Liver Pathology

Contents......Page 8
Series Foreword......Page 16
Preface......Page 18
Acknowledgments......Page 20
Contributors......Page 22
1. Acute Hepatitis......Page 24
1.1 Acute Hepatitis With Inflammation-Dominant Pattern......Page 30
1.2 Acute Hepatitis With Bridging Necrosis......Page 32
1.3 Resolving Hepatitis......Page 34
1.4 Nonspecific Reactive Hepatitis......Page 36
2. Acute Liver Failure......Page 38
2.1 Acute Liver Failure With Necrosis-Dominant Injury Pattern......Page 41
3. Autoimmune Hepatitis/Overlap Syndromes......Page 44
3.1 Autoimmune Hepatitis With Bile Duct Injury Versus Primary Biliary Cirrhosis......Page 49
3.2 Autoimmune Hepatitis–Primary Biliary Cirrhosis Overlap Syndrome......Page 53
3.3 Autoimmune Hepatitis–Primary Sclerosing Cholangitis Overlap Syndrome......Page 55
3.4 Chronic Hepatitis C With Autoantibodies Versus Autoimmune Hepatitis......Page 57
3.5 Syncytial Giant Cell Hepatitis......Page 59
4. Fatty Liver Disease......Page 62
4.1 Steatosis With Inflammation Versus Steatohepatitis......Page 64
4.2 Steatohepatitis With Minimal Ballooning......Page 66
4.3 Steatohepatitis Without Activity......Page 68
4.4 Nonalcoholic Steatohepatitis With Moderate/Marked Portal Inflammation......Page 70
4.5 Steatohepatitis With Elevated Serum Iron Indices and Siderosis......Page 75
4.6 Alcoholic Steatohepatitis......Page 77
4.7 Drugs and NAFLD......Page 79
4.8 Microvesicular Steatosis......Page 80
4.9 Pediatric Fatty Liver Disease......Page 81
4.10 Chemotherapy-Associated Steatohepatitis Due to Irinotecan......Page 84
4.11 Subacute Steatohepatitis......Page 87
5. Hepatic Granulomas and Granulomatous Hepatitis......Page 90
5.1 Necrotizing Epithelioid Granulomas......Page 93
5.2 Sarcoidosis......Page 96
5.3 Fibrin Ring Granulomas......Page 100
5.4 Schistosomiasis......Page 102
5.5 Cat Scratch Disease......Page 105
5.6 Chronic Granulomatous Disease......Page 108
6. Cholestasis......Page 112
6.1 Drug-Induced Pure Cholestasis......Page 119
6.2 Bile Ductular Cholestasis Associated With Sepsis......Page 122
6.3 Crohn Disease With Primary Sclerosing Cholangitis......Page 125
6.4 Chronic Large Bile Duct Obstruction of Uncertain Cause......Page 127
6.5 Primary Sclerosing Cholangitis , Exclude Cholangiocarcinoma......Page 130
6.6 Immunoglobin G4–Associated Cholangitis Versus Primary Sclerosing Cholangitis......Page 133
6.7 Hepatolithiasis......Page 136
7. Bile Duct Damage and Ductopenia......Page 140
7.1 Primary Biliary Cirrhosis With Nonspecific Changes and Positive Antimitochondrial Antibody......Page 143
7.2 Antimitochondrial Antibody-Negative Primary Biliary Cirrhosis......Page 146
7.3 Primary Biliary Cirrhosis With Ductopenia......Page 148
7.4 Primary Biliary Cirrhosis With Cirrhosis......Page 151
8. Ductal Plate Malformations and Cystic Diseases of the Liver......Page 154
8.1 Congenital Hepatic Fibrosis Versus Cirrhosis......Page 166
8.2 Caroli Disease/Syndrome Versus Other Cystic Disease......Page 168
8.3 Adult Polycystic Liver Disease Versus Caroli Disease......Page 170
8.4 Choledochal Cyst......Page 172
8.5 Solitary Hepatic Cyst Versus Hydatid Cyst......Page 174
9. Hereditary Hyperbilirubinemias......Page 176
9.1 Dubin-Johnson Syndrome......Page 180
10. Neonatal Cholestatic Liver Disease......Page 182
10.1 Biliary Atresia......Page 187
10.2 Neonatal Hepatitis With Hypopituitarism......Page 190
10.3 Paucity of Intrahepatic Bile Ducts......Page 193
10.4 Neonatal Hepatitis Due to Alpha-1-Antitrypsin Deficiency......Page 195
11. Sinusoidal Dilatation and Congestion......Page 198
11.1 Budd-Chiari Syndrome Versus Biliary Disease......Page 200
11.2 Sinusoidal Obstruction......Page 203
