Atlas of Liver Pathology E-Book , livre ebook

Atlas of Liver Pathology
Third Edition

Gary C. Kanel, M.D.
Professor of Clinical Pathology, Keck School of Medicine, University of Southern California
Associate Pathologist, Los Angeles County + USC Medical Center and USC University Hospital, Los Angeles, California

Jacob Korula, M.D.
Comprehensive Liver Disease Center, St. Vincent Medical Center, Los Angeles, California
Copyright © 2011, Elsevier Inc.
Saunders
Front Matter

Atlas of Liver Pathology
Third Edition
Gary C. Kanel, M.D.
Professor of Clinical Pathology, Keck School of Medicine, University of Southern California
Associate Pathologist, Los Angeles County + USC Medical Center and USC University Hospital, Los Angeles, California
Jacob Korula, M.D.
Comprehensive Liver Disease Center, St. Vincent Medical Center, Los Angeles, California
Copyright

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ATLAS OF LIVER PATHOLOGY THIRD EDITION ISBN: 978-1-4377-0765-6
Copyright © 2011, 2005, 1992 by Saunders, an imprint of Elsevier Inc.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notice
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Library of Congress Cataloging-in-Publication Data
Kanel, Gary C.
Atlas of liver pathology/Gary C. Kanel, Jacob Korula. -- 3rd ed.
p.; cm.
Liver pathology
Includes bibliographical references and index.
ISBN 978-1-4377-0765-6 (hardcover: alk. paper)
1. Liver--Diseases--Atlases. I. Korula, Jacob. II. Title. III. Title:
Liver pathology.
[DNLM: 1. Liver Diseases--pathology--Atlases. 2. Biopsy--Atlases. 3. Diagnosis, Differential--Atlases. WI 17]
RC846.9.K35 2011
616.3’62--dc22
2010034856
Executive Publisher: William Schmitt
Senior Developmental Editor: Andrew Hall
Publishing Services Manager: Patricia Tannian
Senior Project Manager: Kristine Feeherty
Design Direction: Steven Stave
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
To our families who support us and our colleagues who teach us much
Preface
Although over a decade passed between the publication of the first and second editions of the Atlas of Liver Pathology, the rapid development in understanding the pathophysiologic concepts of diseases and identifying variations in morphologic features of these diseases necessitates a third edition over a much shorter time span.
The new diagnostic tools leading to more sophisticated laboratory testing have been a hallmark in learning the etiology and pathophysiology of diseases. Where before morphologic changes were ascribed to various liver disorders without a good understanding of their significance, the advent of new testing procedures such as genome sequencing much better helps us understand what we see under light microscopy. An excellent example is the ongoing research in liver tumors that examines cellular signaling pathways and molecular profiling, identifies individual genes and gene groups associated with higher instances of the development of hepatocellular carcinoma in cirrhotic livers, and correlates all of the above with the morphology seen in liver biopsy specimens.
The changes in the updated third edition include the use of gross images of various liver diseases with direct correlation with the light microscopy. In addition, the total number of images has increased by approximately 50% from the second edition. What has also been added is a second section addressing specific morphologic changes in table format and listing the various liver diseases associated with these changes. This section, which has been updated from our previous book, Liver Biopsy Evaluation, specifically aids the reader in arriving at diagnoses and differential possibilities solely on morphology, then referring the reader to the text and images of the specific diseases in the first part of the book.
We hope that this new edition will be successful in providing pathologists, clinicians, and students a better understanding of liver pathology and disease concepts and will be a useful practical tool. The overall aim does not change from the previous editions: to offer a concise illustrative text in liver and hepatobiliary pathology.

Gary Kanel, M.D.

Jacob Korula, M.D., Los Angeles, California
Table of Contents
Front Matter
Copyright
Dedication
Preface
Part I: Liver and Hepatobiliary Pathology with Clinical Correlations
Chapter 1: General Aspects of the Liver and Liver Diseases
Chapter 2: Viral Hepatitis
Chapter 3: Cholestasis and Biliary Tract Disorders
Chapter 4: Alcoholic and Non-Alcoholic Fatty Liver Diseases
Chapter 5: Drug- and Toxin-Induced Liver Cell Injury
Chapter 6: Vascular Disorders
Chapter 7: Infectious Disorders, Non-Viral
Chapter 8: Developmental, Familial, and Metabolic Disorders
Chapter 9: Diseases of Hepatic Iron and Copper Metabolism
Chapter 10: Neoplasms and Related Lesions
Chapter 11: Transplantation
Chapter 12: Miscellaneous Conditions
Part II: Liver Biopsy Evaluation: Morphology with Differential Diagnoses
Chapter 13: Introduction
Chronic Liver Diseases: Staging and Grading Systems
Index
Part I
Liver and Hepatobiliary Pathology with Clinical Correlations
Chapter 1 GENERAL ASPECTS OF THE LIVER AND LIVER DISEASES

THE NORMAL LIVER 3
Embryology 3
Gross Anatomy 3
Microanatomy 5
STEM CELLS 9
COMMON PIGMENTS 11
SYSTEMATIC APPROACH IN LIVER BIOPSY INTERPRETATION 12
GENERAL CLINICAL CONSIDERATIONS OF ACUTE AND CHRONIC LIVER DISEASES 12
Acute Hepatic Injury 12
Chronic Hepatic Injury 15

The Normal Liver

Embryology
( Figs 1-1 through 1-5 )
1. The hepatic primordium anlage first appears toward the end of the third week of gestation as a hollow midline outgrowth of the endodermal epithelium (hepatic diverticulum) .
2. Eventually the diverticulum enlarges (proliferation of hepatoblasts) , projects cranially into the mesoderm of the septum transversum, and eventually develops into the hepatic parenchyma.
3. The proliferating endodermal cells form solid anastomosing cords, vesicles, and cribriform tubules that form luminal structures (precursor of the biliary canaliculi).
4. The hepatoblasts (progenitor cells) by way of rapid growth eventually develop into hepatic cords that initially are thickened at birth (muralium multiplex) but eventually evolve into trabeculae one cell thick (muralium simplex) , with those cords adjacent to the portal mesenchyme becoming the ductal plates . These progenitor cells also can generate into both mature hepatocytes and ductules, and they can express markers of both ( α-fetoprotein for liver cells and cytokeratins 7 and 19 for duct epithelium).
5. The mesoderm of the septum transversum forms the lesser omentum, falciform, coronary and triangular ligaments, and hepatic (Glisson’s) capsule.
6. The vascular network , derived from the vitelline and umbilical veins, occurs at the same time as the proliferation of the hepatoblasts, with the cords and vessels anastomosing and forming the hepatic sinusoids.
7. By the fifth week, most of the major vessels (right and left umbilical veins, transverse portal sinus, ductus venosus, portal vein) are identified.
8. The biliary system develops from membranous infoldings occurring between the junctional complexes between individual hepatoblast