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Liver Pathology, An Issue of Gastroenterology Clinics of North America, E-Book

Liver Pathology, An Issue of Gastroenterology Clinics of North America, E-Book

Jay H. Lefkowitch

(2017)

Additional Information

Abstract

Dr. Lefkowitch has created a primer on liver pathology for the gastroenterologist that provides depth of clinical coverage in an area not typically covered in depth for gastroenterologists. This issue will provide state-of-the-art reviews in the areas of NAFLD, liver biopsy, liver pathology, hepatitis, and genomics. Articles are specifically devoted to IgG4-related disease and the liver; current concepts in pediatric NAFLD; evaluation of the pediatric liver biopsy; hepatocellular adenomas: morphology and genomics; drug-induced liver injury: the hepatic pathologist’s approach; liver pathology in alpha-1-antitrypsin deficiency; immunohistochemistry in the diagnosis of hepatocellular carcinoma; HIV infection, antiretroviral therapy and liver pathology; autoimmune hepatitis overlap syndromes and liver pathology; current perspectives on the pathology of hepatocellular carcinoma and its variants; hepatitis E virus and the liver: clinical settings and liver pathology; hepatic progenitor cells; and cholangiocarcinoma: current genomics and pathology, to name a few.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Liver Pathology\r i
Copyright\r ii
Contributors iii
EDITOR iii
AUTHORS iii
Contents vii
Preface: Liver Pathology vii
IgG4-related Disease and the Liver vii
Current Concepts in Pediatric Nonalcoholic Fatty Liver Disease vii
Contemporary Evaluation of the Pediatric Liver Biopsy vii
Hepatocellular Adenomas: Morphology and Genomics viii
Drug-induced Liver Injury: The Hepatic Pathologist’s Approach viii
Antibody-Mediated Rejection After Liver Transplant viii
Immunohistochemistry in the Diagnosis of Hepatocellular Carcinoma viii
Human Immunodeficiency Virus Infection, Antiretroviral Therapy, and Liver Pathology ix
Autoimmune Hepatitis Overlap Syndromes and Liver Pathology ix
Morphologic Subtypes of Hepatocellular Carcinoma ix
Hepatitis E Virus and the Liver: Clinical Settings and Liver Pathology\r ix
Hepatic Progenitor Cells: An Update x
Heart Disease and the Liver: Pathologic Evaluation x
GASTROENTEROLOGY\rCLINICS OF NORTH AMERICA\r xi
FORTHCOMING ISSUES xi
September 2017 xi
December 2017 xi
March 2018 xi
RECENT ISSUES xi
March 2017 xi
December 2016 xi
September 2016 xi
Preface:\rLiver Pathology xiii
Erratum xvii
IgG4-related Disease and the Liver 195
Key points 195
INTRODUCTION 195
EPIDEMIOLOGY 197
PATHOPHYSIOLOGY 197
CLINICAL PRESENTATION 200
RADIOLOGIC PRESENTATION 200
SEROLOGY 200
DISEASE 201
SCLEROSING CHOLANGITIS 203
Hepatic and Perihilar Lesions 203
Involvement of the Bile Duct 204
BIOPSY DIAGNOSIS 206
SCLEROSING CHOLANGITIS 206
DIAGNOSTIC ALGORITHM 206
DIFFERENTIAL DIAGNOSIS 207
Primary Sclerosing Cholangitis 207
Follicular Cholangitis 209
Sclerosing Cholangitis with Granulocytic Epithelial Lesions 210
Bile Duct Carcinoma 210
Hepatic Inflammatory Pseudotumor and Inflammatory Myofibroblastic Tumor 210