11.3 Veno-Occlusive Disease (Sinusoidal Obstruction Syndrome)......Page 205
11.4 Amyloidosis......Page 207
12. Peliosis Hepatis......Page 210
12.1 Alcoholic Lipopeliosis......Page 211
12.2 Lipopeliosis in Transplanted Donor Livers......Page 212
13.1 Hepatoportal Sclerosis......Page 214
13.2 Portal Vein Thrombosis......Page 216
13.3 Budd-Chiari Syndrome......Page 218
13.4 Regressed Cirrhosis Case......Page 222
14. Clinical and Morphological Spectrum of Liver Diseases in Pregnancy......Page 226
14.1 Recurrent Cholestasis of Pregnancy......Page 228
14.2 Acute Fatty Liver of Pregnancy......Page 230
14.3 Toxemia/HELLP Syndrome......Page 233
15. Drug-Induced Liver Injury......Page 236
15.1 Acetaminophen-Induced Fulminant Liver Failure......Page 240
15.2 Statin-Associated Acute Hepatotoxicity......Page 243
15.3 Drug-Induced Autoimmune Hepatitis......Page 246
15.4 Drug-Induced Cholestatic Hepatitis......Page 249
15.5 Drug-Induced Ductopenia......Page 252
15.6 Methotrexate-Induced Chronic Liver Disease......Page 255
15.7 Liver Injury Due to Total Parenteral Nutrition......Page 258
15.8 Amiodarone-Induced Phospholipidosis......Page 260
15.9 Drug-Induced Microvesicular Steatosis......Page 263
16. Cytoplasmic Globules......Page 266
16.1 Alpha-1-Antitrypsin Deficiency......Page 268
16.2 Alpha-1-Antichymotrypsin Deficiency......Page 272
17. Glycogenic Abnormalities on Liver Biopsy......Page 274
17.1 Glycogenic Hepatopathy......Page 278
17.2 Glycogen in the Liver: Abnormal Versus Normal......Page 280
17.3 Glycogenic Hepatopathy, Cause Uncertain......Page 281
17.4 Glycogenic Hepatopathy, Type II Diabetes......Page 283
17.5 Glycogen Pseudo–Ground-Glass......Page 284
17.6 Smooth Endoplasmic Reticulum Proliferation......Page 286
18. Macrophage Infiltrate......Page 288
18.1 Gaucher Disease......Page 294
18.2 Niemann-Pick Disease......Page 296
19. Approach to Liver Biopsy With Minimal or Nonspecific Histologic Findings......Page 298
19.1 Mild Hepatic Steatosis Versus Ito Cell Lipidosis......Page 301
20. Interpreting Iron in Liver Specimens......Page 304
20.1 Genetic Hemochromatosis......Page 307
20.2 Grading Iron......Page 312
20.3 Hepatic Iron Index......Page 314
20.4 Marked Hepatic Iron but No Genetic Mutation......Page 316
20.5 Iron in the Setting of Chronic Hepatitis C......Page 317
20.6 Neonatal Hemochromatosis......Page 319
21. Wilson Disease......Page 322
21.1 Fulminant Form of Wilson Disease......Page 324
21.2 Chronic Hepatitis Due to Wilson Disease......Page 327
21.3 Cirrhosis With Chronic Hepatitis Consistent With Wilson Disease......Page 328
22. Liver Transplant Pathology......Page 330
22.1 Acute Cellular Rejection......Page 332
22.2 Recurrent Hepatitis C......Page 334
22.3 Acute Cellular Rejection Versus Recurrent Hepatitis C......Page 336
22.4 Late Cellular Rejection Versus Autoimmune Hepatitis Versus Recurrent Hepatitis C......Page 338
22.5 Fibrosing Cholestatic Hepatitis C Versus Biliary Obstruction Versus Adverse Reaction to Medication......Page 342
22.6 Mechanical Biliary Obstruction Versus Chronic Rejection......Page 346
22.7 Chronic Rejection Versus Recurrent Primary Sclerosing Cholangitis Versus Non-PSC Stricture......Page 349
22.8 Zone 3 (Centrilobular) Necrosis......Page 353
22.9 Cytomegalovirus Hepatitis......Page 360
22.10 Graft Versus Host Disease......Page 363
23. Benign Hepatocellular Lesions......Page 366
23.1 Atypical Focal Nodular Hyperplasias on Imaging......Page 370
23.2 Focal Nodular Hyperplasia Versus Inflammatory/Telangiectatic Hepatocellular Adenoma......Page 372
23.3 Hepatocellular Adenoma Subtyping: Inflammatory/Telangiectatic Versus Steatotic Adenoma......Page 374
23.4 Hepatocellular Adenoma Subtyping: Associated Liver Nodules......Page 377
