Alcohol-Related Histopathology

  • Reinhard B. Dettmeyer


The effects of chronic alcohol consumption can be detected in a variety of organs using histopathological techniques. Alcoholic liver cirrhosis accompanied by hepatic steatosis is known. Both findings, fibrosis and cirrhosis of the liver, as well as the extent of hepatic steatosis, can be histopathologically evaluated for severity and classified. To these one can add – in varying grades of severity – the histopathological detection of esophageal varices, chronic blood congestion in the spleen, as well as alcoholic fibrosing pancreatitis with duct ectasia, secretory disorders, and adjacent tryptic fatty tissue necrosis. In advanced stages, hepatic cholestasis and cholemic nephrosis may be detectable. Shortly after the last instance of alcohol consumption, one sees alcoholic hyaline in liver tissue (Mallory–Denk bodies). From a differential diagnostic perspective, one should consider alcoholic cardiomyopathy, assuming appropriate macroscopic and microscopic findings are present and despite the fact that making the differential diagnostic distinction from inflammatory cardiomyopathy may be challenging. Rarer alcohol-induced findings include Mallory–Weiss syndrome, Boerhaave syndrome, and the phenomenon referred to as “black esophagus.” Uncharacteristic findings such as gastritis, erosions, and ulceration of the gastric mucosa are often found in chronic alcohol consumption.


  1. Alexander CS (1967) Electron microscopic observations in alcoholic heart disease. Br Heart J 29:200–206CrossRefPubMedPubMedCentralGoogle Scholar
  2. Altenburger DL, Wagner AS, Caravaglia J (2011) A case of black esophagus with histopathologic description and characterization. Arch Pathol Lab Med 135:797–798PubMedGoogle Scholar
  3. Böcker W, Seifert G (1972) Zur Pathologie der Alkohol-Pankreatitis. Dtsch Med Wochenschr 97:803CrossRefPubMedGoogle Scholar
  4. Brennan JL (1967) Case of extensive necrosis of the oesophageal mucosa following hypothermia. J Clin Pathol 20:581–584CrossRefPubMedPubMedCentralGoogle Scholar
  5. Brinkmann B, Fechner G, Karger B, DuChesne A (1998) Ketoacidosis and lactic acidosis – frequent causes of death in chronic alcoholics? Int J Legal Med 111:115–119CrossRefPubMedGoogle Scholar
  6. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR (1999) Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94:2467–2474CrossRefPubMedGoogle Scholar
  7. Bschor F, Keilbach H (1968) Die Bedeutung chronischer Organschäden für die tödliche Alkoholvergiftung. Dtsch Z Gesamte Gerichtl Med 62:183Google Scholar
  8. Bulloch RT, Pearce MB, Murphy ML, Jenkins BJ, Davis JL (1972) Myocardial lesions in idiopathic and alcoholic cardiomyopathy. Study by ventricular septal biopsy. Am J Cardiol 29:15CrossRefPubMedGoogle Scholar
  9. Cascalla JL, Gordo V, Montes R (2012) Severe necrosis of oesophageal and gastric mucosa in fatal methanol poisoning. Forensic Sci Int 220:e9–e12CrossRefGoogle Scholar
  10. Clark JC (1998) Sudden death in the chronic alcoholic. Forensic Sci Int 36:105–111CrossRefGoogle Scholar
  11. Copeland AR (1985) Sudden death in the alcoholic. Forensic Sci Int 29:159–169CrossRefPubMedGoogle Scholar
  12. Dancygier H (1997) “Alkoholische” Leberschäden bei Nichtalkoholikern. Dtsch Med Wochenschr 122:1183–1188CrossRefPubMedGoogle Scholar
