Book Review

Atlas of Liver Pathology

N Engl J Med 1993; 328:517February 18, 1993

Article

Atlas of Liver Pathology
(Atlases in Diagnostic Surgical Pathology.) by Gary C. Kanel and Jacob Korula. 265 pp., illustrated. Philadelphia, W.B. Saunders, 1992. $140. ISBN: 0-7216-2657-2

The divining of the presence of a deep-seated malady from the appearance and relations of cells in a small specimen of liver tissue conjures up an image of ancient ritual and magic. Perhaps this is why liver-biopsy interpretation is viewed by many (particularly its practitioners) as among the higher callings of pathologists. For pathologists, hepatologists, or internists interested in its secrets, this new book is a valuable source.

The contents are organized along traditional lines, with chapters devoted to viral hepatitis, cholestasis and biliary disorders, nonviral infectious disorders, developmental, familial, and metabolic disorders, drugs and toxins, and vascular disorders and a mixed bag of a final chapter that includes transplantation pathology and graft-versus-host reaction. Within each chapter, the various diseases are presented in an innovative and interesting format. Morphologic descriptions appear under two headings, “Major Morphologic Features” and “Other Features”: the first lists several essential morphologic criteria, and the second lists additional details and minor variations. This is followed (in sequence) by sections on differential diagnosis, special stains, immunohistochemistry, aspiration cytology (when relevant), clinical and biologic behavior, and treatment and prognosis. In every section, information is presented in a tabular or lecture-notes style that is both concise and readable.

High-quality photomicrographs are a principal feature of the book. These are mainly color plates, but presumably to contain costs, a large proportion of black-and-white images is also included. Together they illustrate the spectrum of liver disease and include many beautiful examples of rare entities. Tables are judiciously included throughout the text and, for the most part, are directed toward summarizing and elucidating differential diagnosis.

A notable feature of the book is the wealth of pertinent clinical information that is succinctly presented for each disease. This material is very well integrated into the description of the disorder and the approach to diagnosis, and it is communicated with authority equal to that of the pathological descriptions. This success reflects well on the collaboration of pathologist (Dr. Kanel) and internist (Dr. Korula), who drew from the resources and their shared experience at the liver unit and laboratories of the University of Southern California.

This book can be favorably compared with the best of several established small textbooks on liver-biopsy interpretation. It may become a favorite for many because of the accessibility of its information, its concise and authoritative clinical material, and not least, because it so frequently offers good illustrations of uncommon entities that are sparsely depicted, if at all, in other books. Although the designation “atlas” may suggest a bound collection of illustrations and perhaps, to paraphrase Francis Bacon, a book to be tasted rather than to be swallowed or chewed and digested, this beautifully edited and elegantly produced book is no mere sampler, and in its own right it provides a comprehensive and excellent guide to liver-biopsy interpretation.

Michael J. O'Brien, M.D.
Boston University School of Medicine, Boston, MA 02118