23.5 Hepatocellular Adenoma Subtyping: Inflammatory/Telangiectatic Adenoma......Page 379
23.6 Hepatocellular Adenoma Subtyping: Adenoma With Atypical Features......Page 382
24. Biliary Neoplasms......Page 384
24.1 Bile Duct Adenoma Versus Biliary Hamartoma......Page 388
24.2 Intrahepatic Cholangiocarcinoma Versus Hepatocellular Carcinoma......Page 393
24.3 Cholangiocarcinoma in Association With Von Meyenburg Complexes......Page 396
24.4 Diagnosis of Hilar/Extrahepatic Cholangiocarcinoma......Page 398
24.5 Bile Duct Cystadenoma/Carcinoma Versus Foregut Cyst......Page 401
24.6 Biliary Adenofibroma......Page 404
24.7 Biliary Papillomatosis/Intraductal Cholangiocarcinoma......Page 406
25. Hepatocellular Carcinoma......Page 410
25.1 Well-Differentiated Hepatocellular Carcinoma......Page 417
25.2 Poorly Differentiated Hepatocellular Carcinoma......Page 421
25.3 Early Hepatocellular Carcinoma......Page 426
26. Hepatocellular Carcinoma Variants......Page 430
26.1 Pseudoglandular Hepatocellular Carcinoma Versus Cholangiocarcinoma and Metastatic Adenocarcinoma......Page 432
26.2 Hepatocellular Versus Neuroendocrine Carcinoma......Page 435
26.3 Hepatocellular Carcinoma, Clear Cell Variant......Page 437
26.4 Scirrhous Hepatocellular Carcinoma......Page 440
26.5 Combined Hepatocellular-Cholangiocarcinoma......Page 442
26.6 Diffuse Cirrhosis-Like Hepatocellular Carcinoma......Page 444
26.7 Spectrum of Cytoplasmic Contents in Hepatocellular Carcinoma......Page 446
26.8 Poor Differentiation and Vascular Invasion in Hepatocellular Carcinoma......Page 448
26.9 Pedunculated Hepatocellular Carcinoma......Page 450
26.10 Ablated Hepatocellular Carcinoma......Page 451
27. Metastatic Tumors: Illustration of Immunohistochemical Workup......Page 454
27.1 Hepatocellular Carcinoma Versus Metastatic Adenocarcinoma......Page 459
27.2 Hepatocellular Carcinoma Versus Metastatic Polygonal Cell Tumor......Page 461
28. Hepatoblastoma......Page 464
28.1 Biopsy Diagnosis of Hepatoblastoma......Page 470
28.2 Macrotrabecular Hepatoblastoma Versus Hepatocellular Carcinoma......Page 472
28.3 Small Cell Hepatoblastoma Versus Other Small Round Cell Tumors......Page 475
28.4 Teratoid Hepatoblastoma Versus Malignant Teratoma/Yolk Sac Tumor......Page 478
29.1 Cavernous Hemangioma Variants......Page 480
29.2 Epithelioid Hemangioendothelioma......Page 482
29.3 Hepatic Angiosarcoma......Page 485
29.4 Infantile Hemangioma......Page 488
30. Hematopoietic Tumors of the Liver......Page 492
30.1 Dense Small B-Cell Infiltrate With Reactive Follicles......Page 499
30.2 Diffuse Large B-Cell Infiltrate......Page 503
30.3 Portal Infiltrate With Reed-Sternberg Cells......Page 505
30.4 Polymorphic Lymphoid Infiltrate in a Transplant Patient......Page 508
30.5 Sinusoidal T-Cell Infiltrate......Page 510
30.6 Portal and Lobular Infiltration by Blasts......Page 513
30.7 Portal and Lobular Infiltration by Mature Granulocytes......Page 515
31. Other Infiltrative Neoplasms of Liver......Page 518
31.1 Portal-Based Infiltrative Neoplasm Versus Biliary Disease......Page 519
32.1 Mesenchymal Hamartoma......Page 522
32.2 Embryonal Sarcoma......Page 525
32.3 Angiomyolipoma......Page 528
32.4 Angiomyolipoma, Inflammatory Variant......Page 531
32.5 Malignant Angiomyolipoma—Malignant Perivascular Epithelioid Cell Tumor......Page 533
A. Adequacy of Needle Biopsy......Page 538
B. Grading and Staging......Page 540
C. Special Stains in Liver Biopsy Pathology......Page 544
A......Page 546
B......Page 547
C......Page 548
F......Page 550
H......Page 551
K......Page 554
M......Page 555
N......Page 556
P......Page 557
R......Page 558
T......Page 559
Z......Page 560