Liver & intrahepatic bile ducts
General
Patterns of injury
Author: Komal Arora, M.D.
Topic Completed: 1 April 2012
Minor changes: 31 July 2020
Copyright: 2002-2021, PathologyOutlines.com, Inc.
PubMed Search: Patterns of hepatic injury[title]
Table of Contents
Acidophil body | Ballooning (feathery) degeneration | Bile ductules | Bridging necrosis | Centrilobular necrosis | Giant cell transformation | Glycogen nuclei | Interface hepatitis | Interlobular bile duct | Large cell change | Mallory hyaline | Microvesicular steatosis | Macrovesicular steatosis | Necrosis | Passive congestion | Small cell change | Submassive necrosisCite this page: Arora K. Patterns of injury. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/liverpatternshepaticinjury.html. Accessed January 17th, 2021.
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
- Hepatocyte with 6 or more nuclei (Ann Hepatol 2009;8:68)
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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
