The nature of cell death in piecemeal necrosis: Is order emerging from chaos?

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Abstract
Electron microscopic studies of acidophilic or Councilman-like bodies in the liver show that they are manifestations of apoptosis. The morphology and biochemistry of apoptosis suggest a process of active cellular self-destruction rather than degeneration. The incidence of apoptosis indicates that it is normally involved in the regulation of organ size and, in addition, may be triggered by specific pathological stimuli. Cell death produced in vitro by various types of cell-mediated immune injury occurs by apoptosis The occurence of apoptosis in hepatic disease is illustrated and discussed. That it constitutes the only clearly identifiable mode of cell death in most types of acute and chronic hepatitis and in primary biliary cirrhosis is in accord with current concepts of the pathogenesis of these conditions. Furthermore, the morphological features of apoptosis may explain long-standing enigmas in the histology of hepatitis--the cryptic nature of the cell death in piecemeal “necrosis” and the apparent drop-out of large numbers of hepatocytes in many cases of acute hepatitis without overt evidence of necrosis. Apoptosis represents rapid budding of a cell to form numerous globules, the largest of which appear to be acidophilic bodies. All apoptotic fragments are quickly removed by adjacent cells without evident inflammation, permitting the process to occur inconspicuously.
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