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Hepatic Tuberculosis (TB) is extremely rare without miliary involvement in immunocompetent patients. Even in countries like India where TB is a major public health problem only few cases have been diagnosed and treated. We report a case of an immunocompetent patient who presented with undiagnosed pyrexia of 11 days, was initially diagnosed as pyogenic liver abscess, he did not responded to treatment and on liver biopsy was diagnosed as hepatic tuberculoma. Antitubercular treatment (ATT) was started and the patient responded well. We concluded that though hepatic TB is rare in immunocompetent patient, it is important to keep it as a differential diagnosis in patients of liver abscesses who are not responding to treatment in order to avoid needless investigations.

Praziquantel (PZQ) is the main treatment of Schistosomiasis mansoni. However, resistance to it was described. So, there is a necessity to develop novel drugs or to enhance the present drugs. This work aimed to assess the efficacy of PZQ alone and when loaded on liposomes in treatment of S. mansoni infection by parasitological and histopathological studies in experimental murine models. 112 male laboratories bred Swiss Albino mice were used in this work. They were divided into four groups: Group 1: control group; Group 2: infected then treated by PZQ (500 mg/kg) at 7, 30 and 45 days post infection; Group 3: infected then treated by liposome encapsulated PZQ (lip.PZQ) (500 mg/kg) at 7, 30 and 45 days post infection; Group 4: infected then treated by free liposomes at 7, 30 and 45 days post infection. The results showed that G3 caused the highest significant reduction of the total worm count, eggs/gram liver tissue and intestine (97.2%, 99.3%, 99.5%) respectively. Followed by G2 (85.1%, 97.6%, 89.8%) respectively. Regarding the histopathological studies, G3 showed the highest significant reduction in number and diameter of hepatic granuloma (97.6% and 98.1%), followed by G2 (77.2% and 75%) when compared to other groups. In conclusion, lip.PZQ is more effective than free PZQ from all aspects especially when administered 45 days PI.

Background & Aims Clinical manifestation of hepatic involvement in sarcoidosis can vary from asymptomatic disease to severe complications such as cirrhosis and portal hypertension. However, data on hepatic sarcoidosis are limited, and evidence-based recommendations are lacking. Our study aimed to assess the features and clinical course of hepatic sarcoidosis in a predominantly Caucasian cohort. Methods We performed a retrospective study including all patients with hepatic sarcoidosis between 2004 and 2020 in 5 German centres. The median follow-up time was 36 months (range 0.0–195). Data on demographic parameters, clinical manifestations, diagnostic test results, treatment, and outcome were collected. Results A total of 1,476 patients with sarcoidosis and 62 patients with hepatic involvement (4.2%) were identified. Of the patients, 51.6% were female, and 80.6% were Caucasian. Most patients were asymptomatic and were observed to have a cholestatic pattern of liver enzyme elevations. Cirrhosis was detected in 9 patients (14.5%), of whom 6 developed clinical manifestations of portal hypertension. Fifty-four patients were medically treated, most commonly with glucocorticoids (69.4%) or ursodeoxycholic acid (UDCA) (40.3%). Levels of alkaline phosphatase (ALP) decreased by 60.8% on average from baseline in patients treated with glucocorticoids and by 59.9% in patients treated with UDCA. Seventeen patients received treatment augmentation with a second line agent, of whom 8 patients normalised ALP levels during follow-up. None of the patients underwent liver transplantation or developed hepatocellular carcinoma (HCC). Three of the patients died during follow-up owing to liver-related complications. Conclusions Hepatic involvement in sarcoidosis was found in 4.2% of patients with sarcoidosis and was clinically significant in 14.5% of those. These findings highlight the importance of early identifying, monitoring, and treating hepatic sarcoidosis, given its increased mortality when associated with end-stage liver disease. Lay summary Clinical diagnostic and surveillance of hepatic involvement in sarcoidosis has not been standardised, and management of hepatic involvement is a clinical challenge, since it remains poorly characterised in many ways. Our results show that one-third of patients with hepatic sarcoidosis presented with clinically significant portal hypertension, 14.5% suffered from cirrhosis, and 3 patients died owing to liver-related complications. Regarding pharmacological treatment options, corticosteroids and UDCA were the medical agents most frequently used, and both of them have been shown to induce biochemical response in the majority of patients. These findings highlight the importance of correctly and early identifying hepatic involvement in sarcoidosis, because of the potentially progressive course of disease., Graphical abstract, Highlights • There has been little research on clinical characteristics and the clinical outcome of patients with hepatic sarcoidosis. • One-third of patients with hepatic sarcoidosis presented with clinically significant portal hypertension, and 14.5% suffered from cirrhosis. • Biochemically, a cholestatic pattern of liver enzyme elevations was the most common abnormality. • The correct and early identification of hepatic involvement in sarcoidosis is crucial because of the potentially progressive course of disease.

