Staging and Grading Disease Activity in Steatohepatitis
Nonalcoholic Steatohepatitis

Grading of Disease Activity in Nonalcoholic Steatohepatitis

Grading Terminology Criteria
Grade Descriptive Steatosis Hepatocyte
Ballooning
Lobular Inflammation Portal Inflammation
1 Mild Mainly macrovesicular, may involve up to 66% of the lobules Occasional, Zone 3 Scattered neutrophils, occasional mononuclear cells None to mild
2 Moderate Any extent, usually mixed macro- and microvesicular "Obvious", Zone 3 Neutrophils may be noted associated with ballooned hepatocytes, pericellular fibrosis; mild chronic inflammation may be seen Mild to moderate
3 Severe Typically >66% (panacinar); commonly mixed steatosis Marked, predominantly Zone 3 Scattered acute and chronic inflammation; neutrophils may concentrate in Zone 3 areas of ballooning and perisinusoidal fibrosis Mild to moderate


Staging of Nonalcoholic Steatohepatitis

Staging Terminology
Stage Descriptive Comments
1 Zone 3 perivenular, perisinusoidal (pericellular) fibrosis Fibrosis at these sites may be focal or extensive
2 Stage 1 changes + periportal fibrosis Periportal fibrosis may be focal or extensive
3 Bridging fibrosis May be focal or extensive
4 Cirrhosis Cirrhosis

Reference


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Last Modified: Thu Jun 18 10:14:08 EDT 2009