Granulomatosis with Polyangiitis (Formerly Wegener) 211
Multicentric Castleman Disease 212
TREATMENT 212
REFERENCES 212
Current Concepts in Pediatric Nonalcoholic Fatty Liver Disease 217
Key points 217
PEDIATRIC EPIDEMIOLOGY AND RISK FACTORS 217
NONALCOHOLIC FATTY LIVER DISEASE AS A SPECTRUM OF DISEASE 218
THE ROLE OF LIVER BIOPSY 218
PEDIATRIC DISEASE PROGRESSION 219
HISTOLOGIC FEATURES OF PEDIATRIC FATTY LIVER DISEASE 219
SYSTEMS PROPOSED FOR HISTOLOGIC EVALUATION 222
HISTOLOGIC INSIGHTS INTO PATHOGENESIS 224
TREATMENT AND MANAGEMENT 226
EMERGING THERAPEUTIC TARGETS AND THERAPIES 226
SUMMARY 227
REFERENCES 227
Contemporary Evaluation of the Pediatric Liver Biopsy 233
Key points 233
INTRODUCTION 233
Neonatal Cholestasis 234
HEREDITARY DISORDERS OF BILIRUBIN METABOLISM 239
METABOLIC DISORDERS 240
Disorders of Carbohydrate Metabolism 240
Disorders of Amino Acid Metabolism 244
Disorders of Lipid Metabolism 245
Disorders of Peroxisomes 247
Disorders of the Urea Cycle 247
INBORN ERRORS OF COPPER AND IRON METABOLISM 248
LIVER TUMORS 248
SUMMARY 249
REFERENCES 250
Hepatocellular Adenomas 253
Key points 253
HEPATOCELLULAR ADENOMAS: GENOMICS—THE GENOTYPE CLASSIFICATION 254
HEPATOCELLULAR ADENOMAS: MORPHOLOGY—THE GENOTYPE/PHENOTYPE CLASSIFICATION 254
Technical Considerations 254
First hit 255
Morphology Hematoxylin-eosin 255
HNF1α-inactivated hepatocellular adenoma (35%–40%) 255
Typical aspect with steatosis 255
Second hit (in the process of malignant transformation for b-HCA AND b-IHCA)8\r 255
Atypical case without steatosis 256
Inflammatory hepatocellular adenoma (40%–50%) 256
Typical features 256
Atypical features 258
β-catenin–activated hepatocellular adenoma (15%–20%) 258
β-Catenin–activated inflammatory hepatocellular adenoma 258
Unclassified hepatocellular adenoma 259
Morphology Immunohistochemistry 259
Markers 259
Liver-type fatty acid binding protein, the key marker to identify HNF1α-inactivated hepatocellular adenoma 259
C-reactive protein and/or serum amyloid A, the key markers to identify inflammatory hepatocellular adenoma 259
Glutamine synthetase, an excellent surrogate marker to identify β-catenin mutation 259
β-Catenin, a specific marker for β–hepatocellular adenoma but with low sensitivity 261
Additional markers 261
When and how to perform immunohistochemistry 261
Limits of the interpretation 261
Borderline hepatocellular adenoma and hepatocellular carcinoma 262
Multiple Nodules 266
The Background Liver and Clinical Context 267
The Report 268
HEPATOCELLULAR ADENOMA: WHY SHOULD WE CLASSIFY AND DO WE HAVE TO? 268
SUMMARY 268
ACKNOWLEDGMENTS 268
REFERENCES 268
Drug-induced Liver Injury 273
Key points 273
INTRODUCTION 273
USE OF THE LIVER BIOPSY IN DRUG-INDUCED LIVER INJURY 274
CONSIDERATIONS IN THE HISTOLOGIC ASSESSMENT OF DRUG-INDUCED LIVER INJURY 275
CHARACTERISTIC PATTERNS OF INJURY 276
DIFFICULT DIFFERENTIALS 289
FINAL ANALYSIS AND CONSULTATIVE OPINION 291
FINAL THOUGHTS 292
ACKNOWLEDGMENT 293
REFERENCES 293
Antibody-Mediated Rejection After Liver Transplant 297
Key points 297
INTRODUCTION 297
PATHOBIOLOGY 298
CLINICAL FEATURES 298
