Steatohepatitis
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| Steatohepatitis | |
|---|---|
| Diagnosis in short | |
 Steatohepatitis. Trichrome stain. | |
|
| |
| LM | steatosis (usually macrovesicular); hepatocyte injury -- ballooning degeneration (key feature), Mallory bodies; portal bridging (late stage) |
| Subtypes | by etiology (classically): ASH, NASH -- all almost histologically identical |
| LM DDx | steatosis, Wilson disease, hepatitis C, drug-induced liver disease |
| Gross | pale/yellowish, often enlarged |
| Site | liver - see medical liver disease |
|
| |
| Associated Dx | obesity, alcohol abuse |
| Prevalence | common |
| Prognosis | dependent on underlying cause |
| Treatment | dependent on underlying cause |
Steatohepatitis is a fatty change of the liver (steaosis) with (histologic) evidence of liver injury. It can be due to a number of different causes.
General
- Steatohepatitis is a label for a set of histopathologic findings.
- Fat accumulation (in hepatocytes) alone is liver steatosis.
- It may be a pattern seen in drug toxicity, e.g. methotrexate toxicity.[1]
Etiology:
- Alcohol = alcoholic steatohepatitis (ASH).
- Not alcohol = non-alcoholic steatohepatitis (NASH).
- Drug/toxin.[2]
Notes:
- Pathologists can comment on the etiology; however, the histomorphology is not distinctive. In other words, ASH and NASH are clinical diagnoses.
- Steatohepatitis is a misnomer. It is not an -itis; inflammation is not the (predominant) pathologic process.
Microscopic
Features:
- Steatosis (usually macrovesicular) - key feature.
- If less than 10% ... consider alt. diagnosis/disease process.
- Hepatocyte injury:
- Ballooning degeneration - key feature.[3]
- Mallory bodies.
- Mallory body wannabes: "occasional cytoplasmic clumping".
- +/-Chicken-wire perisinusoidal fibrosis +/- zone III (centrilobular) fibrosis (early).
- Late-stage disease - portal bridging.[4]
DDx:
- Steatosis - lacks ballooning degeneration.
- Wilson disease.
- Hepatitis C.
- Drug-induced liver disease.
Grading steatohepatitis
Grading inflammation:[5]
- Grade 1 - steatosis, occasional ballooning degeneration, PMNs.
- Grade 2 - obvious ballooning, obvious PMNs, chronic inflammation.
- Grade 3 - panacinar steatosis.
Image
Steatohepatitis. (WC)
Fibrosis stage 0 Brunt necroinflammatory grade 1 (WC)
Fibrosis stage 1 Brunt necroinflammatory grade 2 (WC)
Fibrosis stage 2 Brunt necroinflammatory grade 1 (WC)
Fibrosis stage 3 Brunt necroinflammatory grade 2 (WC)
Fibrosis stage 4 Brunt necroinflammatory grade 3 (WC)
See also
References
- ↑ MG. 22 September 2009.
- ↑ Farrell, GC. (2002). "Drugs and steatohepatitis.". Semin Liver Dis 22 (2): 185-94. doi:10.1055/s-2002-30106. PMID 12016549.
- ↑ Brunt, EM. (2001). "Nonalcoholic steatohepatitis: definition and pathology.". Semin Liver Dis 21 (1): 3-16. PMID 11296695.
- ↑ Gramlich, T.; Kleiner, DE.; McCullough, AJ.; Matteoni, CA.; Boparai, N.; Younossi, ZM. (Feb 2004). "Pathologic features associated with fibrosis in nonalcoholic fatty liver disease.". Hum Pathol 35 (2): 196-9. PMID 14991537.
- ↑ Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Am J Gastroenterol. 1999 Sep;94(9):2467-74. PMID 10484010.