Open AccessFatty Liver Disease: A Practical Approach
Author(s) -
Mohamed Mostafa,
Amrou Abdelkader,
John Evans,
Catherine Hagen,
Christopher Hartley
Publication year - 2019
Publication title -
archives of pathology and laboratory medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.79
H-Index - 117
eISSN - 1543-2165
pISSN - 0003-9985
DOI - 10.5858/arpa.2019-0341-ra
Subject(s) - steatosis , steatohepatitis , fatty liver , medicine , cirrhosis , context (archaeology) , hepatocellular carcinoma , pathology , nonalcoholic fatty liver disease , fibrosis , liver biopsy , disease , gastroenterology , biopsy , biology , paleontology
Context.— Fatty liver disease is now one of the most commonly encountered entities in the practice of liver pathology. Distinguishing simple steatosis from steatohepatitis is critical because the latter requires follow-up because of long-term risks that include cirrhosis and hepatocellular carcinoma. An organized approach for evaluating liver biopsies with steatosis is recommended to capture all of the relevant features: (1) degree of steatosis, (2) presence or absence of ballooning degeneration, (3) lobular inflammation, and (4) fibrosis. Herein, we provide a stepwise approach that readers can use to evaluate liver biopsies with steatosis, including examples, pitfalls, differential diagnostic considerations, and suggested diagnostic phrasing. Objective.— To provide a stepwise approach for the evaluation of liver biopsies showing significant steatosis (involving ≥5% of liver parenchyma). Data Sources.— Biopsies demonstrating fatty liver disease encountered in our daily practice were examined as well as recent literature. Conclusions.— Effective evaluation of liver biopsies with steatosis requires careful histologic examination and correlation with clinical history, particularly regarding medications, nutrition status, and alcohol use. Examples of uniform reporting, including appropriate use of the nonalcoholic steatohepatitis Clinical Research Network Activity Score, are provided.