Ballooned hepatocytes in steatohepatitis: The value of keratin immunohistochemistry for diagnosis

Ultrastructural findings in human nonalcoholic steatohepatitis

“…The association between MDBs and cellular ballooning is clear [29], but whether this represents separate but related processes, or a loss of cell contours as a result of cytoskeletal injury, remains uncertain. Recently, this relationship has been extended by Lackner et al with the description of steatohepatitis-related ballooned cells as cytokeratin 8/18 'empty cells' often containing MDBs [30]. We further demonstrated the ultrastructural relationship between MDB-containing cells, accumulation of small-to-medium sized fat droplets, and the dilation of the endoplasmic reticulum (ER) [31].…”

Histopathological diagnosis of non-alcoholic and alcoholic fatty liver disease

“…Sensitive depiction of any MDB that may be present can be achieved with ubiquitin antibodies. With regard to ballooning of hepatocytes, which is included in the scoring system, demonstration of the intermediate filament cytoskeleton with antibodies against keratin 8 or 18 may be helpful, as this cytoskeletal system is reduced in cell ballooning (Lackner et al, 2008). The staging of fibrosis is shown in Table1.…”

Histopathology of Non-Alcoholic Fatty Liver Disease

“…The histological recognition of hepatocellular ballooning can show significant inter-observer variation [63] . Loss of the normal hepatocyte keratins, 8 and 18, as detected by immunostaining, might help in the objective identification of ballooned hepatocytes [64] . Apoptotic (acidophil) bodies, another form of hepatocyte injury and a feature of programmed cell death, are common in NASH [65] .…”