Acute fatty liver of pregnancy is a disease of the third trimester which is generally considered to be rare and to have a grave prognosis. This study found an optimistic outlook for patients with acute fatty liver of pregnancy due to early termination of the pregnancy as well as the recognition of milder cases. In prospectively followed women, a maternal mortality of 8% and a fetal mortality of 14% were observed. The disorder also appears to be more common than previously suspected and should be considered in all women with liver dysfunction in late pregnancy, even if they are anicteric. Histologically, the characteristic fine droplet steatosis usually produces distinct vacuolization in sections stained with hematoxylin-eosin. However, early in the course of the illness, liver cells have a ballooned appearance and the presence of lipid is masked. When accompanied by a significant necroinflammatory reaction, this stage may be difficult to distinguish from acute viral hepatitis. Whenever acute fatty liver of pregnancy is suspected, a small piece of the biopsy should be reserved for special stains to confirm the presence of lipid in frozen sections. Significant loss of hepatic parenchyma is a regular accompaniment of acute fatty liver of pregnancy and is due to hepatocytolysis, acidophilic degeneration and liver cell atrophy. Extramedullary hematopoiesis and giant mitochondria are often present; the latter change is probably an adaptive or degenerative response to an altered metabolic environment. Despite the frequent presence of signs and symptoms of toxemia in patients with acute fatty liver of pregnancy, no histologic overlap was observed, suggesting that they represent distinct etiologic entities.

The diseases which affect the liver in pregnancy can be subdivided into those which occur simultaneously with gestation and those which occur in the context of and exclusively during pregnancy. This review deals with the latter group and describes the histopathological features of acute fatty liver of pregnancy and liver disease in toxaemia of pregnancy, hyperemesis gravidarum and intrahepatic cholestasis of pregnancy.

The authors here discuss twelve discrete pathologic entities that they found, in a review of over 500 abdominal CT scans, caused the appearance of a cystic lesion in the liver. The CT characteristics of the various lesions are illustrated, differential points in the patients' histories are noted, and gross and microscopic pathology specimens are correlated with the CT appearances to explain the CT findings. Lesions considered include: simple (bile duct) cyst, adult polycystic kidney disease, Caroli disease, pyogenic abscess, echinococcal cyst, amebic abscess, metastasis, biliary cystadenoma and cystadenocarcinoma, hepatocellular carcinoma, cholangiocarcinoma, biloma, and extrapancreatic pseudocyst.

Necrotizing sarcoid granulomatosis has become a well-defined entity within the spectrum of disorders classified as pulmonary granulomatosis with angiitis. It is characterized clinically by disease generally restricted to the chest, steroid sensitivity, and a good prognosis. Pathologically, confluent granulomas, vasculitis, and bland necrosis are seen. The authors report a patient initially presenting with the typical clinical and pathologic features of necrotizing sarcoid granulomatosis who, on subsequent recurrence, demonstrated a suppurative character to the necrosis. This feature has not been reported previously, and its recognition will allow more cases to be diagnosed correctly. Serum angiotensin converting enzyme (ACE) was not elevated, and ACE could not be demonstrated in tissue from the lung biopsy obtained during recurrence of disease. This further suggests significant differences between this entity and sarcoid.