  13. Day CP (2001) Apoptosis in alcoholic hepatitis: a novel therapeutic agent? J Hepatol 34:330–333CrossRefPubMedGoogle Scholar
  14. Day A, Sayegh M (2010) Acute oesophageal necrosis: a case report and review of the literature. Int J Surg 8:6–14CrossRefPubMedGoogle Scholar
  15. Denk H, Stumptner C, Zatloukal K (2000) Mallory bodies revisited. J Hepatol 32:689–702CrossRefPubMedGoogle Scholar
  16. Denk H, Stumptner C, Fuchsbichler A, Zatloukal K (2001) Alcoholic and nonalcoholic steatohepatitis. Histopathologic and pathogenetic considerations. Pathologe 22:388–398CrossRefPubMedGoogle Scholar
  17. Dettmeyer R, Reith K, Madea B (2002) Alcoholic cardiomyopathy versus chronic myocarditis – immunohistological investigations with LCA, CD3, CD68 and tenascin. Forensic Sci Int 126:57–62CrossRefPubMedGoogle Scholar
  18. Diehl AM, Goodman Z, Ishak KG (1988) Alcohol-like liver disease in nonalcoholics. A clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology 95:1056–1062CrossRefPubMedPubMedCentralGoogle Scholar
  19. Ettinger PO, Wu CF, de la Cruz C, Weisse AB, Ahmed SS, Regan TJ (1978) Arrhythmias and the ‘holiday heart’. Alcohol-associated cardiac rhythm disorders. Am Heart J 95:555CrossRefPubMedGoogle Scholar
  20. Ferries JAJ, Thompson PJ (1981) A histological assessment of the incidence of alcoholic cardiomyopathy in subjects with alcohol associated liver disease. Can Soc Forensic Sci J 14:113–133CrossRefGoogle Scholar
  21. Fontenot AP, Pelak VS (2002) Development of neurologic symptoms in a 26-year-old woman following recovery from methanol intoxication. Chest 122:1436–1439CrossRefPubMedGoogle Scholar
  22. Fracasso T, Brinkmann B, Breike J, Pfeiffer H (2008) Clotted blood as a sign of alcohol intoxication: a retrospective study. Int J Legal Med 122:157–161CrossRefPubMedGoogle Scholar
  23. Fracasso T, Pfeiffer H, Köhler H, Wieseler S, Hansen SD, Jentgens L, Sauerland C, Schmeling A (2011) Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of fatal ethanol intoxication. Int J Legal Med 125:537–542CrossRefPubMedGoogle Scholar
  24. Frenzel H, Roth H, Schwartzkopff B (1988) Alkohol und Herz-Kreislaufsystem. Z Gastroenterol 26(suppl 3):84–96PubMedGoogle Scholar
  25. Gerhard H, Graben N, Risse M, Scharafinski HW (1989) Rhabdomyolyse und akutes myoglobinurisches Nierenversagen nach Alkohol-Intoxikation und Delirium Tremens. Akt Neurol 16:XXVIIGoogle Scholar
  26. Glazer M, Dross P (1993) Necrosis of the putamen caused by methanol intoxication: MR findings. Am J Roentgenol 160:1105–1106CrossRefGoogle Scholar
  27. Goldenberg SP, Wain SL, Marignani P (1990) Acute necrotizing esophagitis. Gastroenterology 98:493–496CrossRefPubMedGoogle Scholar
  28. Griffin SM, Lamb PJ (2008) Spontaneous rupture of the esophagus. Br J Surg 95:1115–1120CrossRefPubMedGoogle Scholar
  29. Hecser L, Siklodi KP, Csiki G, Lungu MF, Jung H, Buda O (2011) Boerhaave syndrome. A case report. Rom J Leg Med 19:281–286Google Scholar
  30. Ichida F (1970) Morphologische Befunde bei chronischer Alkoholintoxikation in Japan. Therapiewoche 20:2351Google Scholar
  31. Itoh S, Igarashi M, Tsukada Y, Ichinoe A (1977) Nonalcoholic fatty liver with alcoholic hyaline after long-term glucocorticoid therapy. Acta Hepatogastroenterol (Stuttg) 24:415–418Google Scholar
  32. Janssen W (1977) Forensische Histologie. Schmidt-Römhild, LübeckGoogle Scholar
