A 45-year-old woman with chronic hepatitis B undergoes liver biopsy. Scattered hepatocytes show intensely eosinophilic, shrunken cytoplasm with pyknotic nuclei and no surrounding inflammatory reaction. Which process best explains this finding?
- A Apoptosis of individual hepatocytes ✓
- B Coagulative necrosis from ischemic injury
- C Ballooning degeneration preceding lytic necrosis
- D Fat necrosis with saponification
Correct answer: A. Apoptosis of individual hepatocytes
Explanation
The Councilman body, an acidophilic apoptotic hepatocyte seen in viral hepatitis, shows shrinkage, intense eosinophilia, pyknosis, and rapid phagocytosis without inflammation. Coagulative necrosis preserves tissue architecture and provokes an inflammatory infiltrate, which is absent here. Ballooning degeneration produces swollen, pale cells rather than shrunken eosinophilic ones. The single-cell pattern without inflammation is the hallmark that distinguishes apoptosis from any form of necrosis.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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