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Differential diagnosis in pathology: Liver disorders
GASTROENTEROLOGY 1995;109:1716-1718
BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor
Mayo Foundation 200 First Street S.W. Rochester, Minnesota 55905
Differential Diagnosis in Pathology: Liver Disorders. Edited by Swan N. Thung and Michael A. Gerber. 180 pp. $79.50. Igaku-Shoin Medical Publishers Inc., New York, New York, 1995. ISBN 0-89640-268-1. Pathologists can now choose between a dozen or so books and atlases on liver biopsy interpretation. The market may appear to be saturated, yet this latest arrival, authored by two well-known experts in the field, is a welcome addition because it uses a new and imaginative approach to hepatic morphology by concentrating on the differential diagnosis between liver diseases that share morphological features but differ profoundly in etiology and indications for treatment. The book is the second volume of a series entitled Differential Diagnosis in Pathology, edited by Jonathan I. Epstein. The book has sections on acute liver disorders, chronic liver diseases, transplant pathology, focal and neoplastic lesions, and pediatric conditions, followed by a bibliography and index. The authors made no attempt to be complete, but they skillfully selected pairs of conditions that are not always easy to distinguish. Most of them are common; for example, cholestatic hepatitis vs. large bile duct obstruction, alcoholic vs. nonalcoholic steatohepatitis, autoimmune hepatitis vs. chronic hepatitis C, cellular rejection vs. biliary tract complications in allografts, adenocarcinoma vs. proliferating bile ductules, or neonatal hepatitis vs. paucity of intrahepatic bile ducts. Some of these conditions cannot be distinguished reliably without clinical information, but pathologists will be grateful for the many helpful hints that are difficult to find in other texts. Although some liver diseases such as massive necrosis in acute viral hepatitis or shock are not commonly found in biopsy specimens, they often are found in autopsy material where similar diagnostic dilemmas may arise. Many conditions are discussed in more than one chapter because they needed to be compared with more than one disease. Thus, more than one illustration can be found of important findings, for example, the florid duct lesion. Each pair of conditions is described in a brief text and illustrated in black and white. Figures are selected with care, and they are of good quality throughout. The figure legends are clear and pertinent. The text follows a uniform format, describing clinical features, histology, prognosis, and therapy. Obviously, histology receives the greatest emphasis. Macroscopic and electron-microscopic findings are mentioned in a few instances that appeared important. This is more an atlas than a textbook and, thus, readers should expect only the briefest possible information on clinical findings and prognosis or therapy. Indeed, this may lead to confusion, for example, when the authors state (page 39) that chronic hepatitis C is
often benign, referring undoubtedly to the short-term prognosis, or when they state that hepatic granulomas are always part of a systemic disease (page 108). The text in each chapter does not always fit on one page, and to keep the illustrations in juxtaposition, some text is completed much later at the end of the section. However, this is a small price to pay for the opportunity to study the illustrations in such a convenient way. The text is not referenced, but readers find pertinent literature for each chapter in the bibliography at the end of the book. A good index is provided. Obsolete terms such as chronic active hepatitis are still part of the text, but the authors have provided a table that should guide pathologists to the current terminology of chronic hepatitis. Some comparisons seem a bit contrived, for example, acute viral hepatitis vs. alcoholic hepatitis, chronic hepatitis vs. &l-antitrypsin deficiency, or Dubin-Johnson syndrome vs. atrophy of the liver. The first two pairs generally are easy to classify, and the need to distinguish between the latter two diagnoses is exceedingly rare. Also, the text could be made a bit more user-friendly by inserting tables with comparisons of the salient features. But I am quibbling here; the authors have reached the aim of the book very well, and practicing pathologists as well as anyone interested in liver pathology will benefit from this volume. JURGEN LUDWIG, M.D.