HISTOLOGIC FEATURES OF ACUTE ANTIBODY-MEDIATED REJECTION 299
COMPLEMENT 4D STAINING 301
CHRONIC ANTIBODY-MEDIATED REJECTION 302
TREATMENT OF ANTIBODY-MEDIATED REJECTION 303
SUMMARY 304
REFERENCES 304
Immunohistochemistry in the Diagnosis of Hepatocellular Carcinoma 311
Key points 311
INTRODUCTION 311
MOST USEFUL HEPATOCELLULAR MARKERS 312
Arginase-1 312
Hepatocyte Paraffin-1 312
Glypican-3 313
Polyclonal Carcinoembryonic Antigen 313
LESS USEFUL HEPATOCELLULAR MARKERS 313
Other HCC Markers with Canalicular Staining Pattern 313
Alpha-Fetoprotein 313
CD34 313
DIAGNOSTIC WORKUP OF MALIGNANT LIVER NEOPLASM 314
Group 1: Arg-1 Positive, CK19 Negative 314
Group 2: Arg-1 Negative, CK19 Positive 314
Group 3: Arg-1 Positive, CK19 Positive 314
Group 4: Arg-1 Negative, CK19 Negative 314
HEPATOCELLULAR CARCINOMA WITH VARIANT HISTOLOGIC FEATURES 316
Early Hepatocellular Carcinoma Versus High-Grade Dysplastic Nodule 316
Combined Hepatocellular Carcinoma–Cholangiocarcinoma 317
Scirrhous Hepatocellular Carcinoma 317
Fibrolamellar Carcinoma 317
WELL-DIFFERENTIATED HEPATOCELLULAR CARCINOMA: DISTINCTION FROM FOCAL NODULAR HYPERPLASIA AND HEPATOCELLULAR ADENOMA 318
Focal Nodular Hyperplasia 318
Inflammatory Hepatocellular Adenoma 318
Hepatocyte Nuclear Factor-1α-Inactivated Hepatocellular Adenoma 318
β-Catenin-Activated Hepatocellular Adenoma 320
Unclassified Hepatocellular Adenoma 321
REFERENCES 321
Human Immunodeficiency Virus Infection, Antiretroviral Therapy, and Liver Pathology 327
Key points 327
INTRODUCTION 327
PRE-ANTIRETROVIRAL THERAPY 328
ANTIRETROVIRAL THERAPY ERA 330
Drug Toxicity in Human Immunodeficiency Virus Disease 331
Non-antiretroviral drugs 332
Antiretroviral drugs 332
Nucleoside reverse transcriptase inhibitors 333
Non-nucleoside reverse transcriptase inhibitors 334
Nevirapine 334
Efavirenz 335
Protease Inhibitors 336
Integrase inhibitors, fusion inhibitors, and CCR5 antagonists 337
Immune reconstitution inflammatory syndrome 337
Causes of death on antiretroviral therapy 337
SUMMARY 338
REFERENCES 338
Autoimmune Hepatitis Overlap Syndromes and Liver Pathology 345
Key points 345
INTRODUCTION 345
CLINICAL INDICATIONS OF AN OVERLAP SYNDROME 348
CAVEATS REGARDING THE DIAGNOSIS OF OVERLAP SYNDROMES 349
DIAGNOSIS OF THE AUTOIMMUNE HEPATITIS–PRIMARY BILIARY CHOLANGITIS OVERLAP SYNDROME 353
DIAGNOSIS OF THE AUTOIMMUNE HEPATITIS–PRIMARY SCLEROSING CHOLANGITIS OVERLAP SYNDROME 353
DIAGNOSIS OF THE AUTOIMMUNE HEPATITIS–CHOLESTATIC OVERLAP SYNDROME 353
MANAGEMENT OF THE OVERLAP SYNDROMES 354
TREATMENT OUTCOMES 356
CAVEATS REGARDING TREATMENT 357
OVERVIEW 358
REFERENCES 358
Morphologic Subtypes of Hepatocellular Carcinoma 365
Key points 365
INTRODUCTION 365
GROWTH PATTERN VERSUS SUBTYPE 365
DEFINITION OF A HEPATOCELLULAR CARCINOMA SUBTYPE 366
MOLECULAR SUBTYPES 366
MAJOR HEPATOCELLULAR CARCINOMA SUBTYPES 367
Carcinosarcoma 367
Definition and hematoxylin and eosin findings 367
Confirmatory tests 368
Clinical findings 368
Molecular findings 368
Other findings 368
Differential 368
Carcinosarcoma with Osteoclast-like Giant Cells 368
Definition and hematoxylin and eosin findings 368
Confirmatory tests 370
