A 55-year-old obese woman with type 2 diabetes and hyperlipidemia is found to have elevated transaminases. Liver biopsy shows macrovesicular steatosis, hepatocyte ballooning degeneration, Mallory-Denk bodies, lobular inflammation, and perisinusoidal fibrosis in zone 3. These findings are diagnostic of:
- A Alcoholic hepatitis
- B Non-alcoholic steatohepatitis (NASH) ✓
- C Autoimmune hepatitis
- D Wilson disease
Correct answer: B. Non-alcoholic steatohepatitis (NASH)
Explanation
Non-alcoholic steatohepatitis (NASH) is histologically indistinguishable from alcoholic hepatitis and shows macrovesicular steatosis, hepatocyte ballooning, Mallory-Denk bodies (aggregates of ubiquitinated intermediate filaments), lobular inflammation, and characteristic zone 3 perisinusoidal/pericellular 'chicken-wire' fibrosis. The diagnosis requires clinical exclusion of significant alcohol use. NASH is the aggressive form of NAFLD and can progress to cirrhosis and HCC, especially in the context of metabolic syndrome.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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