56-year-old male exhibited splenomegaly and spider nevi. He succumbed to ruptured esophageal varices (portal hypertension) (specimen from autopsy).
- Liver parenchyma shows marked nodularity; nodules of hepatocytes are surrounded by dense fibrous scar tissue. Due to central-portal fibrous bridging a central vein is lacking. An excentric efferent venule may be present.
- Marked pericellular and sinusoidal fibrosis (lattice-like or chicken-wire appearance).
- Fibrous septa contain portal tracts and show a predominantly lymphocytic infiltrate and bile ductular proliferations.
- Hepatocytes show minimal macrovesicular steatosis. Some contain mallory’s hyaline (blue, ropey cytoplasmic inclusions that appear eosinophilic in HE stain). Some hepatocytes display hydropic swelling.
- If present, nuclei may be enlarged exhibiting a vesicular chromatin and a prominent nucleolus.
Chronic excessive intake of alcohol is associated with (1) hepatic steatosis, (2) alcoholic hepatitis and (3) cirrhosis. Whereas the first is completely reversible upon cessation of alcohol intake, alcoholic hepatitis frequently progresses to cirrhosis. In cases of established cirrhosis a marked steatosis is frequently absent. Mallory's hyaline and hydropic swelling of hepatocytes are frequently seen in alcoholic liver cirrhosis.