Severe Large Droplet Steatosis, Steatohepatitis and Developing Cirrhosis (H&E)
(1 = hematoxylin and eosin, 2 = trichrome)
This autopsy microscopic slide comes from the liver of a 56 year old woman with a history of hypertension, hyperlipidemia, hypercholesterolemia and chronic back pain who was admitted with hypotensive shock due to major gastrointestinal bleeding and coagulopathy. She died within 24 hours of her gastrointestinal hemorrhage which was within the small intestine and unrelated to esophageal varices . There was no history of alcohol ingestion. The liver at autopsy was grossly hugely enlarged and pale (3180 g or nearly 3 times the normal weight of < 1500 g.) and showed a micronodular outer capsular appearance. (This slide also shows a section of kidney which is not the subject of this laboratory).
Questions
- What are the two major pathologic conditions affecting the liver in this case?
- What stage of disease is present in this liver?
- Can similar changes be seen in alcoholics?
- What are some other etiologies of large droplet fatty liver with or without steatohepatitis?
- Can you explain the patient's gastrointestinal hemorrhage in the absence of postmortem demonstration of bleeding esophageal varices?