Clinical findings 370
Molecular findings 370
Differential 370
Cirrhotomimetic Hepatocellular Carcinoma 370
Definition and hematoxylin and eosin findings 370
Confirmatory tests 371
Clinical findings 371
Molecular findings 371
Other findings 371
Differential 372
Clear Cell Hepatocellular Carcinoma 372
Definition and hematoxylin and eosin findings 372
Confirmatory tests 372
Clinical findings 372
Molecular findings 372
Other findings 373
Differential 373
Combined Hepatocellular Carcinoma–Cholangiocarcinoma 373
Definition and hematoxylin and eosin findings 373
Confirmatory tests 374
Clinical findings 374
Molecular findings 374
Differential 374
Combined Hepatocellular and Neuroendocrine Carcinoma 374
Definition and hematoxylin and eosin findings 374
Confirmatory tests 375
Clinical findings 375
Molecular findings 375
Fibrolamellar Carcinoma 375
Definition and hematoxylin and eosin findings 375
Confirmatory tests 376
Clinical findings 377
Molecular findings 377
Other findings 377
Differential 377
Granulocyte Colony-Stimulating Factor Producing Hepatocellular Carcinoma 377
Definition and hematoxylin and eosin findings 377
Confirmatory tests 378
Clinical findings 378
Molecular findings 378
Differential 378
Lymphocyte-Rich Hepatocellular Carcinoma and Lymphoepithelioma-like Hepatocellular Carcinoma 378
Definition and hematoxylin and eosin findings 378
Confirmatory tests 379
Clinical findings 379
Molecular findings 379
Other findings 380
Differential 380
Sarcomatoid Hepatocellular Carcinoma 380
Definition and hematoxylin and eosin findings 380
Confirmatory tests 380
Clinical findings 380
Molecular findings 380
Hepatitis E Virus and the Liver 393
Key points 393
INTRODUCTION 393
HEPATITIS E VIRUS 394
Virology and Genotypes 394
Global Distribution 394
HEPATITIS E VIRUS INFECTION: CLINICAL SETTINGS 396
Clinical Manifestations of Hepatitis E 396
Acute Hepatitis E 396
Chronic Hepatitis E 396
Extrahepatic Manifestation of Hepatitis E 398
Laboratory Diagnosis of Hepatitis E 398
HEPATITIS E VIRUS INFECTION: LIVER PATHOLOGY 399
Histology of Acute Epidemic Hepatitis E Virus Infection (Genotypes 1 and 2) 399
Histology of Acute Autochthonous Hepatitis E Virus Infection (Genotype 3) 400
Histology of Chronic Hepatitis E Virus (Genotype 3) Infection in Immunocompromised Patients 401
Histologic Differential Diagnoses of Hepatitis E 402
Ancillary Tools for Histology in Hepatitis E 402
SUMMARY 404
REFERENCES 405
Hepatic Progenitor Cells 409
Key points 409
INTRODUCTION 409
HEPATIC PROGENITOR CELLS 410
IDENTIFICATION OF THE HEPATIC PROGENITOR CELL 411
THE HEPATIC PROGENITOR CELL NICHE 413
HEPATIC PROGENITOR CELL AND CANCER 415
SUMMARY 415
REFERENCES 416
Heart Disease and the Liver 421
Key points 421
HISTORICAL PERSPECTIVE 421
PATHOLOGIC HEPATIC ABNORMALITIES IN HEART FAILURE 424
CLINICAL LIVER ABNORMALITIES IN HEART FAILURE 427
HISTOPATHOLOGIC SCORING SYSTEMS FOR THE LIVER IN INDIVIDUALS WITH HEART FAILURE 429
CONGENITAL HEART DISEASE, THE FONTAN PROCEDURE, AND THE LIVER 430
CARDIAC MEDICATIONS, NONALCOHOLIC FATTY LIVER DISEASE, AND LIVER DISEASE IN THE CARDIAC PATIENT 430
SUMMARY 431
REFERENCES 432
Index 437