Centrilobular necrosis in autoimmune hepatitis: a histological feature associated with acute clinical presentation

Abstract

Aims:The characteristic histological feature of autoimmune hepatitis (AIH) is interface hepatitis with predominant portal lymphoplasmacytic necroinflammatory infiltration. Centrilobular necrosis (CN), reminiscent of toxic or circulatory liver injury, has been reported in AIH. The aim of this study was to assess the frequency of CN in patients with AIH and its correlation with laboratory and clinical data. Methods: Liver biopsies were obtained from 114 patients (90 women, 24 men, mean (SD) age 45.4 (19.4) years) with AIH and were evaluated under code by a single pathologist according to the modified Knodell score. Results: CN was found in 20 (17.5%) patients with virtually unaffected portal areas in four cases. Patients with AIH with CN had a higher total hepatic activity index (median (range) 11 (6 to 15) v 5 (2 to 10)) and presented less frequently with cirrhosis (10% v 38%). Patients with CN had a higher frequency of acute onset (87% v 32%), higher bilirubin (median (range) 12.0 (0.43 to 40.0) v 1.9 (0.36 to 46)) and higher ALT levels (median (range) 25.6 (2.7 to 63.9) v 7.2 (0.7 to 62.6)), than did patients with AIH without centrizonal injury. Conclusion: CN with sparing of the portal areas represents a rare histological pattern in AIH. CN is associated with an acute clinical presentation and might reflect an early lesion preceding portal involvement. Recognition of this particular histological appearance enables early diagnosis of AIH and a timely initiation of immunosuppressive therapy.A utoimmune hepatitis (AIH) is characterised by the presence of autoantibodies, hypergammaglobulinaemia, elevated serum transaminases, and the histological evidence of interface hepatitis with a predominantly portal lymphoplasmacytic necroinflammatory infiltrate.

Auxiliary Liver Transplantation as a Transient Treatment for Acute Liver Failure: Two Cases

“…In the first biopsy during transplantation, the patient had only had centrilobular necrosis. These findings are consistent with the known idea that centrilobular necrosis can be the only pathologic feature in up to 2-3% of patients presenting with AIH flares [11][12][13]. Moreover, the patient had positive antimitochondrial antibodies, which, while being more specific for primary biliary cholangitis, might be associated with AIH [14].…”

Development of autoimmune hepatitis type 1 after pulsed methylprednisolone therapy for multiple sclerosis: A case report

“…However, few cases of AIH with centrilobular necrosis (CN) as the dominant finding have been reported [12] . Recently, some cases of CN with autoimmune features have been confirmed as early-stage AIH [13,14] . Acute-onset AIH sometimes does not satisfy AIH criteria serologically and shows CN histologically [14][15][16] .…”

“…Recently, some cases of CN with autoimmune features have been confirmed as early-stage AIH [13,14] . Acute-onset AIH sometimes does not satisfy AIH criteria serologically and shows CN histologically [14][15][16] . Although our patient showed a typical pattern of AIH at the second admission, liver dysfunction at the first admission may have been due to early-stage AIH.…”

Histological Findings of Autoimmune Hepatitis

“…17). Perivenular zonal necrosis and bridging necrosis among portal tracts and central veins, and rarely periportal zonal necrosis, may accompany lobular disarray (Figs 18 and 19) [31][32][33]. In some cases, zonal necrosis (zone 3 necrosis, centrozonal necrosis) located around the central vein, similar to a characteristic of drug-induced liver injury, is prominent (Fig.20) [34,35].…”