Mayo Clinic Rochester, Minnesota
Drug-Induced Liver Disease. Edited by Geoffrey C. Farrell. 673 pp. $159.00. Churchill Livingstone Inc., New York, New York, 1994. ISBN 0-443-04368-X. Hepatotoxcitity, we are informed by Dr. Geoffrey Farrell in this splendid new book, accounts for a relatively small proportion of all cases of identified liver disease. In several surveys performed in the late 1960s and early 1970s, drug-induced liver disease was found to represent 2 % - 5 % of all hospital admissions for jaundice. More recently, in a Danish study, viral hepatitis was found to be five times as common a basis for hospital admission as was adverse hepatic reactions to drugs. Yet, for the practicing gastroenterologist and especially the hepatologist, the issue of hepatotoxicity looms far larger than these figures would suggest because drug-related liver disease represents one of the most common reasons for consultation. Indeed, the problem continues to grow as the pharmacological armamentarium expands almost logarithmically and particularly as multidrug administration for patients with life-threat-
BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor
Mayo Foundation 200 First Street S.W. Rochester, Minnesota 55905
Differential Diagnosis in Pathology: Liver Disorders. Edited by Swan N. Thung and Michael A. Gerber. 180 pp. $79.50. Igaku-Shoin Medical Publishers Inc., New York, New York, 1995. ISBN 0-89640-268-1. Pathologists can now choose between a dozen or so books and atlases on liver biopsy interpretation. The market may appear to be saturated, yet this latest arrival, authored by two well-known experts in the field, is a welcome addition because it uses a new and imaginative approach to hepatic morphology by concentrating on the differential diagnosis between liver diseases that share morphological features but differ profoundly in etiology and indications for treatment. The book is the second volume of a series entitled Differential Diagnosis in Pathology, edited by Jonathan I. Epstein. The book has sections on acute liver disorders, chronic liver diseases, transplant pathology, focal and neoplastic lesions, and pediatric conditions, followed by a bibliography and index. The authors made no attempt to be complete, but they skillfully selected pairs of conditions that are not always easy to distinguish. Most of them are common; for example, cholestatic hepatitis vs. large bile duct obstruction, alcoholic vs. nonalcoholic steatohepatitis, autoimmune hepatitis vs. chronic hepatitis C, cellular rejection vs. biliary tract complications in allografts, adenocarcinoma vs. proliferating bile ductules, or neonatal hepatitis vs. paucity of intrahepatic bile ducts. Some of these conditions cannot be distinguished reliably without clinical information, but pathologists will be grateful for the many helpful hints that are difficult to find in other texts. Although some liver diseases such as massive necrosis in acute viral hepatitis or shock are not commonly found in biopsy specimens, they often are found in autopsy material where similar diagnostic dilemmas may arise. Many conditions are discussed in more than one chapter because they needed to be compared with more than one disease. Thus, more than one illustration can be found of important findings, for example, the florid duct lesion. Each pair of conditions is described in a brief text and illustrated in black and white. Figures are selected with care, and they are of good quality throughout. The figure legends are clear and pertinent. The text follows a uniform format, describing clinical features, histology, prognosis, and therapy. Obviously, histology receives the greatest emphasis. Macroscopic and electron-microscopic findings are mentioned in a few instances that appeared important. This is more an atlas than a textbook and, thus, readers should expect only the briefest possible information on clinical findings and prognosis or therapy. Indeed, this may lead to confusion, for example, when the authors state (page 39) that chronic hepatitis C is
often benign, referring undoubtedly to the short-term prognosis, or when they state that hepatic granulomas are always part of a systemic disease (page 108). The text in each chapter does not always fit on one page, and to keep the illustrations in juxtaposition, some text is completed much later at the end of the section. However, this is a small price to pay for the opportunity to study the illustrations in such a convenient way. The text is not referenced, but readers find pertinent literature for each chapter in the bibliography at the end of the book. A good index is provided. Obsolete terms such as chronic active hepatitis are still part of the text, but the authors have provided a table that should guide pathologists to the current terminology of chronic hepatitis. Some comparisons seem a bit contrived, for example, acute viral hepatitis vs. alcoholic hepatitis, chronic hepatitis vs. &l-antitrypsin deficiency, or Dubin-Johnson syndrome vs. atrophy of the liver. The first two pairs generally are easy to classify, and the need to distinguish between the latter two diagnoses is exceedingly rare. Also, the text could be made a bit more user-friendly by inserting tables with comparisons of the salient features. But I am quibbling here; the authors have reached the aim of the book very well, and practicing pathologists as well as anyone interested in liver pathology will benefit from this volume. JURGEN LUDWIG, M.D.
Mayo Clinic Rochester, Minnesota
Drug-Induced Liver Disease. Edited by Geoffrey C. Farrell. 673 pp. $159.00. Churchill Livingstone Inc., New York, New York, 1994. ISBN 0-443-04368-X. Hepatotoxcitity, we are informed by Dr. Geoffrey Farrell in this splendid new book, accounts for a relatively small proportion of all cases of identified liver disease. In several surveys performed in the late 1960s and early 1970s, drug-induced liver disease was found to represent 2 % - 5 % of all hospital admissions for jaundice. More recently, in a Danish study, viral hepatitis was found to be five times as common a basis for hospital admission as was adverse hepatic reactions to drugs. Yet, for the practicing gastroenterologist and especially the hepatologist, the issue of hepatotoxicity looms far larger than these figures would suggest because drug-related liver disease represents one of the most common reasons for consultation. Indeed, the problem continues to grow as the pharmacological armamentarium expands almost logarithmically and particularly as multidrug administration for patients with life-threat-