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
References (74)
- et al.
Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a case-control study
Hepatology
(2000) - et al.
Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome
Hepatology
(2003) - et al.
Nonalcoholic fatty liver: another feature of the metabolic syndrome?
Clin Nutr
(1999) - et al.
Association of nonalcoholic fatty liver disease with insulin resistance
Am J Med
(1999) - et al.
Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities
Gastroenterology
(2001) - et al.
An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities
Am J Gastroenterol
(2000) Nonalcoholic steatohepatitis: tightening the morphological screws on a hepatic rambler
Hepatology
(1995)- et al.
Nonalcoholic steatohepatitis: an expanded clinical entity
Gastroenterology
(1994) - et al.
Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions
Am J Gastroenterol
(1999) Nonalcoholic steatohepatitis: a study of 49 patients
Hum Pathol
(1989)
Alcohol-like liver disease in nonalcoholics. A clinical and histologic comparison with alcohol-induced liver injury
Gastroenterology
Development of nonalcoholic fatty liver disease after orthotopic liver transplantation for cryptogenic cirrhosis
Liver Transpl
Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity
Gastroenterology
Nonalcoholic fatty liver disease in patients with hepatitis C is associated with features of the metabolic syndrome
Am J Gastroenterol
Mitochondrial abnormalities in nonalcoholic steatohepatitis
J Hepatol
Coordinate induction of energy gene expression in tissues of mitochondrial disease patients
J Biol Chem
A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase
J Hepatol
Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values
Hepatology
Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese
Gastroenterology
Concurrence of histologic features of steatohepatitis with other forms of chronic liver disease
Mod Pathol
Steatosis and chronic hepatitis C: analysis of fibrosis and stellate cell activation
J Hepatol
Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific HCV genotype and visceral obesity
Hepatology
Idiopathic steatohepatitis in childhood: a multi-center retrospective study
J Pediatr
Increased hepatic iron concentration in nonalcoholic steatohepatitis is associated with increased fibrosis
Gastroenterology
Nonalcoholic steatohepatitis and iron: increased prevalence of mutations of the HFE gene in nonalcoholic steatohepatitis
J Hepatol
The natural history of nonalcoholic fatty liver: a follow-up study
Hepatology
Hepatic steatosis after intestinal bypass–prevention and reversal by metronidazole, irrespective of protein-calorie malnutrition
Gastroenterology
Cryptogenic cirrhosis: clinicopathologic findings at and after liver transplantation
Hum Pathol
Cryptogenic cirrhosis and post-transplantation nonalcoholic fatty liver disease
Liver Transpl
Recurrence of nonalcoholic steatohepatitis (NASH) postliver transplantation
Liver Transpl Surg
Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease
Mayo Clin Proc
Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease
Hepatology
Overweight and obesity in the United States: prevalence and trends, 1960–1994
Int J Obes Relat Metab Disord
Body weight status of adults: United States, 1997–98
Adv Data
The extent of the problem of obesity
Am J Surg
Nonalcoholic steatohepatitis: association with obesity and insulin resistance, and influence of weight loss
Diabetes Metab
Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty
Int J Obes Relat Metab Disord
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2022, Journal of the Formosan Medical AssociationCitation Excerpt :Though viral hepatitis remains the most common cause of liver deaths, NAFLD has been an increasing contributor in recent years.21 The histologic characteristic of nonalcoholic steatohepatitis (NASH) was an indicator of cirrhosis, HCC, and liver transplant.22,23 In a cohort study followed up over 10 years, 10% of the NASH patients developed end-stage liver disease and survival was significantly lower than the reference population (70% vs 80%).24
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2021, Biomedicine and PharmacotherapyCitation Excerpt :Non-alcoholic fatty liver disease (NAFLD) is the ectopic accumulation of fat in hepatocytes that refers to disease spectrum of liver disorders and damages [49]. This disease ranges from mild steatosis to hepatic necroinflammation which also known as nonalcoholic steatohepatitis (NASH) [10,38] that is associated with an increased risk of end-stage liver diseases, and often lead to fibrosis and progress to cirrhosis with a higher risk of liver failure and hepatocellular carcinoma [38,52]. Although pathogenesis of the disease is not completely understood, hepatic lipid metabolic disorders are likely to play important roles in its initiation and development [12,48].
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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).