Schistosomiasis remains a serious public health issue and still belongs to the list of neglected diseases in Brazil with a significant socio-economic impact. It is estimated that 207 million people are infected, 500 thousand die annually and 120 million are asymptomatic. The characteristic pathological process is the presence of hepatic granuloma characterized as the body's defense reaction to egg insulation and protection against the release of their antigens. The aim of the study was to evaluate the influence of high fat diet on liver tissue in an experimental model of schistosomiasis mansoni using 35 female mice divided into 4 groups: fat diet and Infected - H + I (n = 9), Infected - I ( n = 7), high fat diet - H (n = 9) and control - C (n = 10). Tissue specimens were fixed and made histological and morphometric studies as numbers, volumes and granulomas developments, as well as quantification of collagen density. The prevailing characterization of granulomatous phase (FG) was observed in group I than H + I, along with a better collagen formation in the H + I group compared to the other groups. During the study we observed the absence of steatosis in H + I group. The study showed that the presence of fat diet alters some rearrangements in granulomatous formation, leading to the need for more intense observations about the theme.

Introduction: Hepatic granulomas are common in patients with sarcoidosis, but clinically significant liver disease is uncommon and poorly studied. We aimed to characterize the frequency and clinical course of hepatic sarcoidosis in an ethnically diverse population. Methods: This is a retrospective study including all cases of hepatic sarcoidosis in a single center. The median follow-up time was 49 months (4–121). Cases were identified based on ICD-9 and ICD-10 codes for granulomatous hepatitis, sarcoidosis, and hepatic sarcoidosis. The Chi-square and Wilcoxon-signed rank tests were used as indicated to assess for differences between groups. Results: Of 286 patients with sarcoidosis, 27 had hepatic involvement; 78% were female and 48% African American. The most common pattern of liver tests abnormalities was cholestatic. Ten patients had clinically significant hepatic involvement: cirrhosis in seven (25.9%), portal hypertension in nine (33%), and portal vein thrombosis in one (3.7%). Sex, race, and ethnicity were not associated with an increased risk of hepatic involvement or symptomatic hepatic sarcoidosis. Most patients received medical treatment, most commonly oral glucocorticoids. At the end of the follow-up period, all patients were alive but two had undergone liver transplantation due to complications of hepatic sarcoidosis. Three patients with hepatic sarcoidosis had initially been classified as AMA-negative PBC. Conclusions: Hepatic sarcoidosis was found in 9.4% of patients with sarcoidosis and was clinically significant in 37% of those. Identifying and monitoring hepatic sarcoidosis is crucial given its potential complications.

Background and Objectives Bone marrow derived mesenchymal stem cells (BM-MSCs) have been proposed as effective treatment of many diseases owing to their unique ability to differentiate into other cell types in vivo. Schistosoma mansoni (S. mansoni) infection is characterized by hepatic granuloma formation around schistosome eggs at acute stage of infection, followed by hepatic fibrosis at chronic and advanced stages. Whether BM-MSCs have an ameliorative effect on hepatic tissue injury caused by S. mansoni infection or not, was inspected in the current study. Materials and Results Female Swiss Albino mice were divided into a control group and an experimental group. Half of control animals served as donors for bone marrow stem cells, and the other half was used to collect liver samples. Experimental group was injected with circariae of S. mansoni, and then subdivided into three subgroups; Subgroup B1, sacrificed after eight weeks of infection without treatment, subgroup B2, received BM-MSCs at the eighth week and sacrificed four weeks later, and subgroup B3, was untreated till the twelfth week of infection. Histological examination of liver samples showed the formation of granulomas and liver fibrosis which were extensive in subgroup B3. However, treated subgroup illustrated improvement of liver histology, signs of hepatocytes regeneration, and possible contribution of oval cell in the process of hepatic and biliary regeneration. Conclusion BM-MSCs decreased liver fibrosis and contributed to an increase in oval cells, generation of new hepatocytes and/or to the improvement of resident hepatocytes in S. mansoni infected mice.

