Late Nonalcoholic Fatty Liver Disease with Cirrhosis: A Pathologic Case of Lost or Mistaken Identity

Seminars in Liver Disease, 04/02/2012

A strategic pathologic approach is discussed, which can be utilized for the pathologic assessment of cirrhosis of unknown cause, particularly when late nonalcoholic fatty liver disease (NAFLD) is suspected.

  • Late-stage nonalcoholic fatty liver disease (NAFLD) may present clinically and/or pathologically as cryptogenic cirrhosis.
  • The subject of this report, a middle-aged obese man with diabetes, underwent liver biopsy at the time of laparoscopic cholecystectomy because the liver surface appeared nodular and thickened.
  • The biopsy showed relatively nondescript cirrhosis at initial low-power microscopic inspection, but glycogenated hepatocyte nuclei (consistent with diabetes), sparse macrovesicular fat, and very rare foci of residual mild steatohepatitis were later found.
  • Slender fibrous septa (without significant inflammation and often enclosing microvessels) were present and interconnected to portal tracts.
  • Immunostains for cytokeratin 7, ubiquitin, and glutamine synthetase provided additional histologic data supporting NAFLD as the cause of the cirrhosis in this case.

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