|

 

This 54-year-old man with a long history of alcohol abuse had been admitted to the
hospital numerous times for abdominal pain thought to be due to gastritis or a peptic
ulcer. On several occasions his serum amylase level was elevated into the range
of 300-500 u/L indicating relapsing or recurrent pancreatitis. Three weeks prior to his
demise, the patient began an alcoholic binge. The binge continued until three days
prior to the patient's death at which time he developed fever and malaise, prompting
him to cease drinking. He was brought to the hospital semi-comatose and with a fever
of 105.4°F. Shortly after arriving at the hospital, the patient died from
massive pneumonia.
 




At autopsy, a necrotizing lobar pneumonia was present which contained organisms

consistent with Klebsiella pneumoniae. The liver was enlarged--weighing 2700 grams-
-and had a yellow-orange color. The liver was firm to palpation and the cut surface
had a slightly granular appearance suggestive of early cirrhosis. The pancreas
showed multiple areas of fibrosis.
This gross photograph of liver tissue illustrates the yellowish
color of the liver parenchyma. The yellow color indicates high
fat content in this tissue. Compare this with the normal dark
red color of liver.
This low-power photomicrograph of liver illustrates a very pale-staining section
with a uniform appearance throughout the section.
Another low-power photomicrograph illustrates again the
pale, washed-out appearance of this tissue. Notice the
numerous holes throughout the tissue. There are
accumulations of inflammatory cells (arrows) around portal
tracts.
A higher-power photomicrograph illustrates more clearly the inflammatory
cells (arrows) around the portal areas.
This higher-power photomicrograph of the centrilobular area gives the
appearance of fatty tissue, as indicated by many empty spaces. Very
few normal liver cells can be seen in this slide. A few more normal-
appearing hepatocytes are present at the left portion of the slide
(arrows).
Another view at the same power illustrates the proliferation of bile ducts in
the interlobular and perichordal regions (arrows).
A high-power photomicrograph of the liver parenchyma shows that each
individual liver cell is filled with a large, clear droplet which represents the
space remaining after lipid was dissolved by the dehydration procedure
used to embed the tissue. '''Note that each empty space is surrounded by
a thin rim of eosinophilic cytoplasm; in many instances, the hepatocyte
nucleus can be seen as well. The red body (arrow) seen within a cell in
the center of the slide is an acidophilic body associated with alcoholic
hepatitis.
An oil red O stain for fat was performed on a frozen section of this liver
tissue. The red droplets represent fat in the tissue which is typical of
fatty degeneration in the liver. By using frozen sections the tissues do
not have to be dehydrated through alcohol solutions and thus the fat
does not get washed out.
This photomicrograph of the liver is from another patient with a history of
alcohol use. There are some clear vacuoles indicating fat droplets (1)
and there are numerous red-staining granular deposits within the
cytoplasm of hepatocytes (2)--this is alcoholic hyalin. Alcoholic hyalin is
easily distinguished from red blood cells (3) that are also present in this
section.
This is a low-power photomicrograph of liver stained with a
trichrome stain. In this section, connective tissue stains green
(arrows) and hepatic parenchymal cells are red. Note that many
of the parenchymal cells have clear spaces indicating fatty
degeneration. The proliferation of scar tissue between the liver
lobules is the result of cirrhosis.
This gross photograph of liver demonstrates severe nodular cirrhosis.
Note the extensive scarring of the capsule and the nodular projections of
tissue through the uncut capsule in this tissue. The green color is due to
the accumulation of bile pigment.
This is a cut surface of the same tissue seen in the previous slide.
Note the marked nodular pattern. The paler-staining areas
between the round nodules represent fibrous connective tissue.




1. What is accumulate in hepatocytes to produce fatty liver?

2. What can cause liver steatosis and what is the probable cause of
fatty liver in this case?
3. Describe mechanism of hepatocellular steatosis in an alcoholic?
4. Is the accumulation of fat in the liver a reversible or an irreversible
event?