Necrosis of hepatocytes may occur in a variety of patterns.
Necrosis may affect single, scattered hepatocytes (drop-out) or groups of hepatocytes.
Usually when multiple hepatocytes undergo necrosis the necrosis occurs in one of the 3 zones of the hepatic lobule.
Location with the Hepatic Lobule
Zone
Example
periportal (around the portal tracts)
1
phosphorus poisoning
midzonal
2
yellow fever
centrilobular (around the central vein
3
cardiogenic shock
Piecemeal necrosis occurs at the limiting plate around a portal tract and is typically seen in chronic active hepatitis.
Panlobular necrosis refers to all 3 zones being affected.
Bridging necrosis may be:
(1) portal vein/triad to portal vein/triad
(2) central vein to central vein
(3) portal to central vein
Confluent necrosis affects multiple adjacent hepatic lobules.
Submassive or massive refers to necrosis affecting the entire liver. If this occurs over a very short period of time then it is fulminant.
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Specialty: Gastroenterology, Clinical Laboratory
