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Liver Biopsy Evaluation. Histological Diagnosis and Clinical Correlations. GC Kanel, J Korula (Pp 255; illustrated). Philadelphia: WB Saunders Company.
Interpretation of liver biopsy findings depends very much on clinicopathological correlation. In some cases, a liver biopsy may be taken in order to reach a primary diagnosis. In other cases, for example a patient with chronic hepatitis C infection, a diagnosis may already have been made and the biopsy is taken for other reasons, in this instance to assess the necroinflammatory grade and fibrosis stage.
This book, which is written by a pathologist (Gary C Kanel) and a physician (Jacob Korula), provides a practical approach to the assessment of liver biopsies and the correlation of histological changes with relevant clinical findings. The book begins by describing a method for the systematic evaluation of changes involving the main components of the liver. The person assessing a liver biopsy specimen is then invited to identify a number of main “morphological landmarks” in the specimen (for example, portal hepatitis with plasma cells and bile duct paucity), for which tables listing possible causes are provided. Having thus identified a number of possible diagnoses (acute rejection of liver allograft, autoimmune cholangitis, Hodgkin's lymphoma, primary biliary cirrhosis, primary sclerosing cholangitis, and viral hepatitis type C are all listed as possible causes of the two features listed above), the reader is referred to brief summaries of the main histological and clinical features of diseases included in the differential diagnosis, in the hope that a definite diagnosis can be made.
The main strength of this book lies in the comprehensive lists it provides of possible causes of the main patterns of damage identified. A large number of illustrations, mostly colour and generally of good quality, are also included. Using this approach should enable the pathologist assessing a liver biopsy specimen to suggest a number of likely diagnoses. Depending on clinical information provided either at the time of biopsy or subsequently, it should be possible to make a specific diagnosis in most cases.
For some of the morphological landmarks identified, the lists of possible causes are so long that their practical value is limited—for example, some 80 causes of “lobular necrosis with inflammation” are listed. The experienced liver pathologist would soon recognise that many of the examples listed are not relevant to the case being assessed but this may not be so easy for the less experienced person. There are also a number of instances where conditions are inappropriately included as possible causes for a particular pattern of damage—for example, right sided heart failure and veno-occlusive disease are listed as causes of portal fibrosis whereas these are both more typically associated with parenchymal fibrosis. There are also a few occasions on which one might quibble with the terminology used—for example, the term “piecemeal necrosis” is used rather than the now preferred “interface hepatitis”, “adenomatous hyperplasia” rather than “dysplastic nodule”, and autoimmune cholangitis is regarded as a variant of autoimmune hepatitis whereas most people now consider this to be a form of AMA negative primary biliary cirrhosis.
For pathologists with little experience of looking at liver biopsies, this book should serve as a useful practical introduction to liver biopsy interpretation. The more experienced liver pathologist faced with a difficult specimen may find the lists of differential diagnoses useful on occasions. Those seeking a more detailed understanding of liver pathology and pathogenetic mechanisms will still wish to have access to one of the larger standard liver pathology texts as a reference manual.
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