Necrosis and Inflammation This image shows confluent necrosis with lymphoplasmacytic inflammation . Swelling, inflammation, and regenerative changes are seen in the remaining parenchyma . Ductular reaction is a common finding in the setting of necrosis and does not necessarily signify biliary disease.
Necrosis Without Inflammation This image shows extensive panacinar necrosis with negligible inflammation , findings typical of toxic pattern of drug injury.
Acetaminophen-Related Acute Liver Failure Multiacinar hemorrhagic necrosis , congestion , and lack of inflammation with sparing of periportal hepatocytes are typical of acetaminophen toxicity but can also be seen in acute ischemia and acute Budd-Chiari syndrome.
Microvesicular Steatosis Multiple small fat droplets are seen filling the cytoplasm . There is no necrosis or inflammation.
TERMINOLOGY
Abbreviations
• Acute liver failure (ALF)
Definitions
• Hepatic encephalopathy and reduced synthetic function evidenced by INR > 1.5
• Duration of disease less than 26 weeks
• Absence of chronic liver disease
Corresponding pathologic term is massive/submassive necrosis or fulminant hepatitis
ETIOLOGY/PATHOGENESIS
Mechanisms of Injury
• Massive/submassive necrosis due to intrinsic hepatotoxins
Most toxins fall in this category
– Carbon tetrachloride, mushroom poisoning, recreational drugs like cocaine and MDMA (ecstasy)
. Swelling, inflammation, and regenerative changes are seen in the remaining parenchyma 
. Ductular reaction 
is a common finding in the setting of necrosis and does not necessarily signify biliary disease.
with negligible inflammation 
, findings typical of toxic pattern of drug injury.
, congestion 
, and lack of inflammation with sparing of periportal hepatocytes 
are typical of acetaminophen toxicity but can also be seen in acute ischemia and acute Budd-Chiari syndrome.
. There is no necrosis or inflammation.
