SDL 22. Metabolic Liver Disease

non-alcoholic steatohepatitis (NASH)

NAFLD; showing predominately macrovesicular steatosis + inflammatory foci (composed of lymphocytes and macs/Kupffer cells)

2 hrs s/p acetaminophen toxicity

centrilobular hepatocytes are vacuolated, shrunken, necrotic (arrows)

non-alcoholic fatty liver disease

chicken wire fibrosis (perivenular/pericellular)

1 hr s/p acetaminophen toxicity

adduct throughout centrilobular + midzonal regions

non-alcoholic fatty liver disease

ballooned hepatocytes w/surrounding inflammatory cells

alcoholic liver disease

hepatis steatosis of mod. degree composed of small + large-droplet fat (steatosis most prominent near central v. (*), extends outward toward portal tract w/increasing severity)

alcoholic steatohepatitis

hepatocyte ballooning degeneration (note swelling + rare-fraction of cytoplasm)

drug-induced acute hepatitis

hepatocyte swelling infiltration of inflammatory cells (black arrow) hepatocellular necrosis (white arrow)

acetaminophen intoxication

massive centrilobular necrosis w/relative preservation of the portal tracts

drug-induced microvesicular steatosis

numerous small lipid droplets throughout cytoplasm of hepatocytes

alcoholic steatohepatitis

portal tract fibrosis in center, associated w/lymphocytic/monocytic inflammatory infiltrate + macrovascular steatosis

drug-induced pure cholestasis

prominent bile plugs present in hepatocytes and canaliculi w/o inflammation or hepatocellular damage

alpha1 antitrypsin deficiency

red cytoplasmic granules

Mallory bodies

red, globular material accumulated in hepatocyte cytoplasm; composed of cytoskeletal intermediate filaments in complex w/ubiquitin (ropy/clumpy eosinophilic inclusions)

drug-induced macrovesicular steatosis

toxic hepatitis; fat vacuoles distending the hepatocyte + pushing the nucleus/cytoplasm to the side