The main pathologic features of alcoholic steatohepatitis include macrovesicular steatosis (as seen here), hepatocellular damage (ballooning, apoptosis, Mallory-Denk bodies), inflammation (neutrophils and lymphocytes), and pericellular fibrosis. In early stages, steatosis is most evident in perivenular areas (acinar zone 3) as shown here. Hepatocytes in periportal areas show ballooning but little lipid accumulation. Alcoholic steatosis is characteristically macrovesicular: large intracellular lipid droplets result in peripheral displacement of the hepatocyte nuclei. Progressive hepatocyte damage eventually leads to cirrhosis and liver failure.