Alcoholic liver disease (ALD) is a common cause of liver disease worldwide and typically occurs with chronic and/or excessive alcohol consumption. The pathological manifestations of ALD encompass a spectrum from steatosis (fatty liver), steatohepatitis (fatty liver with hepatocyte injury), and culminates in fibrosis and cirrhosis. The pathogenesis of ALD is believed to arise due to the toxic effects of ethanol metabolites (acetaldehyde) as well as excessive production of reactive oxygen species which impair hepatocellular function and damage the mitochondrial membranes, cell membrane, and cytoskeleton.

The H&E findings in this biopsy are of a steatohepatitic process characterized by severe steatosis, many ballooned hepatocytes and Mallory hyaline (intracytoplasmic inclusions composed of cytokeratins and ubiquitin). A prominent ductular reaction and mild cholestasis is also seen.

The above findings are also seen in the context of non-alcoholic fatty liver disease (NAFLD). While distinguishing NAFLD and ALD may often be difficult or impossible, the prominence of Mallory hyaline, the degree of ductular reaction and central hyaline sclerosis seen in this biopsy are suggestive of alcoholic liver disease.

The trichrome stain shows extensive bridging fibrosis and nodules compatible with cirrhosis. In certain areas, a distinctive pericellular “chicken-wire” like pattern of fibrosis is also seen which may be seen in both ALD and NAFLD.

This slide shows H&E stain. See Related Content for Trichrome stain.