Relation between central canals and portal tracts in alcoholic hepatitis: A contribution to the pathogenesis of cirrhosis in alcoholics

Abstract

The relation between central canals and portal tracts was determined in 42 biopsy and eight autopsy specimens with histologic signs of acute alcoholic hepatitis. Five stages were recognized. Acute alcoholic hepatitis in the absence of septa between central and portal areas was always centrolobular in the specimens examined. When necrosis associated with inflammation and fibrosis connected hepatic vein tributaries and portal tracts in a “bridge”-like fashion, hepatitic manifestations including alcoholic hyaline were also found in the periphery of the hepatic lobule. The presence of proliferated bile ductules in the “bridges” and thus in the vicinity of sclerosed central veins may create the impression that the main lesion is portal. This might explain the long delay in recognizing that alcoholic hepatitis is basically a central lesion. The collapse of the described bridge-like connections initiates cirrhosis development. This and the occasional massive necrosis occurring in alcoholic hepatitis explain the similarity of the architectural alteration in alcohol and viral hepatitis induced and cryptogenic liver cirrhosis, even if the initial cytologic characteristics are missing.