this series (ISBN 0-85200-205-X, M T P Press Ltd.)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers.Springer-Science+Business Media, B.V.

W igh t D. G. D. Atlas of liver pathology / by D.G.D. Wigh t .—2nd ed.

p. cm. — (Current histopathology ; v. 23) Includes bibliographical references and index. ISBN 978-94-010-4980-1 (casebound) 1. L iver—Diseases—Diagnos is—At lases. I. Title. II. Series. [ D N L M : 1. Liver Diseases—pathology—atlases.

2. Liver—pathology—atlases. W1 C U 7 8 8 J B A v . 2 3 1993 / Wl 17 W657a 1993] RC847.W48 1993 616.3 '6207583—dc20 D N L M / D L C for Library of Congress 93-17187

CIP

Contents

Consultant editor's note 7 Foreword 8

1 Liver biopsy 9 2 Viral hepatitis 14 3 Non-hepatotrophic viruses including HIV and

AIDS 23

• Bacterial and fungal inlections 29 5 Liver abscess 34 6 Parasitic infestations 38 7 Chronic hepatitis 43 8 Neonatal and structural disease 53 9 Metabolic and storage disorders 63

10 Drugs and tox ins 68

" Cirrhosis 78 12 Fatty liver 87 13 Alcoholic liver disease 93 ,. Haemochromatosis and iron storage

disorders 98 15 Wilson's disease 104 16 Cholestas is and bil iary obstruction 109 17 Primary biliary cirrhosis 117 18 Circulatory disorders 122 19 Granulomatous disorders 130 20 Gastrointest inal disease 135 21 Systemic d isease 140 22 Benign tumours and tumour- like

condit ions 145 23 Secondary carcinoma. hepatocellular

carcinoma 154 2. Other primary malignant tumou rs 164 25 Lymphoreticular d isease 171 26 Transplantation 176

Index 182

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Current Histopathology Series

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Already published in this series: Volume 1 Atlas 01 Lymph Node Pathology Volume 2 Atlas 01 Renal Pathology Volume 3 Atlas of Pulmonary Pathology Volume 4 Atlas of liver Pathology Volume 5 Atlas of Gynaecological Pathology Volume 6 Atlas of Gastrointestinal Pathology Volume 7 Atlas 01 Breast Pathology Volume 8 Atlas of Oral Pathology Volume 9 Atlas of Skeletal Muscle Pathology Volume 10 Atlas of Male Reproductive Pathology Volume 11 Atlas of Skin Pathology Volume 12 Atlas of Cardiovascular Pathology Volume 13 Alias of Experimental Toxicological Pathology Volume 14 Alias of Serous Fluid Cytopathology Volume 15 Atlas of Bone Marrow Pathology Volume 76 Atlas o f EaL Nose and Throat Pathology Volume 17 Atlas of Fungal Pathology Volume 18 Atlas of Synovial Fluid Cytopathology Volume 79 Tumours of the Mediastinum Volume 20 Atlas 01 Parasitic Pathology Volume 21 Biopsy of Bone in Internal Medicine Volume 22 Paediatric Neoplasia

Other volumes currenfly scheduled in this series include the following titles

Atlas 01 AIDS Pathology

Atlas 01 Bone Tumours

Atlas of Correlative Surgical Neuropathology and Imaging

Atlas of Endocrine Pathology

Atlas of Ocular Pa thology

Atlas of Renal Transplantation Pathology

Atlas of Soft Tissue Pathology

Consultant Editor's Note

At the present time books on morbid anatomy and histopathology can be divided into two broad groups. extensive textbooks ohen wntten primarily for students and monographs on research tOPICS.

This takes no account of the fact that the vast majority of pathologists are involved in an essentially practical field of general d iagnostic pathology providing an importan t service to their cl inical colleagues. Many of these path ­ologists are expected to cover a broad ra nge of discipl ines and even those who remain solel y within the lield of histopathology usually have single and sole responsibi li ty wi thin the hospital for aU this work They may often have no colleagues in the same depanment. In the l ield of histopathology. no less than in other medicallields. there have been extensive and recent advances. not only in new histochemical techniques but also in the type of specimen provided by new surgical procedures.

