What histologic patterns are typical of fatty liver disease?

What histologic patterns are typical of fatty liver disease?

• A. Microvesicular steatosis with prominent fibrous septa.
• B. Macrovesicular steatosis with ballooning degeneration; mild inflammation; possible Mallory-Denk bodies.
• C. Normal histology.
• D. Extensive cholestasis with bile plugs.

Answer: (B)

Fatty liver disease characteristically shows macrovesicular steatosis with hepatocellular injury. Here, large lipid droplets accumulate in hepatocytes and push the nucleus to the cell periphery (macrovesicular steatosis). This is often accompanied by ballooning degeneration of hepatocytes, a mild inflammatory infiltrate, and Mallory-Denk bodies (eosinophilic cytoplasmic inclusions from cytokeratin aggregation) in steatohepatitis. This combination is the classic histologic pattern for fatty liver disease, including NAFLD/NASH and alcoholic steatohepatitis. The other patterns don’t fit: microvesicular steatosis with prominent fibrous septa points to different conditions like acute fatty liver changes or toxin-induced injury; normal histology would lack steatosis and injury; extensive cholestasis with bile plugs indicates a cholestatic process, not fatty change.

Fatty liver disease characteristically shows macrovesicular steatosis with hepatocellular injury. Here, large lipid droplets accumulate in hepatocytes and push the nucleus to the cell periphery (macrovesicular steatosis). This is often accompanied by ballooning degeneration of hepatocytes, a mild inflammatory infiltrate, and Mallory-Denk bodies (eosinophilic cytoplasmic inclusions from cytokeratin aggregation) in steatohepatitis. This combination is the classic histologic pattern for fatty liver disease, including NAFLD/NASH and alcoholic steatohepatitis.

The other patterns don’t fit: microvesicular steatosis with prominent fibrous septa points to different conditions like acute fatty liver changes or toxin-induced injury; normal histology would lack steatosis and injury; extensive cholestasis with bile plugs indicates a cholestatic process, not fatty change.