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Related Experiment Videos

Autoimmune hepatitis with centrilobular necrosis.

Joseph Misdraji1, Michael Thiim, Fiona M Graeme-Cook

  • 1James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. jmisdraji@partners.org

The American Journal of Surgical Pathology
|April 17, 2004
PubMed
Summary
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Autoimmune hepatitis (AIH) can present with centrilobular necrosis (CN), a rare pattern. Early recognition and steroid treatment for AIH with CN can prevent cirrhosis.

Area of Science:

  • Hepatology
  • Immunology
  • Pathology

Background:

  • Autoimmune hepatitis (AIH) typically presents as chronic portal-based hepatitis.
  • Centrilobular necrosis (CN) is an uncommon predominant pattern in AIH.
  • Recognizing AIH in zone 3 hepatitis is crucial for timely steroid therapy and preventing cirrhosis.

Purpose of the Study:

  • To describe the clinicopathologic features of autoimmune hepatitis (AIH) cases presenting with centrilobular necrosis (CN).
  • To highlight the importance of considering AIH in patients with zone 3 hepatitis.

Main Methods:

  • Retrospective analysis of 6 AIH patients with centrilobular necrosis (CN).
  • Review of clinical history, serologic tests (viral hepatitis B/C, autoantibodies), and liver biopsy findings.

Related Experiment Videos

  • Assessment of response to steroid therapy.

    • Main Results:

    • Six patients (3 male, 3 female, mean age 48) with AIH and CN were identified.
    • Four biopsies showed confluent CN, two showed spotty CN; portal inflammation was mild.
    • All patients responded to steroid therapy; relapses occurred in two cases.

    Conclusions:

    • The histologic spectrum of AIH should include zone 3 hepatitis with centrilobular necrosis (CN).
    • AIH with CN often presents with serologic and clinical evidence of autoimmunity.
    • Timely diagnosis of AIH with CN is vital as it is steroid-responsive, unlike other causes of zone 3 hepatitis.