Fatty Liver Disease Histology Is Varied and Can Suggest Etiology

Atif Zaman, MD, MPH

A review of pathologic features outlines histologic distinctions between alcoholic and nonalcoholic disease.

Alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) — the two most common types of fatty liver disease — are major causes of chronic liver disease worldwide. Authors of a review summarize the pathologic features of these two entities, the histologic features that distinguish ALD from NAFLD, and the differences between pediatric and adult fatty liver disease.

Histologic features of ALD but not NAFLD include fibro-obliterative lesions of the outflow venules, acute canalicular cholestasis, pronounced periportal ductular reaction, periseptal copper accumulation, and foamy degeneration. Whereas steatosis is a defining criterion for NAFLD, this histologic lesion is not always present in ALD. NAFLD is the leading cause of chronic liver disease in U.S. children (estimated prevalence, 10%–20%). Steatohepatitis occurs at similar rates in children and adults. However, in children, simple steatosis is seen in zone 1 rather than zone 3, and no perisinusoidal fibrosis is seen in zone 3.

Citation(s):

Yeh MM and Brunt EM.Pathologic features of fatty liver disease. Gastroenterology 2014 Sep; 147:754.