What are acidophil bodies on liver biopsy?

What Are Acidophil Bodies on Liver Biopsy?

Acidophil bodies are compact eosinophilic cells representing apoptotic hepatocytes that appear as small, round, deeply eosinophilic structures on liver biopsy. 1

Histologic Appearance and Definition

• Acidophil bodies are the morphologic manifestation of hepatocyte apoptosis, appearing as shrunken, intensely eosinophilic (pink) cells with pyknotic or absent nuclei on hematoxylin and eosin staining 1, 2
• These structures represent hepatocytes undergoing programmed cell death, with the characteristic acidophilic (eosinophilic) appearance resulting from cytoplasmic condensation and loss of nuclear material 2
• They are also referred to as "apoptotic bodies" or "Councilman bodies" in some contexts, though acidophil body is the preferred term in hepatopathology 1, 3

Clinical Significance and Disease Associations

Nonalcoholic Steatohepatitis (NASH)

• Acidophil bodies are frequently seen in NASH but are NOT required for diagnosis 1
• The density of acidophil bodies (measured as acidophil body index or ABI) is significantly higher in definite NASH (0.04 ± 0.08 per mm²) compared to borderline/not NASH cases (0.02 ± 0.05 per mm²) 4
• Increased acidophil body density correlates with greater lobular inflammation and the presence of ballooned hepatocytes, suggesting involvement of the apoptotic pathway in NASH-associated liver injury 4

Alcoholic Liver Disease

• Acidophil bodies are commonly observed in alcoholic steatohepatitis alongside other features like ballooning degeneration, Mallory-Denk bodies, and neutrophilic infiltration 1
• The presence of acidophil bodies with ballooning degeneration of hepatocytes is characteristic of active alcoholic hepatitis 1

Viral Hepatitis

• In chronic hepatitis B and C, acidophil bodies are present in small but significantly elevated numbers compared to healthy subjects, indicating apoptosis is involved in disease pathogenesis 2
• In recurrent hepatitis C after liver transplantation, acidophil body counts are markedly elevated (606 ± 101 per cm²) compared to acute rejection (241 ± 53 per cm²), making them useful for distinguishing these conditions 5
• The presence of acidophil bodies with lobular hepatitis suggests viral hepatitis over rejection in the transplant setting 5

Autoimmune Hepatitis

• Acidophil bodies may be seen in the acute presentation of autoimmune hepatitis, where they can resemble acute viral or drug-induced hepatitis 3
• Portal and intra-acinar plasma cells, rosette formation, and emperipolesis are more specific features favoring autoimmune hepatitis over drug-induced liver injury 6

Diagnostic Utility and Limitations

When to Consider Acidophil Body Quantification

• Quantifying acidophil bodies is most useful when distinguishing recurrent hepatitis C from acute rejection post-transplant, where counts >400 per cm² strongly favor hepatitis C recurrence 5
• In NASH diagnosis, increased acidophil body density supports the diagnosis but should be interpreted alongside other histologic features like steatosis, ballooning, and lobular inflammation 4

Important Caveats

• Acidophil bodies are NOT pathognomonic for any single condition—they represent a common pathway of hepatocyte injury (apoptosis) that occurs in multiple liver diseases 1, 2
• The presence of acidophil bodies alone cannot distinguish between viral hepatitis, drug-induced liver injury, autoimmune hepatitis, or NASH—the overall histologic pattern and clinical context are essential 3, 6
• Sampling error can affect quantification, as acidophil bodies may not be uniformly distributed throughout the liver 4

Pathophysiologic Mechanism

• Acidophil body formation reflects activation of apoptotic pathways, including immune-mediated (cytotoxic T lymphocyte) mechanisms in viral hepatitis and metabolic stress pathways in NASH 2, 4
• The apoptotic process involves cytoplasmic condensation, nuclear fragmentation, and eventual phagocytosis by adjacent hepatocytes or Kupffer cells 2