Steatohepatitis

Epidemiology:

• See DDx of Steatosis

Common sites:

Gross features:

Histologic features:

• early stage – changes localized to acinar zone 3
• liver-cell ballooning
• intracytoplasmic Mallory bodies
• irregular, densely eosinophilic strands or clumps
• ubiquitin immunostaining
• inflammatory infiltrates
• neutrophil predmoninant
• perivenular and pericellular “chicken-wire” fibrosis
• grading system (Brunt):
• grade 1 (mild):
• steatosis (mainly macrovesicular) involving up to 66% of lobules
• occasional ballooned perivenular hepatocytes
• scattered neutrophils + / - neutrophils
• none or mild chronic portal inflammation
• grade 2 (moderate):
• steatosis of any degree
• obvious ballooning (mainly perivenular)
• intralobular neutrophils
• perivenular pericellular fibrosis maybe
• mild to moderate portal and intralobular chronic inflammation
• grade 3 (severe)
• panlobular steatosis
• obvious perivenular ballooning and disarray
• marked lobular inflammation
• neutrophils may be concentrated in perivenular areas of ballooning and in areas of pericellular fibrosis if evident
• portal inflammation mild or moderate
• Fibrosis staging (Brunt):

§ Stage 1:

· Pericellular fibrosis in perivenular areas, focal or extensive

§ Stage 2:

· As above, plus focal or extensive periportal fibrosis

§ Stage 3:

· Bridging fibrosis, focal or extensive

§ Stage 4:

· Cirrhosis

Immunophenotype:

Marker:

Sensitivity:

Specificity:

Molecular features:

Other features:

• alchohol is most common cause
• EM – filamentous structure
• Factors that may contribute to whether or not a patient will develop alcoholic liver disease:
• Women more susceptible (decreased gastric metabolism, decreased body mass)
• Genetic susceptibility (unknown?)
1. Polymorphisms in detoxifying enzymes
• Causes of death from alcoholic cirrhosis:
• Variceal bleed
• Hepatic coma
• Infection
• Hepatorenal syndrome
• Hepatocellular carcinoma (3-6%)

References:

o Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999;94:2467-2474.