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Marked cell enlargement with irregularly clumped cytoplasm showing large, clear spaces.

Ballooning degeneration (TOPNOTCH) Robbins Basic Pathology, 8th ed, p633


Multiple tiny fat droplets that do not displace the nucleus which appear in such conditions as alcoholic liver disease, Reye syndrome, and acute fatty liver of pregnancy.

Microvesicular steatosis Robbins Basic Pathology, 8th ed, p633


A single large fat droplet that displaces the nucleus seen in alcoholic liver disease or in the livers of obese or diabetic individuals.

Macrovesicular steatosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p633


Diffuse, foamy, swollen appearance to the hepatocyte caused by retained biliary material.

Feathery degeneration(TOPNOTCH)Robbins Basic Pathology, 8th ed, p633


Poorly stained mummified hepatocytes.

Coagulative necrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p633


Isolated hepatocytes become shrunken, pyknotic, and intensely eosinophilic.

Apoptosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p633


Hepatocyte necrosis is distributed immediately around the central vein, extending into the midzonal area in the setting of ischemia and several drug and toxic reactions.

Centrilobular necrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p633


A pattern of nonrhythmic, rapid extension-flexion movements of the head and extremities, best seen when the arms are held in extension with dorsiflexed wrists, seen in patients with hepatic encephalopathy.

Asterixis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p635


A diffuse process characterized by bridging fibrous septa, in the form of delicate bands or broad scars around multiple adjacent lobes, and the conversion of normal liver architecture into structurally abnormal nodules, encircled by fibrotic bands. Liver architecture is disrupted.

Liver Cirrhosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p635


Presence of "ground-glass" hepatocytes, a finely granular, eosinophilic cytoplasm and "sanded" nuclei, shown by electron microscopy

Hepatitis B infection(TOPNOTCH)Robbins Basic Pathology, 8th ed, p645


Necrotic cells appear to have "dropped out," with collapse of the sinusoidal collagen reticulin framework where the cells have disappeared; scavenger macrophage aggregates mark sites of dropout.

Hepatocyte cytolysis (in viral hepatitis)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p647


Hepatocytes shrink, become intensely eosinophilic, and have fragmented nuclei; effector T cells may be present in the immediate vicinity.

Hepatocyte apoptosis (in viral hepatitis)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p647


The hallmark of serious liver damage.

Fibrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p647


May occur as solitary or multiple lesions, ranging from millimeters to massive lesions, many centimeters in diameter. They are generally produced by gram-negative bacteria such as Escherichia coli and Klebsiella sp.

Pyogenic (bacterial) hepatic abscesses (TOPNOTCH)Robbins Basic Pathology, 8th ed, p648


Liver is enlarged (4-6kg), soft, yellow and greasy.

Hepatic Steatosis (Fatty Liver)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p649


Lipid accumulates to the point of creating large clear macrovesicular globules, compressing and displacing the nucleus to the periphery of the hepatocyte.

Hepatic Steatosis (Fatty Liver)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p649


Eosinophilic, cytoplasmic inclusions characteristic of alcoholic hepatitis.

Mallory bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed, p650


Almost always accompanied by a brisk sinusoidal and perivenular fibrosis; occasionally periportal fibrosis may predominate.

Alcoholic hepatitis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p650


Liver is yellow-tan, fatty, and enlarged, usually weighing over 2 kg. Over the span of years it is transformed into a brown, shrunken, nonfatty organ, sometimes weighing less than 1 kg.

Alcoholic Cirrhosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p650


Pattern of cirrhosis in viral hepatitis.

Macronodular(TOPNOTCH)Robbins Basic Pathology, 8th ed, p650


Pattern of cirrhosis in alcoholic hepatitis.

Micronodular(TOPNOTCH)Robbins Basic Pathology, 8th ed, p650


The liver may shrink to 500 to 700 gm and become transformed into a limp, red organ covered by a wrinkled, overly large capsule. Necrotic areas have a muddy red, mushy appearance with blotchy bile staining. Complete destruction of hepatocytes in contiguous lobules leaves only a collapsed reticulin framework and preserved portal tracts.

Massive hepatic necrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p653


Characterized by deposition of hemosiderin in the following organs: liver, pancreas, myocardium, pituitary, adrenal, thyroid and parathyroid glands, joints, and skin; cirrhosis; and pancreatic fibrosis

Hereditary hemochromatosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p655


Golden-yellow granules in the cytoplasm of periportal hepatocytes, which stain blue with the Prussian blue stain.

Hemosiderin(TOPNOTCH)Robbins Basic Pathology, 8th ed, p655


Green to brown deposits of copper in Descemet membrane in the limbus of the cornea.

Kayser-Fleischer rings (TOPNOTCH)Robbins Basic Pathology, 8th ed, p656


Excessive copper deposition in the liver causing hepatic changes ranging from mild fatty change to massive liver necrosis. In the brain, injury affects the basal ganglia, demonstrating atrophy and cavitation. Kayser-Fleischer rings are characteristic.

Wilson disease(TOPNOTCH)Robbins Basic Pathology, 8th ed, p655


Hepatocytes with round to oval cytoplasmic globular inclusions which are strongly positive in a periodic acid-Schiff stain. By electron microscopy they lie within smooth, and sometimes rough, endoplasmic reticulum.

Alpha-1 antitrypsin Deficiency(TOPNOTCH)Robbins Basic Pathology, 8th ed, p657


A rare disease characterized by microvesicular fatty change in the liver and encephalopathy. Microscopy of hepatocellular mitochondria reveals pleomorphic enlargement and electron lucency of the matrices, with disruption of cristae and loss of dense bodies.

Reye syndrome / "mitochondrial hepatopathies" (TOPNOTCH)Robbins Basic Pathology, 8th ed, p658


A chronic, progressive, and often fatal cholestatic liver disease, characterized by a nonsuppurative destruction of small and medium-sized intrahepatic bile ducts ("florid duct lesion"). On cut surface, the liver is hard, with a finely granular appearance, with extraordinary yellow-green pigmentation.

Primary biliary cirrhosis (TOPNOTCH)Robbins Basic Pathology, 8th ed, p659


A chronic cholestatic disorder, characterized by progressive fibrosis and destruction of extrahepatic and large intrahepatic bile ducts. Affected portal tracts show concentric periductal "onion-skin" fibrosis and a modest lymphocytic infiltrate. Progressive atrophy of the bile duct epithelium leads to obliteration of the lumen, leaving behind a solid, cordlike fibrous scar.

Primary sclerosing cholangitis (TOPNOTCH)Robbins Basic Pathology, 8th ed, p660