A 45-year-old man with alcoholic liver disease shows hepatocyte ballooning on biopsy with cytoplasmic accumulation of irregular eosinophilic material (Mallory-Denk bodies). This material consists primarily of which components?

• A Alpha-1-antitrypsin polymers retained in the endoplasmic reticulum
• B Fibrin degradation products deposited in the hepatocyte cytosol
• C Glycogen granules complexed with heat shock protein 70
• D Keratin 8 and keratin 18 intermediate filaments cross-linked by p62/sequestosome ✓

Explanation

Mallory-Denk bodies (MDB) are composed of keratin 8 and keratin 18 intermediate filaments that have been ubiquitinated and cross-linked with p62/sequestosome-1 and ubiquitin-binding proteins, reflecting impaired protein quality control (autophagy/proteasome dysfunction). They are markers of hepatocyte injury in alcoholic steatohepatitis, NASH, and Wilson disease.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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