Book Review

Histopathology of the Liver

N Engl J Med 1994; 330:148January 13, 1994

Article

Histopathology of the Liver
By Gerald Klatskin and Harold O. Conn. 735 pp. in two volumes, illustrated. New York, Oxford University Press, 1993. $250. ISBN: 0-19-504393-6

This long-awaited atlas of liver histopathology is a superb and a fitting memorial to Dr. Gerald Klatskin, one of the founding fathers of modern hepatology. Known affectionately as “the Klat” to several generations of Yale house staff members and hepatology trainees, Dr. Klatskin was a superb clinician, an outstanding liver pathologist, and an accomplished photographer who combined technical expertise with an eye for artistic composition. I agree with Dr. Harold Conn's comment in the acknowledgment section of volume I: “Many of the photomicrographs were works of art in their own right.”

That this atlas is encyclopedic, exemplifying medical scholarship at its best, comes as no surprise to those who knew Klatskin, for he epitomized medical scholarship. He was both respected and adored by those who trained under him. His knowledge of liver disease and liver histopathology was remarkable. Klatskin made 35-mm color transparencies of virtually every liver biopsy performed at Yale -- approximately 9000. Added to this collection were photomicrographs of unusual liver-biopsy specimens sent to him for consultation or contributed by histopathologist friends. For each liver-biopsy specimen in the collection, a trainee recorded history, physical findings, and laboratory results on one side of a file card. Klatskin wrote a detailed description of the histology on the other side. He was one of few liver pathologists who was also a practicing physician. He took care of many of the patients whose biopsy specimens he interpreted. Thus, he was able to maintain an excellent correlation between the clinical course of the patient and the histologic findings.

From the more than 45,000 color transparencies in Klatskin's collection, he and Conn selected 1092 that appear in the atlas. Klatskin began the book in the late 1970s and had completed 18 chapters by 1984. At that time, his failing health and near-blindness halted the writing. He then asked Conn, one of his first hepatology fellows, to be his coauthor. After Klatskin died in 1986, Conn revised and updated what was already written, completed five additional chapters, and added two new chapters on subjects that did not exist when the book was first planned -- those on liver transplantation and the acquired immunodeficiency syndrome. Colleagues contributed many of the biopsy specimens described in these two new chapters. Klatskin chose his coauthor wisely. All the chapters are well written and superbly illustrated.

Volume I consists of 27 chapters. The first five are on general topics: techniques, the normal liver, abnormalities of lobular architecture, abnormalities of hepatic parenchyma, and abnormalities of the portal tracts. The remaining 22 chapters describe specific disease entities. Volume I could stand alone as an excellent textbook of liver disease. However, it is wonderfully complemented by the figures in volume II, almost all of which are examples of photomicrography at its best. The book is comprehensive yet readable. The photomicrographs are magnificent -- sharp, beautifully composed, and with striking colors. The reproductions are as good as I have seen in any publication. Most of the biopsies illustrated were fixed in Carnoy's solution, arguably the best fixative for small biopsy specimens, and stained with a modified Masson trichrome stain. The resulting combination of reds, blues, and violets is pleasing to look at and, in my opinion, provides better histologic detail than any of the other currently used stains.

This is an outstanding book. I recommend it to all hepatologists and pathologists, and to any physician who cares for patients with liver disease. Volume II is beautiful and could easily grace the coffee tables of those who collect art books.

Marshall Kaplan, M.D.
New England Medical Center, Boston, MA 02111