Random liver biopsy, right lobe
Microscopic description
Moderate large droplet macrovesicular steatosis, involving approximately 50% of hepatocytes (score 2). There is prominent ballooning degeneration with Mallory Denk bodies (score 2) and lobular inflammation (>4 foci/ 20x field; score 3), with satellitosis. Trichrome stain highlights marked pericellular fibrosis, with extensive bridging fibrosis (stage 3). There is focal 1-2+ reticuloendothelial iron deposition (iron stain). There are no diastase resistant cytoplasmic globules in hepatocytes (PASD stain). Reticulin stains on both blocks confirm absence of hepatocellular carcinoma. With prominent neutrophilic lobular inflammation, satellitosis and conspicuous Mallory Denk bodies, histologic features suggest alcoholic fatty liver disease.
Impression
Steatohepatitis, NAS score 7 of 8, fibrosis stage 3 (NASH-CRN system)