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Review
. 2021 Jun;113(3):194-202.
doi: 10.32074/1591-951X-242.

Pathology of non-alcoholic fatty liver disease

Ivana Cataldo  1 , Samantha Sarcognato  1 , Diana Sacchi  1 , Matilde Cacciatore  1 , Francesca Baciorri  1 , Alessandra Mangia  2 , Nora Cazzagon  3 , Maria Guido  1   4
Affiliations
Review

Pathology of non-alcoholic fatty liver disease

Ivana Cataldo et al. Pathologica. 2021 Jun.

Abstract

Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of different conditions which are characterized by hepatic steatosis in the absence of secondary causes. It is currently the most common chronic liver disease worldwide, and its estimated prevalence is about 1.5-6.5%. The only histological finding of steatosis ("simple" steatosis) represents the uncomplicated form of NAFLD, while non-alcoholic steatohepatitis (NASH) is its inflammatory subtype associated with disease progression to cirrhosis and hepatocellular carcinoma (HCC), and represents the major indication for liver transplantation. NASH is still a diagnostic and therapeutic challenge for clinicians and liver biopsy is currently the only accepted method to reliably distinguish NASH from "simple" steatosis. From the histological perspectives, NAFLD and NASH continue to be an area of active interest for pathologists, with a specific focus on better methods of evaluation, morphologic clues to pathogenesis, and predictors of fibrosis progression. This review focuses on histopathology of NAFLD in adults, with the aim to provide a practical diagnostic approach useful in the clinical routine.

Keywords: fatty liver; metabolic syndrome; non-alcoholic; steatohepatitis.

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Conflict of interest statement

Conflict of interest

The Authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Macrovescicular steatosis. (Hematoxylin and Eosin, H&E; original magnification 20x).
Figure 2.
Figure 2.
Microvescicular steatosis is characterized by tiny lipid droplets filling the hepatocyte cytoplasm (H&E; original magnification 60x).
Figure 3.
Figure 3.
Mallory-Denk bodies appear as cytoplasmic hyaline inclusions of ballooned hepatocytes (arrow). (H&E; original magnification 60x).
Figure 4.
Figure 4.
Hepatocyte glycogenosis. The hepatocyte cytoplasm appears homogeneously clear. It may mimic ballooning degeneration but note that the cell contour remains polygonal. Several glycogenated nuclei are also evident (arrow). (H&E; original magnification 20x).
Figure 5.
Figure 5.
Fat droplet surrounded by lymphocytes and macrophages represents a lipogranulomas (arrow). Lipogranulomas are frequently found in fatty liver; they are not considered in the assessment of lobular inflammation. (H&E; original magnification 40x).
Figure 6.
Figure 6.
NASH early stage: delicate perisinusoidal collagen deposition in zone 3. High quality connective tissue stains are required for a correct assessment. (Van Gieson stain; original magnification 20x).
Figure 7.
Figure 7.
Megamitochondria: round eosinophilic intracytoplasmic hepatocyte inclusion (arrow). (H&E; original magnification 60x).
See this image and copyright information in PMC

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