Anatomic Pathology: Liver Pathology

• The characteristic pathologic change seen in preeclampsia includes fibrin within portal tract vessels and periportal sinusoids. In more severe cases, periportal necrosis, hemorrhage, or rupture of the liver may occur.

• When interpreting a liver biopsy specimen, a pathologist should be aware that there are four, relatively rare hepatic conditions unique to pregnancy.

• HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) may show overlapping disease with preeclampsia/eclampsia.

• Details of the four rare hepatic conditions unique to pregnancy are presented in the table.

Liver Disease Unique to Pregnancy
Disease Pathologic Features
Acute fatty liver of pregnancy Microvesicular fat
Occasionally lymphocytes
Intrahepatic cholestasis of pregnancy Bile canalicular cholestasis (perivenular)
Preeclampsia Fibrin in portal vessels and sinusoids
Periportal necrosis if severe
HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) Nonspecific inflammation
Glycogenated hepatocyte nuclei
Periportal fibrin and necrosis
Schutt VA, Minuk GY: Liver diseases unique to pregnancy. Best Pract Res Clin Gastroenterol 2007;21(5):771-792.

Wakim-Fleming J, Zein NN: The liver in pregnancy: disease vs. benign changes. Cleve Clin J Med 2005;72(8):713-721.

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