Article

Concurrence of Histologic Features of Steatohepatitis with Other Forms of Chronic Liver Disease

Saint Louis University Liver Center Department of Pathology, Saint Louis University Health Sciences Center, St Louis, Missouri, USA.
Modern Pathology (Impact Factor: 6.36). 01/2003; 16(1):49-56. DOI: 10.1097/01.MP.0000042420.21088.C7
Source: PubMed

ABSTRACT Steatohepatitis, of either alcoholic or nonalcoholic etiologies, is ultimately diagnosed by clinical-pathologic correlation and is characterized histologically by lesions that differ from the portal-based chronic inflammation and fibrosis of most other forms of chronic liver disease. With the increasing prevalence of steatohepatitis in our society, it is likely that some patients will have coexistent clinical and/or histopathologic findings of steatohepatitis concurrently with another form of liver disease. The aim of this study was to document clinical and histologic findings in biopsies in an academic referral center. Ninety-three non-allograft liver biopsies with lesions of both steatohepatitis and another liver disease were retrospectively identified in 85 patients. The finding of coexisting disease represented 5.5% of all hepatitis C biopsies and 4.0% of other forms of chronic liver disease in the 34 month time period. Clinical chart review of patients with concurrent disease showed the following: Group 1, patients with hepatitis C (n = 54); Group 2, patients with hepatitis C and prior or current history of more than 80 g/d alcohol consumption (n = 20); Group 3, patients with other forms of chronic liver disease (n = 11). Groups 1 and 3 had <10 g/d alcohol use. Obesity (body mass index >30) was noted in 75%, 60%, and 33% respectively, while 94%, 87% and 100% of patients were considered overweight (body mass index > or = 25). Diabetes was reported in 35%, 25%, and 9%. The concurrence of clinical and histologic features of steatohepatitis with another chronic liver disease may be a reflection of the frequency of steatohepatitis in the population at large.

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    • "In addition, since steatosis due to excessive alcohol intake is often morphologically indistinguishable from non-alcoholic fatty liver disease, it is logical that these findings could be equally applicable to non-obese patients. Our findings may also be relevant for other chronic liver diseases, even though the typical Zone 3 hepatocellular injury of NAFLD differs from the portal-based inflammation, fibrosis and spotty lobular necrosis, as seen in other conditions, including hepatitis C [23–24]. "
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    ABSTRACT: Controversy exists over whether or not single-needle liver biopsies are sufficient to compare histological parameters in patients with non-alcoholic fatty liver disease. To identify sampling variability, we biopsied four liver specimens per patient, based on biopsy size (needle vs wedge) and location (left vs right lobe), immediately prior to bariatric Roux-en-Y gastric bypass surgery. Ten prospectively enrolled, morbidly obese patients underwent 40 laparoscopy-guided biopsies; two needle and two wedge from each of 16 left and 16 right liver lobes. The Kappa coefficient for concordance compared histological parameters from left and right lobe needle- and wedge biopsies. Wedge biopsies were considered our 'Gold Standard'. Each patient had two wedge- and two needle liver biopsies. Kappa concordance between all needle and wedge biopsies from right and left lobes showed variability. Wedge- and needle liver biopsies from contralateral lobes had higher concordance with each other, compared to ipsilateral needle/wedge biopsy pairs. Contralateral wedge pairs had higher concordance than contralateral needle/needle pairs. There were no biopsy complications. Wedge biopsy pairs had the best Kappa concordance but contralateral needle/needle biopsy pairs had good Kappa concordance. There were no complications from the 40 needle- and wedge liver biopsies, confirming the safety of laporoscopic multi-biopsy in both liver lobes.
    07/2013; 1(1):51-7. DOI:10.1093/gastro/got006
  • Digestive Diseases and Sciences 49(11-12):1957-61. · 2.55 Impact Factor
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    ABSTRACT: Introduction: Steatohepatitis and hepatitis C virus (HCV) have been related to several clinical and virological factors and fibrosis progression. Objective: To describe clinical and morphological aspects of steatohepatitis associated to HCV. Methods: The study included patients with HCV without treatment. Biopsies were evaluated by METAVIR score and steatohepatitis was evaluated according to criteria of Sociedade Brasileira de Patologia (SBP). Clinical parameters included alcoholic intake history and determination of risk factors for non-alcoholic steatohepatitis (NASH). Results: Steatohepatitis was observed in 42 out of 252 patients (16.6%) with HCV, and 76.2% were male. Risk factors for NASH were present in 37.5% of the patients with genotype 3 and in 73% of the patients with other genotypes (p = 0.05). Obesity was present in 16.7%, diabetes in 16.7%, hyperlipide- mia in 21.4%, and genotype 3 in 38.1%. Macrovacuolar steatosis presented mild intensity in 61.9% and was diffuse in 64.3%. Cirrhosis was present in 33.3% of the patients. Conclusions: Diffuse steatosis and ballooning of mild to moderate intensity characterized steatohepatitis related to HCV. Patients with genotype different from genotype 3 presented with known risk factors for NASH, whereas most of the patients with genotype 3 had only viral genotype as risk factor for steatosis. The frequency of cirrhosis was relevant and suggests that the association of steatohepatitis with HCV contribute to fibrosis progression.
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