A 50-year-old obese woman with metabolic syndrome has a liver biopsy showing steatosis, lobular inflammation, and perisinusoidal fibrosis. Which histological feature, when present, distinguishes NASH from simple steatosis?
- A Macrovesicular steatosis affecting >5% of hepatocytes
- B Perisinusoidal collagen deposition
- C Hepatocyte ballooning degeneration ✓
- D Lipogranulomas
Correct answer: C. Hepatocyte ballooning degeneration
Explanation
Hepatocyte ballooning (enlarged, pale, swollen hepatocytes with rarefied cytoplasm) is the histological hallmark that distinguishes NASH from simple steatosis. It represents cytoskeletal injury (loss of cytokeratin 8/18) and is part of the NAFLD Activity Score (NAS). Simple steatosis has fat accumulation without ballooning or significant inflammation. Perisinusoidal fibrosis and lobular inflammation are also features of NASH but ballooning is the key distinguishing feature.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.