Chronic Viral
Hepatitis
Gross features:
Histologic features:
Grading/Staging of Chronic
Hepatitis:
·
Accurate
grading and staging requires at least 2.0cm of tissue containing 11-15 portal
tracts
·
Up
to 1.0cm from the capsule you can see increased stromal including septa
formation and perhaps focal nodularity in a normal liver
·
Right
lobe sample is more likely to avoid sampling the subcapsular region alone
·
Diagnosis
should include etiology and grading/staging based on most severe degree of
portal or lobular injury (Scheuer)
·
Sample
diagnosis: Chronic hepatitis B with mild piecemeal necrosis (grade 2) and
periportal fibrosis (stage 2)
·
METAVIR
algorithm for activity grade:
Inteface Hepatitis |
Lobular necrosis |
Overall Histologic Activity |
0 |
0 |
0 |
0 |
1 |
1 |
0 |
2 |
2 |
1 |
0 |
1 |
1 |
1 |
1 |
1 |
2 |
2 |
2 |
0 |
2 |
2 |
1 |
2 |
2 |
2 |
3 |
3 |
0 |
3 |
3 |
1 |
3 |
3 |
2 |
3 |
·
Easy
interpretation the overall histologic activity is equal to the highest of the
interface and lobular scores, except if both are 2, in which case the grade is
3.
·
Scheuer:
·
0
no or minimal inflammation
·
1
portal inflammation or lobular inflammation with no necrosis
·
2
mild piecemeal necrosis or focal hepatocellular necrosis
·
3
moderate piecemeal necrosis or severe focal cell damage
·
4
severe piecemeal necrosis or bridging necrosis
·
Scheuer
modified by Batts:
·
0
no activity; may have portal inflammation only
·
1
- minimal:
·
minimal,
patchy interface hepatitis
·
minimal
lobuloar inflammation with occasional spotty necrosis
·
2
- mild:
·
mild
interface hepatitis involving some or all portal tracts
·
mild
lobuloar inflammation with little hepatocellular injury
·
3
- moderate:
·
moderate
interface hepatitis involving all portal tracts
·
moderate
lobular inflammation with hepatocellular degeneration
·
4
severe:
·
severe
interface activity +/- bridging ?fibrosis (or is this necrosis?)
·
severe
lobular inflammation with prominent, diffuse hepatocellular damage
·
Batts
& Ludwig:
·
Portal
/ Interface activity:
·
0
none or minimal
·
1
portal inflammation only
·
2
mild interface hepatitis
·
3
moderate interface hepatitis
·
4
severe interface hepatitis
·
Lobular
activity:
·
0
none
·
1
inflammatory cells but no hepatocellular death
·
2
focal cell death
·
3
severe focal cell death
·
4
damage includes bridging necrosis
·
Ishak
grading (modified from Knodell Hepatitis Activity Index HAI):
·
A.
periportal or periseptal interface hepatitis
·
0
absent
·
1
mild (focal, few portal areas)
·
2
mild/moderate (focal, most portal areas)
·
3
moderate (continuous around < 50% of tracts or septa)
·
4
severe (continuous around > 50% of tracts or septa
·
B.
confluent necrosis
·
0
absent
·
1
focal
·
2
zone 3 necrosis in some areas
·
3
zone 3 necrosis in most areas
·
4
zone 3 necrosis + occasional portal-central bridging
·
5
zone 3 necrosis + multiple portal-central bridging
·
6
panacinar or multiacinar necrosis
·
C.
Focal (spotty) lytic necrosis, apoptosis and focal inflammation
·
0
absent
·
1
- <2 foci per 10x field
·
2
2-4 foci per 10x field
·
3
5-10 foci per 10x field
·
4
- >10 foci per 10x field
·
D.
Portal inflammation
·
0
none
·
1
mild, some or all portal areas
·
2
moderate, some or all portal areas
·
3
moderate / marked, all portal areas
·
4
marked, all portal areas
·
Original
Knodell HAI included fibrosis in activity and had bridging necrosis together
with interface hepatitis for a score of 0 to 22.
·
Stage:
degree of fibrosis
·
Laennec
- modified METAVIR)
·
Stage
0: no definite fibrosis
·
Stage
1: enlarged fibrotic portal tracts
·
Stage
2: periportal fibrosis, delicate septae, rare portal to portal septa,
without architectural distortion
·
Stage
3: several septae, or bridging fibrosis with architectural distortion, no
obvious cirrhosis
·
Stage
4: cirrhosis (probable or definite)
1.
4A
delicate fibrous septae
2.
4B
broad fibrous septae
3.
4C
geographic areas of extinction
·
METAVIR
·
F0
no fibrosis
·
F1
stellate enlargement of portal tracts but without septum formation
·
F2
enlargement of portal tracts with rare septum formation
·
F3
numerous septa without cirrhosis
·
F4
cirrhosis
·
Scheuer,
modified by Batts & Ludwig:
·
0
no fibrosis
·
1
enlarged fibrotic portal tracts
·
2
periportal expansion; portal-portal septa maybe, but intact architecture
·
3
bridging fibrosis with architectural distortion, no obvious cirrhosis
·
4
cirrhosis, probable or definite
·
Ishak
(modified Knodell hepatitis activity index HAI):
·
0
no fibrosis
·
1
fibrous expansion of some portal
areas, with or without short fibrous septa
·
2
fibrous expansion of most portal
areas, with or without short fibrous septa
·
3
fibrous expansion of most portal areas, with occasional portal-portal
bridging
·
4
fibrous expansion of portal areas with marked bridging (portal-portal and
portal-central)
·
5
Marked bridging (portal-portal and / or portal-central) with occasional
nodules (incomplete cirrhosis)
·
6
Cirrhosis, probable or definite
References: