A 55-year-old alcoholic develops jaundice, coagulopathy, and encephalopathy over 4 weeks. Liver biopsy shows zone 3 (pericentral) necrosis, Mallory-Denk bodies (intracytoplasmic eosinophilic aggregates), neutrophilic infiltration, and ballooning degeneration. The molecular composition of Mallory-Denk bodies includes:
- A Amyloid fibrils of misfolded serum albumin
- B Glycogen-laden smooth ER proliferation
- C Ubiquitinated, aggregated keratins 8 and 18 with p62/sequestosome-1 and heat shock proteins ✓
- D Hemosiderin granules from iron overload
Explanation
Mallory-Denk bodies (formerly Mallory hyaline) are intracytoplasmic inclusions consisting of aggregated intermediate filaments — specifically ubiquitin-labeled, misfolded keratins 8 and 18 — along with p62/sequestosome-1 (an autophagy adapter), ubiquitin-binding proteins, and heat shock proteins HSP70/HSP90. They represent failed proteolytic clearance of damaged cytokeratin. They occur in alcoholic hepatitis, NASH, primary biliary cholangitis, Wilson disease, and other hepatocellular injuries. Mallory-Denk bodies are not specific to alcohol but are very characteristic of alcoholic hepatitis when accompanied by neutrophilic satellitosis.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.