Ballooning hepatocyte

Hepatocytes are the main type of cell that make up the liver. They are responsible for many important functions, including storing energy, making proteins, and breaking down toxins. A ballooning hepatocyte is a damaged liver cell that has swollen to several times its normal size. Pathologists use the word “ballooning” because the cell looks puffed up like a balloon. Under the microscope, the cell appears enlarged, and its body (called the cytoplasm) looks clear or empty instead of dense and pink like a normal hepatocyte.

Ballooning hepatocytes are a sign that the liver has been injured and that some of the cells are struggling to survive or are dying.

What conditions are associated with ballooning hepatocytes?

Ballooning hepatocytes can be seen in many different liver diseases, especially those that cause inflammation or ongoing cell injury.

Steatohepatitis

This is one of the most common causes of ballooning hepatocytes. Steatohepatitis means inflammation of the liver that occurs along with fat buildup inside liver cells.

There are two main types:

• Alcoholic steatohepatitis (ASH): Caused by heavy or long-term alcohol use.

• Nonalcoholic steatohepatitis (NASH): Caused by factors such as obesity, diabetes, or high cholesterol, often linked to metabolic syndrome.

Ballooning hepatocytes are one of the key microscopic features doctors look for when diagnosing steatohepatitis.

Viral hepatitis

Viruses such as hepatitis A, B, C, D, and E infect hepatocytes and cause inflammation. This infection damages liver cells, and ballooning hepatocytes may be seen when the cells are swollen and struggling to survive.

Drug-induced liver injury

Certain medications, toxins, or herbal supplements can injure the liver and cause ballooning hepatocytes. Examples include acetaminophen (especially at high doses), some antibiotics, anticonvulsants, cholesterol-lowering drugs (statins), and some herbal remedies.

Other causes

Ballooning hepatocytes may also be seen in autoimmune hepatitis, exposure to certain toxins, or other conditions that stress and injure the liver.

Why are ballooning hepatocytes important in a pathology report?

When ballooning hepatocytes are described in a pathology report, it tells your doctor that the liver cells are being damaged.

This is important because:

• It helps confirm a diagnosis of steatohepatitis or other liver disease.

• It may explain abnormal liver blood tests or symptoms.

• It provides information about the severity of the liver injury, since ballooning is a sign of significant stress on liver cells.

Your doctor will interpret this finding along with other features in the biopsy, your medical history, and your blood test results.

Questions to ask your doctor

• What caused ballooning hepatocytes in my liver biopsy?

• Does this mean I have steatohepatitis or another type of liver disease?

• Are the changes in my liver reversible with treatment or lifestyle changes?

• What steps can I take to protect my liver and prevent further damage?

• Will I need follow-up biopsies or regular monitoring of my liver function?