Centrolobular Necrosis
Definition
Hepatocellular necrosis in zone 3 of the hepatic acinus, the zone most vulnerable to ischaemia due to lowest oxygen tension and highest cytochrome P450 activity. The characteristic hepatic finding in heat stroke, also seen in right-heart failure and paracetamol overdose.
- Location
- Zone 3 of the hepatic acinus
- Vulnerability cause
- Lowest oxygen tension, highest cytochrome P450 activity
- Classic cause
- Heat stroke
- Also seen in
- Right-heart failure, paracetamol overdose
- Tissue type
- Hepatocellular
Common questions
Why does zone 3 die first in both heat stroke and paracetamol overdose despite different causes?+
Zone 3 sits farthest from the blood supply entering the liver lobule, so it receives the least oxygen, and it also carries the highest concentration of cytochrome P450 enzymes, which both worsens ischaemic injury and generates the toxic paracetamol metabolite in overdose.
Can centrolobular necrosis alone confirm heat stroke as the cause of death?+
No, because right-heart failure and paracetamol toxicity produce the same pattern. It must be interpreted alongside scene circumstances, core temperature history, toxicology and other autopsy findings before attributing it to a specific cause.
Related terms
- Coagulative Necrosis
- Cell death in which the architecture of the tissue is preserved as a firm, pale eschar because the denaturing agent precipitates proteins...
- Liquefactive Necrosis
- Cell death in which the normal tissue architecture is dissolved into a soft, liquid mass. Produced by strong alkalis (hydroxide saponifies lipids...
- Paradoxical Undressing
- Removal of clothing in the final phase of hypothermia, driven by central thermoregulatory failure and peripheral vasodilatation producing a subjective sensation of...
- Paraquat Lung Score
- Radiological scoring system combining chest X-ray infiltrate extent and CT parenchymal changes to predict 30-day mortality in paraquat poisoning. Developed at the...
- Wischnewski Spots
- Small, haemorrhagic, oval erosions at the tips of the gastric rugal folds. The most specific autopsy finding in hypothermia, present in 56-85%...