  33. Johnson SB (2008) Esophageal trauma. Semin Thorac Cardiovasc Surg 20:46–51CrossRefPubMedGoogle Scholar
  34. Kadis P, Balazic J, Ferlan-Marolt V (1999) Alcoholic ketoacidosis: a cause of sudden death of chronic alcoholics. Forensic Sci Int 103:53–59CrossRefGoogle Scholar
  35. Kagawa M (1970) Histopathologische Leberuntersuchungen an unausgewählten Sektionsfällen. Überprüfung des Vorkommens von “Mallory-Körpern”, Fett-Cirrhosen und “acidophilen Einschlüssen”. Jap J Leg Med 24:427PubMedGoogle Scholar
  36. Keresztesi AA, Asofie G, Chinezu L, Jung H (2016) Acute esophageal necrosis (“black esophagus”): case series in forensic autopsies casuistry. Rom J Leg Med 24:87–91Google Scholar
  37. Maier W (1983) Cerebral computed tomography of ethylene glycol intoxication. Neuroradiology 24:175–177PubMedGoogle Scholar
  38. Mallory FB (1911) Cirrhosis of the liver. Five different types of lesions from which it may arise. Bull Johns Hopkins Hosp 22:69–75Google Scholar
  39. McClain CJ, Barve S, Deaciuc I, Kugelmans M, Hill D (1999) Cytokines in alcoholic liver diseases. Semin Liver Dis 19:205–219CrossRefPubMedGoogle Scholar
  40. Morgan BW, Ford MD, Follmer R (2000) Ethylene glycol ingestion resulting in brainstem and midbrain dysfunction. J Toxicol Clin Toxicol 38:445–451CrossRefPubMedGoogle Scholar
  41. Morin Y, Daniel P (1967) Quebec beer-drinkers cardiomyopathy etiological considerations. Can Med Ass J 97:926–928PubMedPubMedCentralGoogle Scholar
  42. Nanji AA (1998) Apoptosis and alcoholic liver disease. Semin Liver Dis 18:187–190CrossRefPubMedGoogle Scholar
  43. Natori S, Rust C, Stadheim LM, Srinivan A, Burgart LJ, Gores GJ (2001) Hepatocyte apoptosis is a pathologic feature of human alcoholic hepatitis. J Hepatol 34:248–253CrossRefPubMedGoogle Scholar
  44. Noronha M, Salgadinho A, Ferreira de Almeida MJ (1982) Alcohol and pancreas: clinical associations and histopathology of minimal pancreatic inflammation. Am J Gastroent 77:827–832Google Scholar
  45. Oehmichen M, Auer RN, König HG (2006) Forensic neuropathology and associated neuropathology. Springer, Berlin Heidelberg/New York/TokioGoogle Scholar
  46. Ogbuihi S (1989) Zur Pathomorphologie chronischer alkohol-assoziierter Myokardveränderungen. Z Rechtsmed 102:231–239PubMedGoogle Scholar
  47. Olds K, Langlois NEI, Blumbergs P, Byard RW (2014) The pathological features of Wernicke encephalopathy. Forensic Sci Med Pathol 10:466–468CrossRefPubMedGoogle Scholar
  48. Parai JL, Kodikara S, Milroy CM, Pollanen MS (2012) Alcoholism and the Armanni-Ebstein lesion. Forensic Sci Med Pathol 8:19–22CrossRefPubMedGoogle Scholar
  49. Pribilla W, Härtel G, Albrecht M (1966) Veränderungen des Knochenmarks bei chronischem Alkoholismus. Med Klin 61:1031Google Scholar
  50. Regan TJ, Levinson GE, Oldewurtel HA, Frank MJ, Weisse AB, Moschos CB (1969) Ventricular function in non-cardiacs with alcohol fatty liver. Role of ethanol in production of cardiomyopathy. J Clin Invest 48:397–407CrossRefPubMedPubMedCentralGoogle Scholar
  51. Richardson PJ, Wodak AD, Atkinson L, Saunders JB, Jewitt DE (1986) Relation between alcohol intake, myocardial enzyme activity and myocardial function in dilated cardiomyopathy. Evidence for the concept of alcohol induced heart-muscle disease. Br Heart J 56:165–170CrossRefPubMedPubMedCentralGoogle Scholar
