Figure 3
(a) Nonalcoholic steatohepatitis is characterized by zone 3 accentuation of the lesions of steatosis (large and small droplet type), ballooning and lobular inflammation. There may also be a component of portal chronic inflammation (not illustrated). The findings in this biopsy are indistinguishable from alcoholic steatohepatitis. (b) The earliest stage of fibrosis in NASH is zone 3 perisinusoidal collagen deposition in a ‘chickenwire’ pattern (central zone on right, portal tract on left). This pattern is also seen in alcoholic liver disease, and therefore is not useful in distinguishing the two (trichrome stain).
