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Staging and Grading Disease Activity in 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 |
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Last Modified: Thu Jun 18 10:14:08 EDT 2009
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