Histology Course S II 4 Department of Pathology, University of Zurich Histokurs

S II 4 massive hepatic necrosis HE further information (German) on HiPaKu
  ICD-10: K72

31-year-old female. Mushroom poisoning (Amanita phalloides). Death after 14 days with hepatic coma with remarkable icterus.

- Extensive sublobular to lobular liver necrosis which predominantly affects zones 2 and 3.
- Scattered areas of total necrosis
- Within the necrosis, marked by mesh grid, ceroid-storing macrophages can be recognised.
- Zone 1 only partially preserved, with macro- and microvesicular, small- to moderate-sized-drop steatosis
- Bile ductule-like structures (so called pseudoductules), originated from hepatocyte regeneration
- Inflammatory infiltrates localised especially in the area of portal fields
- In the remaining parenchyma: bile in the distended canaliculi, in the ductules and pseudoductules

Other causes of massive liver necrosis: intoxication with paracetamol or tetracarbon

Similar distribution pattern of the necrosis in fulminant hepatitis of viral or medicinal aetiology (e.g halothane)