Fulminant hepatic necrosis

Fulminant hepatic necrosis is extensive cell death in the liver. It is classified as a medical liver disease.

General

Etiology:

• Viral, i.e. Hepatitis A, Hepatitis B; Hepatitis C - extremely rare.
• Trauma.
• Shock.
• Poisoning, e.g. mushrooms.

Microscopic

Features:

• Hepatocyte necrosis - key feature.
• Bile duct proliferation.
• Inflammatory cell infiltrate.

DDx:

• Cholangiocarcinoma.
• Angiosarcoma.
• Necrotic metastatic tumour.

Images

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Submassive hepatic necrosis. Patient had transaminases in the thousands that rapidly dropped to normal. A/ Pink preserved parenchyma strews empty necrotic spaces. B. Focus of necrosis with no apparent hepatocytes macrophages abuts apparently normal liver. C. Iron stain shows the macrophages bear hemosiderin. D. Reticulin stain highlights the recently dead liver cells. E. Reticulin stain shows a necrotic bridge forming; the multiple small black circles preclude diagnosis of a fibrous bridge. F. Trichrome shows the necrotic bridge (“collapse”) lacks much collagen deposition, as would be expected for bridging fibrosis.

See also

• Necrosis.
• Medical liver disease.