  52. Riesner K, Janssen W (1978) Alkoholbedingte Kardiomyopathie und plötzlicher Herztod. Beitr Gerichtl Med 36:352–358Google Scholar
  53. Roncati L, Gualandri G, Fortuni G, Barbolini G (2012) Sudden death and lipomatous infiltration of the heart involved by fat necrosis resulting from acute pancreatitis. Forensic Sci Int 217:e19–e22CrossRefPubMedGoogle Scholar
  54. Rubin E (1979) Alcoholic cardiomyopathy in heart and skeletal muscle. N Engl J Med 301:28CrossRefPubMedGoogle Scholar
  55. Schuck M (1983) Vergleichende, quantitative, makroskopische und mikroskopische Untersuchungen an Alkoholiker- und Kontrollgehirnen. Habil Schrift MünchenGoogle Scholar
  56. Spodick DH, Pigott VM, Chirife R (1979) Preclinical cardiac malfunction in chronic alcoholism. N Engl J Med 287:677–680CrossRefGoogle Scholar
  57. Strnad P et al (2008) Mallory-Denk bodies: lessons from keratin-containing hepatic inclusion bodies. Biochim Biophys Acta 1782:764–774CrossRefPubMedGoogle Scholar
  58. Tamura A, Kusachi S, Nogami K, Yamanishi A, Kajikawa Y, Hirohata S, Tsuji T (1996) Tenascin expression in endomyocardial biopsy specimens in patients with dilated cardiomyopathy: distribution along margin of fibrotic lesions. Heart 75:291–294CrossRefPubMedPubMedCentralGoogle Scholar
  59. Thomsen JL, Felby S, Theilde P, Nielsen E (1995) Alcoholic ketoacidosis as a cause of death in forensic cases. Forensic Sci Int 75:163–171CrossRefPubMedGoogle Scholar
  60. Torvik A, Lindboe CF, Rodge S (1982) Brain lesions in alcoholics. A neuropathological study with clinical correlation. J Neurol Sci 56:233–248CrossRefPubMedGoogle Scholar
  61. Tsokos M (2011) Black esophagus. Forensic Sci Med Pathol 7:374–376CrossRefPubMedGoogle Scholar
  62. Tsokos M, Herbst H (2005) Black oesophagus: a rare disorder with potentially fatal outcome. A forensic pathological approach based on five autopsy cases. Int J Legal Med 119:146–152CrossRefPubMedGoogle Scholar
  63. Tsukamoto H, Gaal K, French SW (1990) Insights into the pathogenesis of alcoholic liver necrosis and fibrosis: status report. Hepatology 12:599–608CrossRefPubMedGoogle Scholar
  64. Türk EE, Anders S, Tsokos M (2002) Mallory-Weiss syndrome as the cause of sudden, unexpected death. Arch Kriminol 209:36–44PubMedGoogle Scholar
  65. Unuma K, Harada K, Funakoshi T, Uemura K (2011) Sudden death of an alcoholic elderly man with acute esophageal necrosis (black esophagus). Forensic Sci Int 212:e15–e17CrossRefPubMedGoogle Scholar
  66. Venara A, Pavageau AH, Maillart CR, Jousset N (2013) Sudden death due to black esophagus: a case report. Am J Forensic Med Pathol 34:16–17CrossRefPubMedGoogle Scholar
  67. Zatloukal K et al (2007) From Mallory to Mallory-Denk bodies: what, how and why? Exp Cell Res 313:2033–2049CrossRefPubMedGoogle Scholar
  68. Zhou C, Byard RW (2011) Armanni-Ebstein phenomenon and hypothermia. Forensic Sci Int 206:e82–e84CrossRefPubMedGoogle Scholar
  69. Živković V, Nikolić S (2013) The unusual appearance of black esophagus in a case of fatal hypothermia: a possible underlying mechanism. Forensic Sci Med Pathol 9:613–614CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Reinhard B. Dettmeyer
    • 1
  1. 1.University Hospital Giessen Institute of Forensic MedicineGiessenGermany

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