Hepatic vascular diseases

Hepatic vascular diseases often present with non-specific and subtle histologic changes that could be easily overlooked during the evaluation of liver biopsies and surgical material. A liver biopsy typically samples small vasculature and thus is not a sensitive tool to evaluate the histopathology of large blood vessels. Vascular disease is rarely clinically suggested in the differential diagnosis of a case, and the indication for the liver biopsy is usually “elevated liver enzymes” or “cirrhosis”. Hence, when evaluating liver diseases, pathologists may overlook subtle histopathologic changes associated with vascular disease and instead focus on hepatitis, biliary disease or cirrhosis. Pathologists evaluating liver biopsies should be familiar with vascular diseases and their clinical implications. Recognizing hepatic vascular disorders is critical in order to trigger appropriate medical management. This review provides a brief overview of relatively common hepatic vascular diseases that surgical pathologists may encounter in practice.