The present study was performed to elucidate the efficacy of Apis mellifera L bee venom (BV) or proplis (200 mg/kg orally for three consecutive days) on Schistosoma mansoni infected mice. The results recorded reduction in the total worm burden, numbers of immature eggs and the ova count in hepatic tissue in BV (sting or injection) or proplis treated groups as compared to the infected group. Histological examination illustrated a significant increase (P ≤ 0.05) in the diameter of hepatic granuloma in BV treated groups (272.78 and 266.9, respectively) and a significant decrease in proplis treated mice (229.35) compared with the infected group (260.67). Electrophoretic pattern of RNA showed a decrease in mean of maximal optical density in liver and intestine of S. mansoni infected mice treated with bee venom (sting or injection) as compared with infected group. Flow cytometry analyses of RNA or apoptotic percentage of worms recovered from BV sting (19 and 49 % respectively); BV injected (20.5 and 51.17 %, respectively) and proplis (35 and 23.93 %, respectively) groups were compared with S. mansoni infected group (37.87 and 39.21 %, respectively). It can be concluded that administration of bee venom or proplis are effective in case of S. mansoni infection. Although bee venom cause increase of granuloma diameter and this might be due to venom concentration and further studies are required to avoid such harmful effect.

We present five cases in whom two rare entities were simultaneously found within the liver, i.e. hepatocellular adenomas (HCAs) and granulomas. Coexistence of both entities confuses diagnosis. Our aim is to disclose the association between HCA and hepatic granulomas. Five patients presented with HCA for which they underwent resection. During laparotomy or at pathological examination, granulomas were found in tumorous and non-tumorous tissue. No specific cause for the granulomas was found. Immunohistochemistry showed overexpression of C-reactive protein and serum amyloid A in 4/5 patients, classifying these lesions as inflammatory HCA. HCA and especially the inflammatory subtype may cause formation of granulomas in (peri-)tumorous tissue as a local response to persistent inflammation and/or the presence of a tumor. Both HCA and hepatic granulomas have also been associated with oral contraceptive use. In conclusion, HCAs associated with hepatic granulomas derive from a local response to (inflammatory) HCA or neoplasm, chronic use of oral contraceptives, or a combination of these factors.

An abdominal abscess caused by spilled stones is a serious complication of laparoscopic cholecystectomy that requires drainage or reoperation to remove the scattered stones. Herein, we report the case of a 50-year-old woman, who was on dialysis for renal failure. She underwent major hepatectomy for a liver abscess caused by stones spilled during laparoscopic cholecystectomy.

A 66-year-old man with postsigmoidectomy status for colon cancer received laparoscopic partial hepatectomy due to a hepatic mass with employing titanium clips were for a vascular clamp. Histological examination showed liver metastasis from sigmoid colon cancer. Twenty-nine months after the partial hepatectomy, a mass developed on the stump at the hepatic resection. Laparoscopic left lateral segmentectomy was conducted under suspicion of cancer recurrence and an automatic titanium stapling device was used. The macroscopically cut surface of the liver showed a grey-white solid nodule measuring 23 x 20 mm and involving metal clips. The nodule was consistent with granuloma microscopically. Twenty-three months after the segmentectomy, a mass reappeared on the hepatic radial margin and an open left lateral hepatic lobectomy was performed because of its growth tendency. Histopathological examination revealed granuloma similar to the previous instance. Since these nodules formed a granulomatous lesion surrounding metal staples/clips and evidence of caseous necrosis was lacking, granuloma due to surgical staples/clips was suspected. Sporadic case reports of postoperative pulmonary granuloma at the staple line have been published previously, but there are no articles detailing a case involving hepatic granuloma. We present our case as the first report of postoperative staple-line hepatic granuloma.

The formation of granulomas in host tissues in response to trapped Schistosoma japonicum eggs is central to the etiology of schistosomiasis. However, analysis of the host hypersensitivity reactions that result in granuloma formation, in schistosome infection, is not without difficulty. This is due, in part, to the fact that the parasites continuously deposit their eggs as clusters. In order to synchronize host reactions, we established an experimental model of hepatic granuloma formation whereby in vitro laid schistosome eggs are implanted directly into normal and cytokine-deficient mice livers. This model, validated by comparison with an infection model, was used to analyze cytokine regulation of granuloma formation around S. japonicum eggs. Combined models of implantation and cercarial infection were also studied. With special reference to IL-4, IL-13, IFN-gamma and IL-18, our in vitro schistosome egg implantation model has shed new light on the roles of cytokines in both the acute and chronic stages of schistosome egg-induced granuloma formation.

