Pathologists Are From Mars, Hepatologists Are From Venus: Hepatic Vascular Disorders—Blocked, Budd-ed, and Baffled

The diagnosis of hepatic vascular disorders raises several challenges for clinicians, radiologists, and pathologists. These disorders include sinusoidal/postsinusoidal etiologies like sinusoidal obstruction syndrome (SOS), Budd-Chiari syndrome, and cardiac/pericardial disease. Diagnosis of these conditions as well as the interpretation of fibrosis and nodular lesions in this setting can be challenging. The terminology and diagnostic criteria for portal vein and presinusoidal etiologies are also not well defined and have been grouped under a variety of terms like noncirrhotic portal fibrosis, idiopathic portal hypertension, and obliterative portal venopathy. The term porto-sinusoidal vascular disorder (PSVD) has been recently proposed. A multisociety initiative to review and standardize the nomenclature was jointly managed by the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, the Latin American Society for Study of Liver, and Asian Pacific Association for the Study of the Liver, with support and input from global pathology societies and the United States and Canadian Academy of Pathology. Both PSVD and noncirrhotic portal hypertension (NCPF) were considered acceptable terms based on the discussions. The clinical, radiologic, and pathologic criteria for diagnosis of PSVD were discussed and are currently being finalized. This session includes cases that illustrate diagnostic challenges and other clinically relevant aspects of hepatic vascular disorders with a focus on criteria and the appropriate use of the term PSVD.