Grading and Staging NAFLD

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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