Atlas of Liver Pathology

Transcription

1 Atlas of Liver Pathology

2 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.

3 Copyright 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 X, MTP Press Ltd.) A catalogue record for this book is available from the British Library. ISBN ISBN (ebook) DOI / Library of Congress Cataloging-in-Publication Data 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. Wight D. G. D. Atlas of liver pathology / by D.G.D. Wight. 2nd ed. p. cm. (Current histopathology ; v. 23) Includes bibliographical references and index. ISBN (casebound) 1. Liver Diseases Diagnosis Atlases. I. Title. II. Series. [DNLM: 1. Liver Diseases pathology atlases. 2. Liver pathology atlases. W1 CU788JBAv / Wl 17 W657a 1993] RC847.W ' dc20 DNLM/DLC for Library of Congress CIP

4 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 Drugs and toxins 68 " Cirrhosis Fatty liver Alcoholic liver disease 93,. Haemochromatosis and iron storage disorders Wilson's disease Cholestasis and biliary obstruction Primary biliary cirrhosis Circulatory disorders Granulomatous disorders Gastrointestinal disease Systemic disease Benign tumours and tumour-like conditions Secondary carcinoma. hepatocellular carcinoma Other primary malignant tumours Lymphoreticular disease Transplantation 176 Index 182 5

5 Current Histopathology Series 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 of 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 6

6 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 diagnostic pathology providing an importan t service to their cl inical colleagues. Many of these pathologists 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 responsibility within the hospital for au this work They may often have no colleagues in the same depanment. In the lield 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 clinical 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 facilities. 3. New types of material. e.g. those derived from endoscopic biopsy should be covered fully. 4. There should be an adequate number of illustrations on each subject to demonstrate the variation in appearance that is encountered. 5. Colour illustrations should be used wherever they aid recognition. Consultant histopathologists. pathologists in training. clinicians and medical students will find the second edition of this 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 hepatitis 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 original aim of 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 7

7 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 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 pathological features of the subject under discussion. Pathogenetic mechanisms are discussed where these are known and where morphology can contribute to their understanding. 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 positive 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 hepatitis. 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 relevant sections). to Miss Susen Green for help with typing the manuscript; and finally to my colleagues in Histopathology and to my family for their tolerance during another long period of gestation.,