Quinine is used for the treatment of malarial infection, though not in common use. It is especially valuable for the parenteral treatment of severe illness owing to drug-resistant strains of Plasmodium falciparum. Quinine is also known to occasionally cause acute renal failure (ARF). Although quinine is listed in some reviews as a cause of acute interstitial nephritis, most cases of quinine-associated acute renal failure have been attributed to the hemolytic-uremic syndrome (HUS). Only two cases of acute renal failure due to acute interstitial nephritis associated with quinine have been reported [1, 2]. To our knowledge, there have been 6 reported cases of quinine-induced hepatic granuloma [3–8]. We report a case of quinine-induced acute interstitial nephritis (AIN) along with granulomatous hepatitis, both of which were confirmed on biopsy. A 50-year-old Nigerian man was admitted to the hospital with complaints of fever and general fatigue. He had been prescribed quinine as an antimalarial drug in a Nigerian hospital. The patient was febrile and showed nonoliguric ARF and liver dysfunction. In this case, liver injury showed gradual and spontaneous resolution after discontinuing quinine, and ARF resolved after treatment with oral prednisolone.

INTRODUCTIONEnterobius vermicularis or “pinworm” infection of the liver is an extremely rare condition with only five cases previously reported in literature. It is characterized by the presence of granulomas in the liver with a necrotic core, containing adult helminthes or their ova. Because of the relatively mild symptomatology associated with this disease, prior to the arrival of modern imaging methods hepatic enterobiasis was an incidental intra-operative finding during abdominal surgery for other conditions. In recent years however, with high-resolution abdominal imaging readily available and the improved safety of hepatic resection, a lower threshold for treating suspicious hepatic nodules aggressively with surgery is being adopted.PRESENTATION OF CASEWe present the second case in international literature, where E. vermicularis of the liver was mistaken for malignancy and led to hepatic resection and perform a literature review of the five previously documented cases of hepatic enterobiasis.DISCUSSIONOur report identifies certain trends in this condition's aetiology and clinical behaviour, but due to its rarity definitive answers cannot yet be established.CONCLUSIONWe do not advocate a change in the current approach of suspicious hepatic nodules, but we do feel that better understanding of the mechanisms involved with hepatic enterobiasis could, in the future, prevent unnecessary surgery.

We assessed the value of liver biopsy in the diagnosis of fever of unknown origin (FUO) in hospital-based patients by a retrospective analysis of all cases (24 cases) seen at the University of Michigan Medical Center over a 5-year period. Based on the findings of a liver biopsy performed in the cour

The histopathological description of intralobular hepatic granulomas in animals with a defined clinical status (asymptomatic, oligosymptomatic and symptomatic animals) was reported. Seventy-one mongrel dogs naturally infected with Leishmania chagasi were obtained from two Brazilian endemic areas: João Pessoa, PB and Belo Horizonte, MG. The hepatic parasite load was determined and compared to granuloma formation. Liver fragments from all infected animals showed remarkable leishmaniotic granulomatous inflammatory reaction. Granulomas with variable size were constituted by macrophages (parasitized or not with amastigotes of L. chagasi), some epithelioid cells, small numbers of lymphocytes, plasma cells, and rare neutrophils. Asymptomatic dogs had higher numbers of granulomas than oligosymptomatic and symptomatic animals from both geographical regions. However, the average diametric size of granulomas was very heterogeneous in all groups, independently of the geographic region (P>0.05). Parasite tissue load did not show any difference among liver fragments of all animals, especially when considering the defined clinical status and/or their geographic origin. Descreve-se a formação de granulomas hepáticos na leishmaniose canina em animais com classificação clínica definida - assintomáticos, oligossintomáticos e sintomáticos. Setenta e um animais, sem raça definida e naturalmente infectados com Leishmania chagasi, foram obtidos de duas regiões endêmicas brasileiras: João Pessoa, PB e Belo Horizonte, MG. A carga parasitária tecidual foi determinada mediante emprego do Leishmania Donovani Units (LDU) e comparada com a formação de granulomas hepáticos. Fragmentos de fígado de todos os animais infectados mostraram reação granulomatosa notadamente leishmaniótica. Granulomas de variáveis tamanhos eram constituídos por macrófagos, parasitados ou não com formas amastigotas de L. chagasi, algumas células epitelióides, pequeno número de linfócitos e plasmócitos, e raros neutrófilos. Cães assintomáticos apresentaram maior número de granulomas do que os animais oligossintomáticos e sintomáticos, em ambas as regiões geográficas. As médias dos diâmetros foram heterogêneas em todos os grupos, independente da região geográfica (P>0,05). Quanto ao parasitismo (LDU), não houve diferença entre as amostras de fígado, especialmente quando se consideraram a classificação clínica e a região geográfica.

