Postmoem histologic sections taken from the liver of a 19-year-old female who died from an overdose of acetaminophen would most likely revea
The type and distribution of necrotic hepatocytes is often a clue as to the cause of the hepatic injury. Focal scattered necrosis is characteristic of viral hepatitis, but may also be seen with bacterial infections or other toxic insults. In focal necrosis, there is necrosis of single hepatocytes, or small clusters of hepatocytes, that is randomly located in some, but not all, of the liver lobules. In contrast, zonal necrosis refers to the finding of hepatocellular necrosis in identical areas in all of the liver lobules. There are basically three types of zonal necrosis. Centrilobular (acinar zone 3) necrosis is characteristic of ischemic injury (hea failure or shock), toxic effects (acetaminophen toxicity), carbon tetrachloride exposure, or chloroform ingestion. Drugs such as acetaminophen may be metabolized in zone 1 to toxic compounds that cause necrosis of zone 3 hepatocytes because they receive the blood from zone 1. Midzonal (zone 2) necrosis is quite rare, but may be seen in yellow fever, while peripoal (zone 1) necrosis is seen in phosphorus poisoning or eclampsia. Submassive necrosis refers to liver cell necrosis that crosses the normal lobular boundaries. Classically the necrosis goes from poal areas to central veins (or vice versa) and is called bridging necrosis. If the hepatocellular necrosis is severe, it is called massive necrosis. This type of extensive necrosis is described as acute yellow atrophy, as grossly the liver appears soft, yellow, flabby, and decreased in size with a wrinkled capsule. It may be produced by hepatitis viruses (usually B or C), drugs, or chemicals. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition
Centrilobular necrosis
Focal scattered necrosis
Midzonal necrosis
Peripoal necrosis
General pathology