Criteria
Diagnosis of metabolic dysfunction-associated steatohepatitis (MASH)[65]
Histologic picture of steatohepatitis.
Convincing evidence of minimal or no alcohol consumption (<40 g/week).
Absence of serologic evidence of viral hepatitis.
Histologic (Brunt) criteria[4]
Liver biopsy showing:[Figure caption and citation for the preceding image starts]: A wedge biopsy of the liver from a 52-year-old female organ donor; the biopsy shows moderate mixed micro- and macrovesicular steatosis; there is no significant lobular inflammation or necrosis (hematoxylin and eosin, [H&E] stain, x 200)From the collection of Kapil B. Chopra, MD [Citation ends].
[Figure caption and citation for the preceding image starts]: A case of metabolic dysfunction-associated steatohepatitis; the biopsy shows ballooning degeneration of the hepatocytes (middle right) and spotty lobular inflammation in addition to mixed micro- and macrovesicular steatosis (H&E, x 200)From the collection of Kapil B. Chopra, MD [Citation ends].
Steatosis
Hepatocyte ballooning degeneration
Mild diffuse lobular mixed acute and chronic inflammation
Perivenular
Perisinusoidal collagen deposition
Zone 3 accentuation may be detected.
Other commonly observed features include Mallory's hyaline, vacuolated nuclei in periportal hepatocytes, lobular lipogranulomas, periodic acid-Schiff (PAS)-diastase-resistant Kupffer cells, and pericellular fibrosis (in those with advanced stages of fibrosis or cirrhosis).
Nonalcoholic fatty liver disease (NAFLD) activity score[5]
This scoring system consists of histologic features and addresses the full spectrum of lesions of MASLD and is the standard used in clinical trials: steatosis (0 to 3), lobular inflammation (0 to 2), hepatocellular ballooning (0 to 2), and fibrosis (0 to 4). Scores of >5 correlate with a diagnosis of MASH, and biopsies with scores of <3 are considered as not MASH.
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