| [ Summary ] |
Cryptogenic cirrhosis is defined as cirrhosis without certain etiologies (eg, hepatitis viral infection or alcohol intake). A diagnosis of cryptogenic cirrhosis should be made after full clinical and pathological examination to rule out other etiologies. Clinical features associated with NASH, such as obesity and diabetes mellitus, are also common in patients with cryptogenic cirrhosis, suggesting that the latter is frequently the end result of NASH. In our re-evaluation of 7 autopsied cases diagnosed as cryptogenic cirrhosis from 1996 to 2005, diabetes mellitus and obesity were present in 71 % and 43 % of the patients, respectively. In pathological examination, most cases displayed sub-mono-lobular small cirrhotic nodule, perivenular fibrosis and focal cell ballooning of hepatocytes, although the extent of fatty deposition was very mild (< 5 % of hepatic parenchyma). These findings also suggested the involvement of NASH in the hidden etiology of cryptogenic cirrhosis. Pathological features such as fatty change and steatohepatitis, often diminish in the end stages of NASH (burnt-out NASH). Therefore, the establishment of clinical and pathological diagnostic criteria for burnt-out NASH is mandatory for an accurate evaluation of the etiology of cirrhosis. |