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World J Gastroenterol. Nov 14, 2010; 16(42): 5286-5296
Published online Nov 14, 2010. doi: 10.3748/wjg.v16.i42.5286
Histopathology of nonalcoholic fatty liver disease
Elizabeth M Brunt, Dina G Tiniakos
Elizabeth M Brunt, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, United States
Dina G Tiniakos, Laboratory of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
Author contributions: The authors contributed equally to this work.
Correspondence to: Elizabeth M Brunt, MD, Professor, Department of Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St. Louis, MO 63110, United States.
Telephone: +1-314-3620101 Fax: +1-314-2688950
Received: March 9, 2010
Revised: April 27, 2010
Accepted: May 4, 2010
Published online: November 14, 2010

Histological analysis of liver biopsies remains a standard against which other methods of assessment for the presence and amount of hepatic injury due to nonalcoholic fatty liver disease (NAFLD) are measured. Histological evaluation remains the sole method of distinguishing steatosis from advanced forms of NAFLD, i.e. nonalcoholic steatohepatitis (NASH) and fibrosis. Included in the lesions of NAFLD are steatosis, lobular and portal inflammation, hepatocyte injury in the forms of ballooning and apoptosis, and fibrosis. However, patterns of these lesions are as distinguishing as the lesions themselves. Liver injury in adults and children due to NAFLD may have different histological patterns. In this review, the rationale for liver biopsy, as well as the histopathological lesions, the microscopically observable patterns of injury, and the differential diagnoses of NAFLD and NASH are discussed.

Keywords: Fatty liver, Steatosis, Nonalcoholic fatty liver disease, Nonalcoholic steatohepatitis, Fibrosis