Liver and intrahepatic bile ducts - nontumor
General
Patterns of hepatic injury

Author: Komal Arora, M.D. (see Authors page)

Revised: 15 November 2017, last major update April 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Patterns of hepatic injury[title]

Cite this page: Arora, K. Patterns of hepatic injury. PathologyOutlines.com website. http://pathologyoutlines.com/topic/liverpatternshepaticinjury.html. Accessed November 20th, 2017.
Acidophil body
  • Type of focal necrosis in which dead hepatocyte is identifiable as shrunken, eosinophilic round body with variable nucleus, usually not accompanied by inflammation
  • Also called Councilman body, single cell death, apoptotic cell
  • Signifies nonspecific hepatocellular injury

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Acidophil bodies

Ballooning (feathery) degeneration
  • Swelling of hepatocytes with increased and pale cytoplasm, nonspecific
  • Leads to lytic necrosis and replacement by inflammatory cells

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Feathery (ballooning) degeneration

Bile ductules
  • Proliferate in pathologic conditions and can differentiate into hepatocytes to repopulate a destroyed liver
  • Small ovoid cells lying singly at periphery of portal tract or as strings within the lobule; not accompanied by artery
  • Mild bile ductular proliferation may be due to obstruction without bile duct disease (Mod Pathol 2004;17:874)

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Bile ductules due to chronic hepatitis C

Bridging necrosis
  • May also be called confluent
  • Necrotic cells spans adjacent lobules in portal-portal, portal-central or central-central pattern (Am J Dig Dis 1978;23:1076)

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Bridging necrosis

Centrilobular necrosis
  • Necrotic hepatocytes around central vein, usually due to ischemia, drugs or toxins
  • Common finding at autopsy because it is associated with circulatory failure or shock, which is common before all deaths
  • Distinguish from coagulative necrosis (hepatocytes are necrotic away from central vein)

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Centrilobular (left) versus coagulative necrosis (right)

Giant cell transformation

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Giant cell transformation

Glycogen nuclei
  • Homogenous clearing of hepatocyte nuclei, usually with enlargement, usually periportal
  • Seen in most biopsies in a few nuclei
  • Abundant in hyperglycemia, glycogen storage disease, Wilson disease, nonalcoholic steatohepatitis

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Glycogen nuclei

Interface hepatitis
  • Inflammatory cells between inflamed portal tracts and periportal parenchyma

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Interface hepatitis

Interlobular bile duct
  • Bile duct of medium sized portal tract that is centrally located in tract and accompanies similarly sized arteriole

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Interlobular bile ducts

Large cell change
  • Also called large cell dysplasia
  • Atypical hepatocytes with nuclear and cytoplasmic enlargement, nuclear pleomorphism with hyperchromasia, multinucleation but normal nuclear to cytoplasmic ratio
  • Often periseptal; doesn't deform surrounding architecture
  • May be associated with prolonged cholestasis
  • Appears to NOT be a premalignant condition (Hum Pathol 2009;40:1774)
Mallory hyaline
  • Also called Mallory bodies
  • Irregular, rope-like, sharply defined, intracytoplasmic eosinophilic deposits of cytokeratin, may assume C shape around nucleus, often in ballooning cells, surrounded by neutrophils in alcoholic liver disease
  • Associated with alcoholic and nonalcoholic steatohepatitis, various cholestatic conditions, Wilson disease
  • Positive stains: CK8, ubiquitin

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Mallory hyaline

Microvesicular steatosis
  • Multiple tiny intracytoplasmic fat droplets that do not displace the nucleus
  • May be so small that they simulate ballooning degeneration
  • Associated with alcoholic liver disease, acute fatty liver of pregnancy, outdated tetracycline, valproic acid, Reye syndrome, nucleoside analog therapy for HIV (Arch Pathol Lab Med 1999;123:189, Mod Pathol 2007;20:S40)

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Microvesicular steatosis

Macrovesicular steatosis
  • Single large intracytoplasmic fat droplet that displaces nucleus; associated with alcoholic liver disease, obesity, diabetes, nonalcoholic steatohepatitis, drug reactions, cystic fibrosis

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Macrovesicular steatosis

Oil Red O (fat) stain

Necrosis
  • Bridging necrosis (joins structures such as portal tracts), centrilobular necrosis and coagulative necrosis are described above; submassive necrosis is described below
  • Focal necrosis: individual hepatocytes, usually apoptosis (see acidophil body above)
  • Massive necrosis: all hepatocytes in biopsy
  • Piecemeal necrosis: affects hepatocytes at limiting plate; either necrosis of cells or irregularity of limiting plate caused by loss of hepatocytes and replacement with inflammatory cells or fibrosis; usually minimal lobular inflammation is present) or zonal (specific region such as centrilobular)

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Massive necrosis


Focal necrosis

Piecemeal necrosis

Passive congestion
  • Common finding at autopsy because associated with circulatory failure, which is common before all deaths
  • Also called nutmeg liver
  • Due to right sided cardiac decompensation
  • Liver large, tense, cyanotic around edges with congestion of centrilobular sinusoids
  • Over time, develops centrilobular necrosis

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Nutmeg liver

Small cell change
  • Also called small cell dysplasia
  • Small hepatocytes with increased nuclear density
  • May have basophilic cytoplasm but no significant nuclear atypia or enlargement
  • Usually present in clusters
  • Found in regeneration, atrophy, premalignant or malignant conditions (Oncol Rep 2010;23:1229)
Submassive necrosis
  • Prominent necrosis involving centrilobular zones or entire lobules in most of liver; associated with hepatic failure
  • May also be called confluent necrosis
  • Bile ductular proliferation prominent in necrotic zones in late stages
  • No significant collagen or elastic fiber deposition
  • Collapse of reticulin network in necrotic zones