The histologic spectrum of nonalcoholic fatty liver disease☆
Section snippets
Hepatic steatosis
In 1981, Ludwig et al [1] published their landmark paper describing a distinct clinicopathologic entity they named NASH. The features traditionally recognized as components of NAFLD include steatosis, acute and chronic inflammation that is usually most severe in the lobular parenchyma, cytologic ballooning and glycogen nuclei of hepatocytes, perisinusoidal fibrosis, and Mallory hyaline. Macrovesicular steatosis is the key histologic feature of NAFLD or NASH and continues to be the cornerstone
How reliably can the histologic features of nonalcoholic steatohepatitis be assessed?
Two studies have been performed to assess the variability in pathologic interpretation of features of NAFLD [29], [43]. The first study [43] evaluated 19 histologic parameters. The concordance was assessed by the k coefficient [44], which is a measure of concordance for repeated measurements. A value greater than 0.6 represents high concordance, and a value below 0.4 represents low concordance. In this study, six parameters were found to have a concordance greater than 0.4. These were the
Recurrence after transplantation
There are several reports describing the recurrence of fatty liver and steatohepatitis after orthotopic liver transplantation [27], [69], [70], [71], [72], [73], [74]. In one study [27], 27 patients were evaluated for the development of NAFLD after liver transplantation. The patients were transplanted for either well-documented NASH or cryptogenic cirrhosis and a clinical profile containing features of syndrome-X. Protocol biopsies were performed in all cases, allowing assessment of histologic
Summary
Nonalcoholic fatty liver disease encompasses a spectrum of histologic lesions characterized primarily by hepatic macrovesicular steatosis along with various combinations of cytologic ballooning, Mallory hyaline, pericellular fibrosis, and scattered inflammatory changes. Over time, patients with florid steatohepatitis are at risk for progression to cirrhosis of the liver. Liver biopsy remains the gold standard for the diagnosis of fatty liver and steatohepatitis. There are several pitfalls in
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2020, Life SciencesCitation Excerpt :The global epidemic of metabolic diseases, such as obesity, type 2 diabetes and dyslipidemia, is accompanied by an increased incidence of non-alcoholic fatty liver disease (NAFLD) worldwide [1]. Despite some studies discuss the conceptualization of this liver disease [2,3]; conventionally NAFLD is characterized by a histological disease spectrum, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis and eventually to hepatocarcinoma [1,4]. NAFLD physiopathology is complex, since hepatic fat deposition may result from isolated or combined changes in fatty acid (FA) metabolism, due to 1) increase in the FA supply from the diet, or via adipose tissue lipolysis; 2) increase in de novo lipogenesis; 3) decrease in FA β-oxidation; and/or 4) decrease in TG export by the very-long density lipoproteins (VLDL) [3].
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This work was supported, in part, by an award from the National Institutes of Health to Dr. Sanyal (K 24 DK 02755-04).