American Board of Pathology (ABPath) Practice Test 2026 - Free Pathology Exam Practice Questions and Study Guide

Starry-sky liver is a distinctive histological pattern observed in liver biopsy specimens, characterized by the presence of numerous small aggregates of macrophages containing lipid-laden phagocytic cells, amidst a relatively normal liver parenchyma. This appearance is particularly associated with hepatitis, especially in the context of viral infections, including those due to HIV/AIDS.

In hepatitis associated with AIDS, the starry-sky pattern arises due to the increased phagocytic activity of Kupffer cells (the liver macrophages) as they respond to the inflammation and infection. This contrasts with other conditions like cirrhosis, alcoholic liver disease, or nonalcoholic fatty liver disease, where prominent features such as portal tract fibrosis, necrosis, or steatosis may dominate the histological landscape without producing the distinct starry-sky appearance.

Thus, the association of starry-sky liver with hepatitis, particularly in the context of HIV/AIDS infection, highlights the pathological changes occurring during viral hepatitis that lead to this striking histological finding.