panlobular necrosis

Definition: Panlobularnecrosis (panacinar necrosis) and multilobular necrosis (multiacinar necrosis) are terms used to describe confluent necrosis involving entire single lobules or several adjacent lobules respectively.

In a minority of patients with acute hepatitis, confluent necrosis extends throughout entire lobules or acini (panlobular necrosis or panacinar necrosis) or several adjacent ones (multilobular necrosis or multiacinar necrosis). This is a common feature in patients with "fulminant hepatitis".

The term ‘massive hepatic necrosis’ is also sometimes used, but can be misleading in so far as a needle biopsy specimen may not be representative of the liver as a whole and can lead to over- or under-estimation of the true extent of liver damage.

This throws doubt on the usefulness of liver biopsy as a means of assessing prognosis in "severe acute hepatitis". Sometimes, multilobular necrosis involves only the subcapsular zone, and a small needle specimen may then give a falsely pessimistic picture.

In multilobular necrosis, the parenchyma is replaced by collapsed stroma, inflammatory cells and activated macrophages.

Around the surviving portal tracts, there are prominent duct-like structures, some of which probably represent proliferation of pluripotential progenitor cells.

Late-onset hepatic failure is a term used for patients developing encephalopathy between 8 and 24 weeks after onset of symptoms.

Study of liver biopsies and explanted livers from these patients has shown a consistent pattern of map-like necrosis together with areas of nodular regeneration.

See also

 hepatic necrosis
 hepatocytic necrosis