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
- In the remaining parenchyma: bile in the distended canaliculi,
in the ductules and pseudoductules
Other causes of massive liver necrosis: intoxication with paracetamol
Similar distribution pattern of the necrosis in fulminant hepatitis
of viral or medicinal aetiology (e.g halothane)