Book Review
Gastroenterology — Surgical and Medical
Diagnostic Liver Pathology
N Engl J Med 1994; 331:555-556August 25, 1994
- Article
Diagnostic Liver Pathology
By Randall G. Lee. 517 pp., illustrated. St. Louis, Mosby-Year Book, 1994. $115. ISBN: 0-8016-2805-9A founding principle of the field of hepatology is the use of the liver biopsy as an aid to the diagnosis and management of hepatic diseases. Nevertheless, monographs dedicated to liver pathology are relative newcomers in the 50-year history of modern hepatology and hepatopathology. In recent years, however, there has been a rapid increase in the number of such textbooks, perhaps reflecting the explosion of understanding about hepatic biology and pathobiology and the morphologic interpretation thereof.
For the student or practitioner of hepatopathology, there have been three general categories of textbook. The first are the encyclopedic compendiums of hepatic pathology. In this category are Pathology of the Liver (Roderick W.W. MacSween, Peter P. Anthony, and Peter J. Scheuer, eds. 2nd ed. New York: Churchill Livingstone, 1987), for which a third edition is in production, and Histopathology of the Liver (Gerald Klatskin and Harold D. Conn. New York: Oxford University Press, 1993). Although they serve as superb primary reference sources, systematic study of these books can be quite daunting. The second category is made up of the compact reference books, represented by Liver Biopsy Interpretation (Peter J. Scheuer. 4th ed. Philadelphia: Bailliere Tindall, 1988), with a new edition in press, Liver Pathology (Robert L. Peters and John R. Craig, eds. New York: Churchill Livingstone, 1986), and Biopsy Diagnosis of Liver Disease (Dale C. Snover. Baltimore: Williams and Wilkins, 1992). These books are excellent for general pathologists, fellows, and students, but they do not always satisfy the thirst for more extensive information on particular topics. The third group contains atlases, such as Atlas of Liver Pathology (Gary C. Kanel and Jacob Korula. Philadelphia: W.B. Saunders, 1992), which are well illustrated but do not provide complete discussions.
Enter Dr. Lee's Diagnostic Liver Pathology onto the scene. In number of pages, this book is smaller than the encyclopedic textbooks, which are both about 700 pages, and roughly twice the size of the compact textbooks (about 300 pages). This intermediate-sized textbook is a robust monograph that presents information much more extensively than is possible in the compact books or atlases. At the same time, the friendliness of a single author's writing style is maintained throughout the book, and the chapters are well coordinated, making systematic study an enticing prospect.
In this book's 15 chapters, a discussion of general principles precedes chapters on acute and chronic hepatitis, cholestasis and bile-duct disorders (including those of infants and children), fatty disorders, and other inflammatory and infectious disorders. Chapters on metabolic disorders, fibrosis, and cirrhosis are followed by others on vascular and drug-related disease, transplantation, and neoplasms and masses. This book is unusual in that the penultimate chapter is devoted to cysts and fibropolycystic diseases. Each chapter on a category of disease begins with a brief overview, followed by subsections on clinical features, pathological features, prognostic factors, and differential diagnosis.
This book is liberally illustrated with black-and-white photomicrographs, all of which are in a large format (3.5 by 5 in.) and of exceptional clarity and quality. There are no color photomicrographs. The tables are not numerous but are well chosen and placed. Each chapter has extensive references, both the classic works on the topic and the recent literature up to and including 1992.
This textbook is immediately appealing for its clarity of writing and its accuracy in content and illustration. The first chapter, on general principles, is a state-of-the-art discussion of the general approach to liver pathology. Each subsequent chapter is well organized and reflects current knowledge in the fields of hepatopathology and, when relevant, hepatology. In including information on clinical features and prognostic factors, Lee reflects the all-important function of a liver pathologist, which is to relate histopathological information to the clinical situation.
In the chapter on chronic hepatitis he gives considerable emphasis to chronic persistent hepatitis, chronic active hepatitis, and chronic lobular hepatitis, despite recent publications in the literature (not cited) recommending the deemphasis of such subcategorization. Whether there are other deficiencies in this book depends primarily on one's point of view. Discussions of the most obscure liver diseases are not as extensive as those found in the book by MacSween et al. The color photography of Klatskin and Conn is unsurpassable. Elegance of information presented in tabular form is best found in Snover's book. However, for anyone who wishes to master the field of hepatic pathology, Lee's textbook is an exemplary study tool and source of systematic information. For those who are already expert in the field, this textbook is a refreshing work for review and a satisfying reference source.
A difficult choice is in store for clinicians who want to select one book on hepatic pathology, since both Lee's book and that of Klatskin and Conn would serve their purposes well. In favor of Lee's book, however, is its price, which makes it more affordable for trainees and practitioners alike.
This book is superb and will readily meet the needs of both pathologists and hepatologists looking for a single useful book on hepatopathology. Lee's monograph is a welcome addition to the select group of outstanding textbooks of liver pathology.
James M. Crawford, M.D., Ph.D.
Brigham and Women's Hospital, Boston, MA 02115- Citing Articles (1)
Citing Articles
1
Douglas O. Faigel, David C. Metz. (1996) Prevalence, etiology, and prognostic significance of upper gastrointestinal hemorrhage in diabetic ketoacidosis. Digestive Diseases and Sciences 41:1, 1-8
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