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World J Gastroenterol. Nov 28, 2014; 20(44): 16474-16479
Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16474
Pathology of alcoholic liver disease, can it be differentiated from nonalcoholic steatohepatitis?
Puja Sakhuja
Puja Sakhuja, Department of Pathology, GB Pant Hospital, New Delhi 110002, India
Author contributions: Sakhuja P solely contributed to this manuscript.
Correspondence to: Puja Sakhuja, MD, Professor, Department of Pathology, GB Pant Hospital, Room 327, JL Nehru Marg, New Delhi 110002, India. pujasak@gmail.com
Telephone: +91-11-23233001-5327 Fax: +91-11-23239442
Received: May 23, 2014
Revised: July 28, 2014
Accepted: September 12, 2014
Published online: November 28, 2014
Abstract

The liver involvement in alcoholic liver disease (ALD) classically ranges from alcoholic steatosis, alcoholic hepatitis or steatohepatitis, alcoholic cirrhosis and even hepatocellular carcinoma. The more commonly seen histologic features include macrovesicular steatosis, neutrophilic lobular inflammation, ballooning degeneration, Mallory-Denk bodies, portal and pericellular fibrosis. Nonalcoholic steatohepatitis (NASH) is a condition with similar histology in the absence of a history of alcohol intake. Although the distinction is essentially based on presence or absence of a history of significant alcohol intake, certain histologic features favour one or the other diagnosis. This review aims at describing the histologic spectrum of alcoholic liver disease and at highlighting the histologic differences between ALD and NASH.

Keywords: Alcoholic liver disease, Steatosis, Steatohepatitis, Fibrosis, Cirrhosis, Hepatocellular carcinoma, Non-alcoholic steatohepatitis

Core tip: Alcoholic steatohepatitis (ASH) is well described. Absence of steatosis should not rule out ASH. Nonalcoholic steatohepatitis though histologically similar to ASH, does have important differences, which a pathologist should recognize.