Sarcoidosis and primary biliary cirrhosis (PBC) are thought to be two distinct disorders of unknown origin. However, both are characterized by hepatic granuloma formation and may also manifest cutaneous granulomatous inflammation. In this report, we describe two cases of cutaneous sarcoidosis occurring in the setting of PBC and review 7 additional cases from the literature of granulomatous skin disease associated with PBC. Although the pathogenesis of both sarcoidosis and PBC remains elusive, the simultaneous occurrence of these uncommon diseases suggests a common pathway may contribute to granuloma formation in both disorders.

A 6-y-old girl developed fever, soft-tissue mass in the right chest wall, osteomyelitis of the 10th rib and hepatic granuloma. Cat scratch disease was diagnosed by histological examination of the mass and serological tests. The patient was treated successfully with antibiotics and recovered completely, as shown by a 10 month follow-up.

Histopathologic and morphometric (area, perimeter, major and minor diameters) analysis of hepatic granulomas isolated from twelve naturally infected Nectomys squamipes were compared to four experimentally infected ones and six C3H/He mice. Liver paraffin sections were stained for cells and extracellular matrix. Both groups of N. squamipes presented peculiar granulomas consisting predominantly of large macrophages, full of schistosome pigment, characterizing an exudative-macrophage granuloma type, smaller than the equivalent granuloma type in mouse. Naturally infected animals exhibited granulomas in different stages of development, including large number of involutional types. Morphometric analysis showed that all measurements were smaller in naturally infected animals than in other groups. The results demonstrated that both N. squamipes groups reproduced, with small variations, the hepatic granuloma aspects already described in cricetidium (Calomys callosus), showing a genetic tendency to set up strong macrophage responses and small granulomas. Unexpectedly, natural infection did not engender distinguished histopathological characteristics distinct from those derived from experimental single infection, showing changes predominantly secondary to the duration of infection. It appears that the variability of the inocula (and the number of infections?) interfere more with the quantity than with the quality of the pathological changes, denoting some morpho-functional determinism in the response to schistosomal infection dependent on the animal species.

The human impact of visceral leishmaniasis is significant. Some 500,000 new cases are reported annually, and epidemics may decimate local populations. A more complete understanding of the human immune response and its pathological consequences are needed for the design of vaccines and for improvements in therapy. This will require more thorough clinical investigation, and also a better appreciation of the usefulness and limitations of animal models. This review will concentrate on recent observations on patients with active VL. It will summarize recent progress in studies using a murine model that may have most bearing on human disease. Finally, it discusses future research directions aimed at elucidating the pathogenesis of VL.

We report a 10-year-old girl with a 3.0- by 3.5-cm giant hepatic granuloma caused by Bartonella henselae. Such a solitary and large granuloma associated with B. henselae infection has not been previously reported. We believe that B. henselae infection is a consideration in the differential diagnosis of a large hepatic mass.

A case of hepatic granuloma resembling a simple cystic lesion of the liver in computed tomography with clinical manifestation of erythema nodosum is presented. The causes of hepatic granulomas and the importance of liver biopsy or exploratory laparotomy in their diagnosis are discussed with a review of the literature.

