Elsevier

Clinics in Liver Disease

Volume 8, Issue 3, August 2004, Pages 481-500
Clinics in Liver Disease

The histologic spectrum of nonalcoholic fatty liver disease

https://doi.org/10.1016/j.cld.2004.04.013Get rights and content

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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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      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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      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).

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