For a quick reference of how to grade and stage histopathological lesions of non-alcoholic fatty liver disease....
Grading for Steatosis
GRADE 1. <33% of hepatocytes affected
GRADE 2. 33-66% of hepatocytes affected
GRADE 3. >66% of hepatocytes affected
Grading for Steatohepatitis
GRADE 1. MILD
Steatosis
Predominantly MACROvesicular
Involves up to 66% of lobules
Ballooning
Occasional, hepatocytes around ZONE 3
Lobular Inflammation
Scattered and MILD acute inflammation (PMNs)
Occasional chronic inflammation (lymphs)
Portal Inflammation
None or Mild
GRADE 2. MODERATE
Steatosis
Any degree
Usually mixed MACRO and MICRO-vesicular steatosis
Ballooning
OBVIOUS, present in ZONE 3
Lobular Inflammation
PMNs may be noted in association with ballooned hepatocytes
PERI-CELLULAR fibrosis
Mild chronic inflammation (lymphocytes) may be seen
Portal Inflammation
Mild to Moderate
GRADE 3. SEVERE
Steatosis
Typically involves >66% of lobules (PAN-ACINAR)
Commonly MIXED (Macro & Micro-vesicular)
Ballooning
MARKED- Predominantly ZONE 3
Lobular Inflammation
Scattered acute (PMN) and chronic (lymph) inflammation
PMNs may be concentrated in zone 3 areas of ballooning
PERI-SINUSOIDAL fibrosis
Portal Inflammation
Mild to Moderate
Staging for Fibrosis
STAGE 1:
Zone 3 perivenular, perisinusoidal, or pericellular fibrosis
Focal or extensive
STAGE 2:
Same as stage 1, with focal or extensive PERIPORTAL (zone 1) fibrosis
STAGE 3:
Same as above, with BRIDGING FIBROSIS (focal or extensive)
STAGE 4:
Cirrhosis (forms nodules)
Pictures will be uploaded soon...
Reference:
David A. Sass et al. "Nonalcoholic Fatty Liver Disease: A clinical Review". Digestive Diseases and Sciences. Vol 50, No. 1 (January 2005), pp 171-180. DOI: 10.1007/s10620-005-1267-z
Zachary D. Goodman. "Grading and staging systems for inflammation and fibrosis in chronic liver diseases". 0168-8278/$32.00 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.
doi:10.1016/j.jhep.2007.07.006
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