I hope this book will become a well-thumbed resource for those first learning liver pathology and those more experienced who have a specific question while looking at a liver biopsy. I very much enjoy liver pathology and have a fine collection of liver pathology books. All have strengths, and some are truly excellent. I can easily tell which books I have found most practical and useful over the years by their dog-eared pages and well-creased spines, and it is my hope that this book will appear similar, after some time on your shelf.A\This edition was preceded by two excellent editions authored by Stephen Geller and Lydia Petrovic. They set the bar high! I hope this current edition continues in the fine tradition they set forward.A\In my own training in liver pathology, which I suppose never really ends, I have greatly benefited by excellent teachers and colleagues. These include faculty then at the University of Pittsburgh Medical Center—Jake Demetris, Mike Nalesnik, Parmjeet Randhawa, and Tong Wu—and faculty then at Johns Hopldns Hospital—John Boitnott and Bob Anders. Many liver biopsies benefit from being shared with colleagues and trainees, shared because they are hard, shared because they are interesting, or shared because they have a teaching point. Opportunities for sharing, when taken, strengthen both parties and improve patient care. I am grateful for the many cases shared with me by these outstanding teachers and colleagues. Thanks also to the pathologists who have sent consults over the years. It has been a privilege to review them, and I have learned much from interacting with pathology and clinical colleagues around the world.A\I am also indebted through my association with the many outstanding liver pathologists who are members of the Laennec Society and the Gnomes, powerful intellects and great company, from which I have greatly benefjtted.A\Finally, my thanks to Norm Barker, a friend and colleague in the specialty of medical illustration, who helped with many of the images and whose commitment to excellence in medical illustration is greatly appreciated. Michael Torbenson, MD

Preface v

1 General Approach to Biopsy Assessment 1

2 General Approach to Biopsy Reports 8

3 The Almost Normal Liver Biopsy 11

4 Liver Injury Patterns 21

5 Acute and Chronic Viral Hepatitis 57

6 Other Infections of the Liver 91

7 Granulomatous Disease 99

8 Drug Effects 120

9 Fatty Liver Disease 147

10 Autoimmune Hepatitis 171

11 Biliary Tract Disease and Cholestatic Liver Disease 188

12 Pediatric Cholestatic Liver Disease 217

13 Vascular Disease 240

14 Transplant Pathology 263

15 Iron Overload Disease 299

16 Wilson Disease and Other Genetic Diseases 321

17 Liver Disease in Systemic Conditions 345

18 Pediatric Benign and Malignant Tumors 369

19 Adult Benign and Malignant Mesenchymal Tumors 390

20 Benign and Malignant Hepatocellular Tumors 410

21 Benign and Malignant Biliary Tumors 455

22 Other Tumors of the Liver 473

Appendix: The Language of Liver Pathology: Definitions of Key Terms 478

Index 503

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