A 48-year-old man who drinks 6–8 units of alcohol daily for 20 years presents with right upper quadrant discomfort, jaundice, and hepatomegaly. Liver biopsy shows ballooning degeneration of hepatocytes, Mallory-Denk bodies (intracytoplasmic eosinophilic inclusions), neutrophilic lobular infiltrates, and pericellular (chicken-wire) fibrosis around zone 3 hepatocytes. What is the diagnosis?
- A Non-alcoholic steatohepatitis (NASH)
- B Acute viral hepatitis B with lobular disarray
- C Alcoholic hepatitis ✓
- D Primary biliary cholangitis (PBC)
Explanation
The triad of ballooning degeneration, Mallory-Denk bodies (aggregates of ubiquitinated cytokeratin 8/18 intermediate filaments), and neutrophilic lobular infiltrates in the context of heavy alcohol use is diagnostic of alcoholic hepatitis. The characteristic pericellular 'chicken-wire' fibrosis begins in zone 3 (centrilobular) due to relative hypoxia there. NASH has a nearly identical histology but occurs without significant alcohol use. PBC shows florid duct lesions and portal granulomas; acute viral hepatitis shows lymphocytic lobular inflammation and acidophil bodies.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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