Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions

Liver biopsy interpretation for the gastroenterologist

Liver biopsy interpretation continues to play an integral role in diagnosis and management of most forms of liver disease. In this review, the common histopathologic features of the more commonly encountered processes, chronic hepatitis, autoimmune hepatitis, and chronic cholestatic liver diseases, are discussed. In addition, areas of ongoing investigation and controversy, including steatohepatitis and dysplasia, are reviewed. Finally, the pathology of adult metabolic liver disease, drug-induced liver disease, and various miscellaneous disease processes, including venous outflow obstruction, acute fatty liver of pregnancy, and fulminant hepatic failure, are reviewed.

A rapid non-enzymatic method for the preparation of HMW DNA from blood for RFLP studies

AIMS

To define a new histological staging and grading system for primary biliary cirrhosis (PBC), to provide more information reflecting clinical laboratory data and the prognosis to hepatologists.

METHODS AND RESULTS

First, 17 histological lesions of PBC were scored in 188 needle liver biopsy specimens. Factor analysis yielded three independent groups of factors: factor 1 (fibrosis, fibrous piecemeal necrosis, orcein-positive granules, bile plugs, Mallory bodies, feathery degeneration, bile duct loss and atypical ductular proliferation); factor 2 (portal inflammation, eosinophilic infiltration, lymphoid follicles, epithelioid granulomas, interface hepatitis and chronic cholangitis); and factor 3 (interface hepatitis, lobular hepatitis, acidophilic bodies and pigmented macrophages). The eight findings of factor 1, but not factors 2 and 3, were significantly correlated with clinical laboratory data and scores in the Mayo Clinic's prognostic model. Factor 1 lesions may reflect histological progression (staging), while factor 2 and 3 lesions may relate to necroinflammatory activity (grading). Then, we devised a staging and grading system using three lesions (bile duct loss, fibrosis and orcein-positive granules) from factor 1 and three from factors 2 and 3 (chronic cholangitis, interface hepatitis and lobular hepatitis).

CONCLUSION

This new system might provide more pathological information on PBC patients for hepatologists.