MODERN PATHOMORPHOLOGICAL FEATURES AND PROSPECTIVE DIREC-TIONS OF NONALCOHOLIC STEATO-HEPATITIS DIAGNOSTICS

Non-alcoholic steatohepatitis (NASH) is a form of metabolic liver damage where morphological fatty changes (steatosis) are associated with lobular inflammation (interlobular and/or periportal), hepatocyte damage and/or fibrosis. The term covers pathogenetic links, ranging from non-alcoholic steatohepatitis to ‘cryptogenic' cirrhosis. A pathomorphological study of 12 core biopsy samples revealed that the (high/low) intensity of degenerative, inflammatory and sclerotic changes was almost the same for all patients. Both the activity of the process and the fibrosis appeared to be less intensive in seven cases. The Knodell Histology Activity Index was observed to range from four to seven. In these samples, no more than 1/3 of hepatocytes were affected by fatty degeneration, and the inflammatory infiltrate (consisting of a small number of macrophages, solitary Kupffer cells, and a moderate amount of T-lymphocytes) was focal, with some inflammatory infiltrate cells found among the hepatocytes. α-SMA expression was observed in some myofibroblasts. The Knodell Histology Activity Index ranged from 8 to 12 in five cases. Fatty degeneration was found in 2/3 of the hepatocytes in the biopsy or in all of them. The cellular infiltration was more evident, with a tendency to form dense focal accumulations, and consisted of a large number of macrophages, a prominent amount of hypertrophic Kupffer cells, and moderate or large quantities of T- and B-lymphocytes. α-SMA expression was found in a high number of myofibroblasts close to portal tracts, in interlobular sections, zones of cellular infiltration, and certain areas between hepatocytes, which can be a predicting sign of ЕМТ. In addition, we developed a special map that not only represents patient's condition in a formal way, but also allows one to come up with an integration assessment of pathomorphological changes, based on histochemical and immunohistochemical staining used for the quantification and assessment of changes in the liver of NASH patients.