Histopathological findings of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis

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SPECIAL FEATURE: REVIEW ARTICLE Diagnosis and assessment of nonalcoholic fatty liver disease / nonalcoholic steatohepatitis using ultrasound elastography

Histopathological findings of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis Masayoshi Kage1 · Shinichi Aishima2 · Hironori Kusano3 · Hirohisa Yano3 Received: 2 October 2020 / Accepted: 9 October 2020 © The Japan Society of Ultrasonics in Medicine 2020

Abstract Nonalcoholic fatty liver disease (NAFLD) is based on the concept of pathological morphology as well as clinical findings, and is broadly categorized into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The differential diagnosis between NAFL and NASH is important because NASH has the potential to progress to cirrhosis and hepatocellular carcinoma. NAFL is simple hepatic steatosis without hepatocellular injury, while NASH is characterized by macrovesicular steatosis, inflammation, and ballooning hepatocytes with a predominantly centrilobular (zone 3) distribution. Liver biopsy is a useful test for diagnosing NAFLD, but it is invasive. Therefore, various noninvasive methods including diagnostic imaging have been developed in recent years. To verify their usefulness, it is necessary to clarify in detail how the pathological findings are reflected in the image findings as imaging and histopathological findings are closely related. We describe the main histological features of NAFLD, i.e., steatosis, inflammation, ballooning hepatocytes, Mallory-Denk bodies, and fibrosis, as well as the evolutional process to liver cirrhosis. Keywords  Nonalcoholic fatty liver · Nonalcoholic steatohepatitis · Liver pathology

Introduction With the recent increase in metabolic disorders such as diabetes mellitus, obesity, and dyslipidemia, nonalcoholic fatty liver disease (NAFLD) is becoming an increasingly common chronic liver disease worldwide. According to a recent metaanalysis, the overall global prevalence of NAFLD diagnosed by imaging was estimated to be around 25% [1]. NAFLD comprises a variety of clinical and histopathological changes, and is broadly categorized into nonalcoholic fatty liver (NAFL, simple steatosis) and nonalcoholic steatohepatitis (NASH). The 2018 American Association for the * Masayoshi Kage kage.m@junshin‑u.ac.jp 1



Department of Medical Engineering, Junshin Gakuen University, 1‑1‑1 Chikushigaoka, Minami‑ku, Fukuoka 815‑8510, Japan

2



Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan

3

Department of Pathology, School of Medicine, Kurume University, Kurume, Japan



Study of Liver Diseases (AASLD) practice guidelines [2] defined NAFL by histologic evidence of hepatic steatosis without signs of hepatocellular injury including ballooning degeneration. The important criteria for the histological diagnosis of NASH include the presence of macrovesicular steatosis, inflammation, and ballooning hepatocytes with a predominantly centrilobular (zone 3) distribution. The differential diagnosis between NAFL and NASH is