クロールプロマジン及びアルドメット服用後,肝機能異常が現われ,肝生検にて著明な肝内胆管病変を呈した症例を経験した.症例は71歳,女性で,クロールプロマジンを約18カ月,アルドメットを1カ月服用後肝障害が現われた.肝組織では肝内胆管の破壊像が認められ,同一門脈域に類上皮細胞肉芽腫及びリンパ濾胞を形成する多数の炎症細胞浸潤が認められたが,胆汁うっ滞の所見は認められなかった.組織上では原発性胆汁性肝硬変(PBC)と類似した点もみられたが,門脈域への形質細胞の浸潤がめだたず,肝内胆管の数の減少も認められない点でPBCとは異なっていた.また,抗ミトコンドリア抗体も陰性であった.本例は薬剤の中止により肝機能はすみやかに改善し,リンパ球刺激試験で両薬剤が陽性であったことより,クロールプロマジン,アルドメット両薬剤の関与により多彩な組織像を呈した薬剤性肝障害と考えられた.

Liver biopsy was carried out in 35 cases of disseminated tuberculosis. Seventeen percent showed evidence of tubercle on liver and was noted more often in miliary tuberculosis (33%), tuberculous meningitis (26%) and in tuberculous bronchopneumonia (15%). Hepatomegaly of greater than 4 cm with abnormal liver function tests revealed tuberculous granuloma more often as compared with 2–4 cm liver enlargement. SGOT was significantly raised in hepatic granuloma.

guinea pigs. In subsequent years, the occurrence of the granuloma of brucellosis has been reported in the tissues of mice by Feldman and Olson,2 of monkeys by Huddleson and Hallman,3 of dogs by Margolis et al,4 and of rats and rabbits by Nyka.5 Spink et al6 have observed granulomas in sections of liver obtained by biopsy from many patients having culturally proven brucellosis. Similar findings in sections of biopsied human bone marrow were reported by Sundberg and Spink.7 Although the uniform character of

Hepatic granuloma occurs rarely in the polymyalgia rheumatica syndrome. A case was presented of a 62-year-old woman with polymyalgia rheumatica, elevated concentrations of hepatic enzymes, and granuloma of the liver. Low doses of corticosteroids produced a marked improvement in the patient's condition and a return of liver function tests to normal. This is apparently the first case of polymyalgia rheumatica associated with liver granuloma that has been reported in Israel.

A nodule of the liver was incidentally noted during left colectomy for a large villous adenoma in a 74-year-old man. Microscopic examination disclosed a granuloma of the liver containing numerous Enterobius vermicularis ova and a cross-section of the nematode. This is the fourth reported case of hepatic oxyuriasis and the second case reported in North America.

An unusual case of a woman with primary biliary cirrhosis and cutaneous sarcoidosis is described. The factors that allow a specific diagnosis of each condition are presented and the literature pertaining to such complex and unusual cases is presented.

Aphthoid ulceration is well known in Crohn's colitis and may also occur in several other forms of infective and inflammatory colitis. We report a case of colonic tuberculosis exhibiting this sign. A 37-year-old Iraqi man, suffering from end-stage renal failure secondary to chronic pyelonephritis, received a living, related transplant graft four years prior to presentation. Three weeks post-operatively he developed pyrexia, hepatomegaly and marked elevation in his liver enzyme assays. Liver biopsy showed a hepatic granuloma, but no tubercle bacilli.

Summary A calcified nodule on the liver of a 62-year-old man from North Carolina, USA, contained a degenerated nymph of Linguatula serrata . The nodule was incidentally discovered at laparotomy for malignant lymphoma and cholelithiasis. The cuticle was all that remained of the parasite, but sclerotized openings and large spines on the cuticle proved the parasite was L. serrata , a pentastomid arthropod. Anatomic location and size of the parasite indicated that it was consistent with the nymphal stage of L. serrata . This is the fifth confirmed infection of humans from North America by a pentastomid parasite.

A collection of 107 photomicrographs, representing a variety of hepatic disorders, serves as the purpose of this small volume. The lesions constitute the range of histologic patterns encountered in a diagnostic (needle) biopsy service. Included are variations of the normal, nonspecific evidences of injury, infectious and toxic hepatitis, obstructive jaundice, cirrhosis, hepatic granuloma, neoplasm, and a small number of miscellaneous conditions. In the main the illustrations are of excellent quality; several do not meet these standards, and in a few instances reproduction leaves much to be desired. Occasional examples appear to exhibit postmortem features. The 41 pages of text are prepared in outline form. Although 208 references are cited, elaboration is spotty and uncritical. This applies as well to the disappointingly sketchy descriptions of the photographs. For the pathologist or clinician well versed in the histologic features of liver disorders the book offers little. Others, lacking this experience, may profit