Pathology of alcoholic liver disease, can it be differentiated from nonalcoholic steatohepatitis?

Table 1 Histopathologic abnormalities in nonalcoholic steatohepatitis[4]

Necessary components

Steatosis, macro > micro; accentuated in Zone 3

Lobular inflammation, mild; scattered polymorphonuclear leukocytes as well as mononuclear cells

Ballooning of hepatocytes; most apparent near steatotic liver cells, in Zone 3

Usually present but not necessary

Zone 3 perisinusoidal fibrosis

Zone 1 hepatocellular glycogenated nuclei

Lipogranulomas in the lobules; usually small

Occasional acidophil bodies or periodic acid Schiff-stained Kupffer cells

Fat cysts

May be present, not necessary

Mallory’s hyaline in ballooned hepatocytes - usually Zone 3; typically poorly formed, may require immunostaining for ubiquitin, p62 or CK 7, 18, 19 to confirm

Hepatocellular iron, usually grade 1

Megamitochondria in hepatocytes