MEDizzy - A 30-year-old woman presents with malaise and increasing

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General Pathology (I)

A 30-year-old woman presents with malaise and increasing fatigue. Physical examination finds a yellow tinge to her skin and sclera, and laboratory evaluation finds elevated serum liver enzymes. After further workup, the diagnosis of viral hepatitis is made. This workup included a liver biopsy, which revealed scattered, eosinophilic cells (Councilman bodies), but very little inflammation was present. These Councilman bodies were formed by an active process that characteristically lacks an inflammatory response and results from the activation of genes that form new enzymes, such as endonucleases. These enzymes subsequently destroy the cell itself. Which of the following terms best describes this process?

ExplanationApoptosis is a distinctive pattern of cell death that is described as a “programmed suicide” process of cells through which stimulation of endogenous endonucleases causes cleavage of nuclear chromatin. Apoptosis as originally defined is a purely morphologic process that differs from necrosis in several respects. Apoptosis involves single cells, not large groups of cells, and with apoptosis the cells shrink and there is increased eosinophilia of cytoplasm. The shrunken apoptotic cells form apoptotic bodies, which may be engulfed by adjacent cells or macrophages. With apoptosis there is no inflammatory response, the cell membranes do not rupture, and there is no release of macromolecules. Importantly, apoptosis is an active process in which activation of endonucleases causes peripheral condensation of chromatin (the most characteristic feature) and formation of multiples of DNA base pair fragments (called a DNA “ladder”).