This is the histologic appearance of hepatic macrovesicular steatosis (fatty change). The lipid accumulates in the hepatocytes as vacuoles. These vacuoles have a clear appearance with H&E staining. The most common cause of fatty change in developed nations is alcoholism. However, other causes can lead to a condition termed non-alcoholic fatty liver (NAFL) disease. In developing nations, kwashiorkor in children is one cause. Diabetes mellitus, obesity, metabolic syndrome, and severe gastrointestinal malabsorption are additional causes.

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