What is vacuolar degeneration?

Vacuolar degeneration is a term pathologists use to describe a change in cells where small, clear, bubble-like spaces—called vacuoles—develop inside the cell’s cytoplasm. The cytoplasm is the fluid-filled area of a cell that surrounds the nucleus and contains structures that help the cell function. These vacuoles appear empty under the microscope because they do not contain the usual cell contents. Vacuolar degeneration is a descriptive term rather than a specific diagnosis. It tells the doctor that the cells in the sample have been injured or stressed in a way that caused these changes.

Where does vacuolar degeneration occur?

Vacuolar degeneration can occur in many tissues and cell types throughout the body.

Pathologists most often describe it in:

• Epithelial cells – These are cells that line surfaces and form barriers, such as the skin, mucous membranes, and glandular tissues.

• Liver cells (hepatocytes) – Vacuolar change here can be due to conditions like fatty liver disease, certain infections, or drug-related injury.

• Kidney cells – May be seen in response to toxins, low oxygen supply, or metabolic disorders.

• Muscle cells – Including heart muscle, where vacuolar degeneration can indicate damage from a lack of blood flow or certain metabolic problems.

What causes vacuolar degeneration?

Vacuolar degeneration can be caused by many different conditions or injuries to cells, including:

• Cell injury from infection: Viral infections, such as hepatitis in the liver or certain skin infections, can lead to vacuolar changes.

• Immune system attack: In autoimmune diseases like lupus erythematosus, immune cells may damage normal tissues and create vacuolar changes in affected cells.

• Toxins and drugs: Some chemicals and medications can injure cells, leading to vacuole formation.

• Metabolic disturbances: Conditions that alter the cell’s ability to process fats, proteins, or sugars may result in vacuolar degeneration.

• Ischemia (lack of blood supply): When tissues do not get enough oxygen and nutrients, cells may develop vacuoles as part of injury.

• Skin diseases: In dermatopathology, vacuolar degeneration of basal keratinocytes is often seen in conditions such as lichen planus, lupus erythematosus, and other interface dermatitis disorders.

How is vacuolar degeneration described in a pathology report?

When pathologists examine a tissue sample under the microscope, they may describe “vacuolar degeneration” to indicate that vacuoles were seen in the cells. The report may specify:

• Which cell type is affected.

• Where in the tissue the change was seen.

• The severity and extent of the degeneration.

• Any other associated features, such as inflammation, necrosis (cell death), or fibrosis (scarring).

Because vacuolar degeneration is a nonspecific finding, the report will also include other information and observations that help identify the cause.

Why is vacuolar degeneration important?

Vacuolar degeneration is important because it is a visible sign of cell injury. On its own, it does not tell you exactly what disease is present, but it is a clue that helps guide the diagnosis. The pattern of vacuolar change, the cell types involved, and the presence of other features in the tissue can help your doctor determine the underlying cause and whether treatment is needed.

Questions to ask your doctor

• Which tissue in my sample showed vacuolar degeneration?

• What is the most likely cause of this change in my case?

• Are there other features in my pathology report that help explain this finding?

• Does this change require treatment or follow-up?

• Could this finding be related to an infection, autoimmune disease, or medication I’m taking?