Modern morphological characteristics of alcoholic, non-alcoholic and toxic steatohepatitis

Objective: to characterize the pathological features of alcoholic, non-alcoholic and toxic steatohepatitis (SН) for use in forensic-histological diagnostics. Material and methods. By histological (G), histochemical (HC) and immunohistochemical (IHC) methods we studied changes in 239 liver biopsy samples of 450 deceased patients with alcoholic, non-alcoholic, toxic SH and hepatic steatosis. Results. Chronic alcoholic, non-alcoholic and toxic SG is characterized by zonal steatosis of hepatocytes; the presence of steatonecrosis and apoptosis of hepatocytes, ballooning hepatocytes, hepatocytes with Mallory-Denk bodies, lesions of lobular necrosis and sinusoidal steatopeliosis, portal-lobular infiltrates of leukocytes, lymphocytes and macrophages; moderate perisinusoidal infiltration of CD68 + by macrophages, plasma cells, CD4 + and CD8 + T‑lymphocytes; as well as perisinusoidal-pericellular or portal-Z1-3perisinusoidal fibrosis of the liver. It differs from simple steatosis and acute toxic-drug hepatic steatosis by the presence of inflammatory changes and liver fibrosis. Conclusions. Despite certain microscopic differences between alcoholic, non-alcoholic and toxic SG for their differential diagnosis, the expert-histologist requires clinical and laboratory data of patients and the results of forensic chemical studies of the deceased patients.