2017, Number 2
<< Back Next >>
Ann Hepatol 2017; 16 (2)
Perspectives on NASH Histology: Cellular Ballooning
Caldwell S, Lackner C
Language: English
References: 21
Page: 182-184
PDF size: 104.92 Kb.
ABSTRACT
Interpretation of liver biopsy in NAFLD can be challenging to distinguish histological NASH from non-NASH fatty liver – a broad dichotomy
which carries significant prognostic and therapeutic implications and underlies the utility of many non-invasive tests. There
is usually a reasonable degree of inter-observer agreement for some key parameters like steatosis, inflammation and fibrosis staging.
However, the assessment of cellular ballooning can be a stumbling block even for experienced observers. Below, we recount some
aspects of the history of histological definitions in NASH and propose specific methods to more objectively identify cellular ballooning
in routine biopsy assessments.
REFERENCES
Ludwig J, Viggiano TR, McGill DB, Ott BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980; 55: 434-8.
Diehl AM, Goodman Z, Ishak KG. Alcohol-like liver disease in nonalcoholics. Gastroenterology 1988; 95: 1056-62
Powell EE, Cooksley WG, Hanson R, Searll J, Halliday JW, Powell LW. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 1990; 11: 74-80.
Caldwell SH, Oelsner DH, Iezzoni JC, Hespenheide EE, Battle EH, Driscoll CJ. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology 1999; 29: 664-9.
Poonawala A, Nair SP, Thuluvath PJ. Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: a casecontrol study. Hepatology 2000; 32: 689-92.
Teli MR, James OFW, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: A followup study. Hepatology 1995; 22: 1714-19.
Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: A spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413-19.
Ekstedt M, Franzen LE, Mathiesen UL, et al. Long-term follow- up of patients with NAFLD and elevated liver enzymes. Hepatology 2006; 44: 865-73.
Rafiq N, Bai C, Fang Y, et al. Long-term follow-up of patients with nonalcoholic fatty liver. Clin Gastroenterol Hepatol 2009; 7: 234-8.
McPherson S, Hardy T, Henderson E, Burt AD, Day CP, Anstee QM. Evidence of NAFLD progression from steatosis to fibrosing- steatohepatitis using paired biopsies: implications for prognosis and clinical management. J Hepatol 2015; 62: 1148-55.
Ratziu V, Charlotte F, Heurtier A, Gombert S, Giral P, Bruckert E, Grimaldi A, et al. LIDO Study Group. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 2005; 125: 1898-906.
Lackner C, Gogg-Kamerer M, Zatloukal K, Stumptner C, Brunt EM, Denk H. Ballooned hepatocytes in steatohepatitis: the value of keratin immunohistochemistry for diagnosis. J Hepatol 2008; 48: 821-8.
Rangwala F, Guy CD, Lu J, Suzuki A, Burchette JL, Abdelmalek MF, Chen W, et al. Increased production of sonic hedgehog by ballooned hepatocytes. J Pathol 2011; 224(3): 401-10.
Caldwell S, Ikura Y, Dias D, Isomoto K, Yabu A, Moskaluk C, Pramoonjago P, et al. Hepatocellular ballooning in NASH. J Hepatol 2010; 53: 719-23.
Hirsova P, Gores GJ. Ballooned hepatocytes, undead cells, sonic hedgehog, and vitamin E: therapeutic implications for nonalcoholic steatohepatitis. Hepatology 2015; 61: 15-7.
Kleiner DE, Yah MM, Guy CD, Ferrell L, Cummings O, Contos MJ, Brunt EM, et al. Creation of a continuous visual scale of ballooned hepatocytes in non-alcoholic fatty liver disease. Hepatology 2008; 48(Suppl.): 815A.
Juluri R, Vuppalanchi R, Olson J, Unalp A, Van Natta ML, Cummings OW, Tonascia J, et al. Generalizability of the Nonalcoholic Steatohepatitis Clinical Research Network histologic scoring system for nonalcoholic fatty liver disease. J Clin Gastroenterol 2011; 45: 55-8.
Gawrieh S, Knoedler DM, Saeian K, Wallace JR, Komorowski RA. Effects of interventions on intra- and interobserver agreement on interpretation of nonalcoholic fatty liver disease histology. Ann Diagnost Path 2011; 15: 19-24.
Bedossa P, FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology 2014; 60(2): 565-75.
Argo CK, Ikura Y, Lackner C, Caldwell SH. The fat droplet in hepatocellular ballooning and implications for scoring nonalcoholic steatohepatitis therapeutic response. Hepatology 2016; 63: 1056-7
Yeh MM, Brunt EM. Pathology of nonalcoholic fatty liver disease. Am J Clin Pathol 2007; 128: 837-47.