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Review
. 2016 May;20(2):293-312.
doi: 10.1016/j.cld.2015.10.011. Epub 2015 Dec 28.

Histology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in Adults and Children

David E Kleiner  1 , Hala R Makhlouf  2
Affiliations
Review

Histology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in Adults and Children

David E Kleiner et al. Clin Liver Dis. 2016 May.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the liver disease associated with obesity, diabetes, and the metabolic syndrome. Although steatosis is a key histologic feature, liver biopsies of patients with NAFLD can show a wide range of findings. Nonalcoholic steatohepatitis (NASH) is a progressive subtype of NAFLD first defined by analogy to alcoholic hepatitis. Young children may have an alternate pattern of progressive NAFLD characterized by a zone 1 distribution of steatosis, inflammation, and fibrosis. Several grading and staging systems exist, but all require adequate biopsies. Although NASH generally shows fibrosis progression over time, some patients show regression of disease.

Keywords: Histology; Liver biopsy; Scoring; Staging; Steatohepatitis; Steatosis.

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Figures

Figure 1
Figure 1
Patterns of steatosis in NAFLD. A. Zone 3 center steatosis with sparing of periportal areas (40×). B. Zone 1 periportal steatosis with sparing of central vein region (100×). C. A patch of microvesicular steatosis in a case of NASH (600×).
Figure 2
Figure 2
Inflammatory infiltrates in NAFLD. A. Lobular inflammation in NASH. A microgranuloma is seen to the right of the small lymphocytic infiltrate. (600×). B. Portal inflammation is mild and may focally involve the limiting plate. (400×)
Figure 3
Figure 3
Ballooned hepatocytes and Mallory-Denk bodies in NASH. A. Ballooned hepatocytes near a central vein (400×). B. Ballooned hepatocytes with large Mallory-Denk body cytoplasmic inclusions (600×).
Figure 4
Figure 4
Fibrosis progression in NASH. A. Early perisinusoidal fibrosis with delicate collagen strands between ballooned hepatocytes (600×). B. Advanced perisinusoidal fibrosis (200×). C. Bridging fibrosis with extensive networks of perisinusoidal fibrosis nearly encircling a regenerative nodule. (100×) D. Established cirrhosis (40×). (All Masson stains)
Figure 5
Figure 5
Zone 1 Pattern of NAFLD. A. Steatosis surrounds and bridges between portal areas (40×). B. Steatosis spares the central vein (top, center) but surrounds the portal area (100×). C. Portal inflammation infiltrates adjacent parenchyma (200×). D. Periportal fibrosis is present (Masson, 200×).
See this image and copyright information in PMC

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