Liver histology shows hepatocytes with eosinophilic cytoplasm and nuclear fragmentation; which process is most likely occurring?

• A. Necrosis
• B. Metaplasia
• C. Apoptosis
• D. Dysplasia

Answer: (C)

Programmed cell death, or apoptosis, presents with coordinated cellular changes where the cell shrinks, the chromatin condenses, and the nucleus fragments into small pieces (karyorrhexis). The cytoplasm often becomes densely eosinophilic as proteins denature and organize during this process, and the dying cell breaks into apoptotic bodies that are promptly cleared by phagocytes. In the liver, hepatocytes showing eosinophilic cytoplasm with nuclear fragmentation fit this pattern, and are sometimes described as apoptotic hepatocytes or Councilman bodies in the setting of liver injury. This orderly death contrasts with necrosis, which involves cell swelling, loss of membrane integrity, and a inflammatory response; metaplasia refers to a change in cell type, and dysplasia denotes disordered growth without the specific nuclear fragmentation seen in apoptosis.