There is a great need for the provISion of appropriate informat ion for this group. This need has been defmed In the following terms:

, . It should be aimed at the general clin ical pathologist or histopathologist with existing practical tra ining . but should have value for the trainee pathologist.

2. It should concentrate on the practical aspects of histopathology taking account of the new techniques which should be within the compass of the worker in a unit with reasonable facili t ies.

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3. New types of material. e.g. those derived from endo­scopic biopsy should be covered fu lly.

4. There should be an adequate number of illustrat ions on each subject to demonstrate the variation in appear­ance that is encountered .

5. Colour illu strations should be used wherever they aid recognition.

Consultant histopathologists. patholog ists in training . clinicians and medical students will find the second edition of th is popular atlas to be a useful addition to their learning and practice. Expanding knowledge about infective liver disease. disorders associated with new therapeutic agents. autoimmune hepati tis and other topics are dealt with in this new addi tion. Pictures have been added and changed but the basic principles enunciated by the author remain. He emphasizes the increasing importance of clinico ' palhological correlation and the need to try to understand the pathogenetic mechanisms of liver disorders. Medical students and pathologists in trainmg will find this approaCh of great value.

It is a special pleasure 10 introduce a second ed ition in this series of Atlases by a colleague of long standing . The origi nal aim o f the series to produce up - to-date bench manuals for those al the sharp end of histopathology is an achievement that IS being maintained.

G. A. Gresham

Foreword

Although the technique of needle biopsy of the liver was introduced as long ago as 1883 by Paul Ehrlich. it has only come into general use in the last 10-20 years. It is now an accepted procedure in most large general hospi­tals. Concurrently with new advances and interest in liver disease. there have been considerable advances in the design of biopsy needles. Moreover, surgeons and laparo ­scopists are more likely to biopsy the liver under direct vision than in the past. The consequence of these changes has been that increasing demands are being made upon pathologists.

This book is intended for the practising pathologist. the trainee pathologist and for the clinician who performs biopsies of the liver. 11 is designed to provide. with the help of many colour illustrations. a practical guide to histopathological diagnosis of liver disorders. Particular emphasis is placed upon clinicopathological correlation and the need for the pathologist to be in full possession of all the available clinical information for his opinion to be of value.

Whilst it is in no way attempting to compete with larger texts, the book is intended to be more than just an atlas and thus each section includes a brief description of the main clinical and patholog ical features of the subject under discussion . Pathogenetic mechanisms are dis­cussed where these are known and where morphology can contribute to their understand ing. Similarly. although the majority of the illuslfations are of histological prep­arations. macro-photographs are included where these are helpful. It has not been thought necessary to state magnification factors for the micrographs. H&E stain has been used unless specified otherwise.

Where appropriate. attention will also be drawn to the limitations of biopsy. A biopsy represents only a tiny fraction of the liver as a whole and although many diseases are diffuse. the biopsy may not be entirely representative. Amongst our own material. approximately

,

25% of biopSies provide no posit ive diagnosis. despite the fact that a proportion of these patients are subsequently shown to be suffering from primary liver d isease.

Because of the emphasis on clinicopathological corre ­lations and pathogenetic mechanisms, I believe the book w ill also be of use to postgraduates and residents in other branches of medicine. especially those studying for higher examinations. and to senior medical students_

In this new edition, the basic philosophy rema ins the same. but many advances. for example in viral hepatit is. have required that many chapters have had to be rewritten or extensively revised. and many new illustrations have been added.

All illustrations are of sections stained with haematoxy­lin and eosin unless otherwise stated. Magnifications are no longer included since they are now widely recognized as having little or no value.

ACKNOWLEDGEMENTS I am deeply indebted to many people without whose help this book would never have been written. In particular. I am grateful to Dr J anice Anderson for much help and encouragement; to Chris Burton and the late Peter Haslam for the macroscopic photography; to the technical staff of the Department of Histopathology. Addenbrooke's Hospital. for invaluable technical help; to the members of my slide club for sending me numerous sections over many yea rs: to Dr David Ansell. Professor M S R Hutt. Dr Fernando Parad inas. Dr Bernard Portmann and Prof Michel Reynes for letting me have specific sections to photograph (indicated in the re levant sections). to Miss Susen Green for help with typing the manuscript; and f inally to my colleagues in Histopathology and to my family for their tolerance during another long period of gestation.