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

 

 

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