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Steatohepatitis. Brunt necroinflammatory grade 1. Brunt fibrosis stage 1. Steatosis afflicts about 30% of hepatocytes; note the absence of visible triads (Row 1 Left 20X). Cytoplasmic tufts of ballooning degeneration [violet arrows] were commonly found; a lymphohistiocytic aggregate [blue arrow], important for NAFLD, but not for Brunt, is seen (Row 1 Right 400X). A triad shows a vein [green arrow], an artery [red arrow], an interlobular duct [blue arrow], and proliferating bile ductules [cyan arrows]; only a few lymphocytes are seen (Row 2 Left 400X). Central vein shows only a few endothelial cells, with somewhat packed hepatocytes surrounding it (Row 2 Right 400X). Trichrome shows mostly space of Disse fibrosis [black arrows], sometimes adjoining hepatocytes [green arrows] show this is a stage 1 fibrosis (Row 3 Left 400X). Trichrome shows a central vein with a minimum of sclerosis; an interhepatocyte fibrous extension [arrow] displays the very beginning of fibrosis (Row 3 Right 400X). | Steatohepatitis. Brunt necroinflammatory grade 1. Brunt fibrosis stage 1. Steatosis afflicts about 30% of hepatocytes; note the absence of visible triads (Row 1 Left 20X). Cytoplasmic tufts of ballooning degeneration [violet arrows] were commonly found; a lymphohistiocytic aggregate [blue arrow], important for NAFLD, but not for Brunt, is seen (Row 1 Right 400X). A triad shows a vein [green arrow], an artery [red arrow], an interlobular duct [blue arrow], and proliferating bile ductules [cyan arrows]; only a few lymphocytes are seen (Row 2 Left 400X). Central vein shows only a few endothelial cells, with somewhat packed hepatocytes surrounding it (Row 2 Right 400X). Trichrome shows mostly space of Disse fibrosis [black arrows], sometimes adjoining hepatocytes [green arrows] show this is a stage 1 fibrosis (Row 3 Left 400X). Trichrome shows a central vein with a minimum of sclerosis; an interhepatocyte fibrous extension [arrow] displays the very beginning of fibrosis (Row 3 Right 400X). | ||
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[[File:1 NASH 09 680x512px.tif| Steatohepatitis. Brunt necroinflammatory grade 2. Brunt fibrosis stage 2.]] | |||
[[File:2 NASH 09 680x512px.tif| Steatohepatitis. Brunt necroinflammatory grade 2. Brunt fibrosis stage 2.]] | |||
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[[File:3 NASH 09 680x512px.tif| Steatohepatitis. Brunt necroinflammatory grade 2. Brunt fibrosis stage 2.]] | |||
[[File:4 NASH 09 680x512px.tif| Steatohepatitis. Brunt necroinflammatory grade 2. Brunt fibrosis stage 2.]] | |||
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[[File:5 NASH 09 680x512px.tif| Steatohepatitis. Brunt necroinflammatory grade 2. Brunt fibrosis stage 2.]] | |||
[[File:6 NASH 09 680x512px.tif| Steatohepatitis. Brunt necroinflammatory grade 2. Brunt fibrosis stage 2.]] | |||
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Steatohepatitis. Brunt necroinflammatory grade 2. Brunt fibrosis stage 2. | |||
Steatosis is not pan-acinar, precluding grade 3 (Row 1 Left 40X). Cytoplasmic tufts [arrows] were commonly seen establishing frequent ballooning degeneration of grade 2 (Row 1 Right 400X). Trichrome shows periportal fibrosis [arrow] establishing fibrosis stage 2 (Row 2 Left 400X). PAS D shows a triad with mild damage, with an interlobular bile duct [green arrow] with luminal sheered epithelium, not neutrophils, a hepatic arteriole [red arrow], a hepatic venule [blue arrow], proliferating bile ductules [cyan arrows]; PAS-D macrophages [black arrows] in triad & sinusoid evidence damage; Neutrophils [magenta arrows] in proliferating bile ductules mean nothing, but in sinusoids indicate damage (Row 2 Right 400X). Reticulin fibers in steatosis afflicted areas can appear abnormally lost, which should not be deemed evidence of hepatocellular carcinoma (Row 3 Left 400X). Reticulin stain here shows hepatocyte acini [arrows], evidence of hepatocellular injury (Row 3 Right 400X). | |||
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