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Histopathology of Nonalcoholic Fatty Liver Disease

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Non-Alcoholic Fatty Liver Disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) has a wide histological spectrum encompassing simple steatosis, which generally has a benign course and is present in all patients and nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD that may be accompanied by fibrosis leading in some patients to advanced liver disease with cirrhosis. Hepatocellular carcinoma may develop in a background of pre-cirrhotic NASH or NASH cirrhosis. Currently, liver biopsy remains the most accurate tool for diagnosing NASH in patients with image-detected liver steatosis, appropriate clinical characteristics, mainly related to the metabolic syndrome, and unexplained hypertransaminasemia. Clinical guidelines recommend selective liver biopsy in NAFLD patients with medium to high risk of advanced fibrosis and patients with competing etiological factors for hepatic steatosis or coexisting chronic hepatopathy. This chapter will focus on the histopathology of NAFLD in adults, children, and special populations in the setting of the metabolic syndrome, and will assess differential diagnosis from alcohol-related liver disease, concurrence with other chronic liver disease, histological scoring systems, and applications for clinical trials.

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Acknowledgments

Dina Tiniakos acknowledges support from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No. 777377 (LITMUS) funded by European Union’s Horizon 2020 Research and Innovation programme and EFPIA.

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Authors and Affiliations

  1. Department of Pathology, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Dina G. Tiniakos

  2. Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

    Dina G. Tiniakos

  3. First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Stratigoula Sakellariou

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  1. Dina G. Tiniakos
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Correspondence to Dina G. Tiniakos .

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  1. Department of Medical Sciences, Division of Gastroentrology and Hepatology, University of Turin, Turin, Italy

    Elisabetta Bugianesi

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Tiniakos, D.G., Sakellariou, S. (2020). Histopathology of Nonalcoholic Fatty Liver Disease. In: Bugianesi, E. (eds) Non-Alcoholic Fatty Liver Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-95828-6_3

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