Table 1:

Causes of Hepatic Necrosis with Associated Demographics, Pathological Features, and Ancillary Studies Available to Aid in Diagnosis.

Category	Age	Clinical Presentation	Gross Features	Microscopic Features	Ancillary Studies
Alcohol	Adulthood	Variable, may result in ALF or ACLF	Enlarged, fatty liver or cirrhosis	Steatosis, lobular inflammation, Mallory bodies
Intrinsic drug (acetaminophen, halothane, carbon tetrachloride)	Varies	ALF	Centrilobular necrosis	Zone 3 necrosis without significant inflammation	Toxicology
Idiosyncratic drug (numerous including antimicrobial, herbal, and CNS agents)	Varies; typically adulthood	Subacute liver failure	Varies; possible submassive necrosis and regenerative nodules	Varies	Toxicology
Hepatotrophic viruses	Varies, typically adulthood	Varies, including ALF and ACLF	Varies	Portal lymphocytic infiltrate	Serology, PCR, IHC stains
Non-hepatottrophic viruses	Varies	ALF	Punctate pale lesions throughout parenchyma	Patchy necrosis, viral inclusions	Serology, PCR, IHC stains
Autoimmune	Young adults	Varies, including ALF and ACLF; also endocrine dysfunction, elevated IgG, autoantibodies	Varies	Zone 3 necrosis, plasma cell infiltrate, resetting, and emperipolesis
Ischemia	Varies, typically adulthood	Circulatory collapse, blood loss, CHF	Varies, purple discoloration to passive congestion	Varies, typically Zone 3 necrosis
Metabolic	Childhood	Varies	Varies	Varies	Special stains

ALF - Acute liver failure

ACLF - Acute-on-chronic liver failure

CNS - Central nervous system PCR - Polymerase chain reaction IHC - Immunohistochemical

CHF - Congestive heart failure