Anatomic Pathology: Liver Pathology

• Centrilobular necroinflammation is a major histologic finding in a variant histologic form of autoimmune hepatitis.

• Centrilobular necroinflammation also may be seen as a possible manifestation of liver allograft rejection in more severe cases of acute rejection or in “late” settings often many months after transplantation. Sometimes the rejection is histologically limited to only centrilobular necroinflammation (so-called isolated central perivenulitis) without accompanying typical changes of portal tract bile duct damage, inflammation, and portal vein endotheliitis.

• Lack of awareness of the entity of autoimmune centrilobular necroinflammation can result in attribution of necroinflammatory lesions to “drug hepatitis” or other causes that are usually not relevant in the particular clinical setting.

• Assessment of serum autoantibodies (including antinuclear, anti–smooth muscle, anti–liver-kidney microsomal, and other autoantibodies) and serum IgG level is important to support the diagnosis of variant form of autoimmune hepatitis further.

• The prominence of lymphoplasmacytic inflammation at the sites of centrilobular necrosis is an important feature to distinguish from acetaminophen toxicity, which usually causes centrilobular coagulative necrosis with few lymphocytes or plasma cells.