Histopathologic diagnosis of chronic viral hepatitis

Abstract

Morphological evaluation of the liver continues to play a centralrole for the diagnosis, grading and staging of chronic viral hepatitis.The defining morphology is necroinflammation, that is hepatocyteinjury and inflammation. Hepatocyte injury is usually irreversible,and presents as apoptosis and/or necrosis. Mononuclear cellinfiltration of the portal tracts, that is usually accompanied byperiportal (interface) and lobular inflammation is typical. Continuednecroinflammatory activity at the limiting plate destroyingperiportal parenchyma initiates fibrogenesis leading to cirrhosis.Fibrosis can be reversible with fragmentation of scar tissue,resolving vascular derangements and parenchymal regeneration.Grading is a measure of the intensity of necroinflammatory activityand staging is a measure of fibrosis and architectural alteration.Besides staging, Laennec scoring system, subdividing cirrhosisthat is based on histologic parameters of fibrous septa width andnumber, has been advised to be used in reporting chronic viralhepatitis.Keywords: Viral hepatitis, Grading, Staging, Biopsy

References

1. Scheuer PJ, Lefkowitch JH. Chronic hepatitis. In: Scheuer
2. PJ, Lefkowitch JH, eds. Liver Biopsy Interpretation, 7th ed.
3. Elsevier Saunders, 2005: 145-170.
4. Theise ND, Bodenheimer HC, Ferrell LD. Acute and chronic
5. viral hepatitis. In: Burt AD, Portmann BC, Ferrell L, eds.
6. MacSween’s Pathology of the Liver, 6th ed. Edinburg
7. Churchill-Livingstone-Elsevier, 2012:361-402.
8. Hytiroglou P. Hepatitis B and C. In: Saxena R, ed. Practical

9. Hepatic Pathology, 1th ed. Elsevier Saunders, 2011: 215-234.
10. Yerian LM, Lamps LW. Acute and chronic infectious
11. hepatitis. In: Odze DR, Goldblum JR, eds. Surgical Pathology
12. of the GI Tract, Liver, Biliary Tract, and Pancreas, 3rd ed.
13. Philedelphia: Elsevier Saunders, 2015:1228-1261.
14. Guido M, Mangia A, Faa G. Chronic viral hepatitis: The
15. histology report. Dig Liver Dis 2011;43:S331-S343.
16. De Groote J, Desmet VJ, Gedigk P, et al. A classification of
17. chronic hepatitis. Lancet 1968;2:262-8.
18. Ludwig J, McFarlane IG, Rakela J and the International
19. Working Party. Terminology of chronic hepatitis. Am J
20. Gastroenterol 1995;90:181-9.
21. Crawford JM, Burt AD. Anatomy, pathophysiology and basic
22. mechanisms of disease. In: Burt AD, Portmann BC, Ferrell
23. L, eds. MacSween’s Pathology of the Liver, 6th ed. Edinburg
24. Churchill-Livingstone-Elsevier, 2012: 1-77.
25. Theise ND. Liver biopsy assessment in chronic viral hepatitis
26. a personal, practical approach. Modern Pathol 2007;20:S3-
27. S14.
28. Schattenberg JM, Galle PR, Schuchmann M. Apoptosis in
29. liver disease. Liver Int 2006;26:904-11.
30. Hano H, Takasaki S, Endo Y, Harada T, Komine K, Koike
31. Y. Histologic reassessment of the role of bridging fibrosis
32. in the angioarchitectural features associated with lobular
33. distortion of the liver in chronic viral hepatitis. Hepatol Res
34. 46:E70-8.
35. Friedman SL. Mechanisms of hepatic fibrogenesis.
36. Gastroenterol 2008;134:1655-69.
37. Iwaisako K, Brenner DA, Kisseleva T. What’s new in liver
38. fibrosis? The origin of myofibroblasts in liver fibrosis. J
39. Gastroenterol Hepatol 2012;27(suppl 2):65-68.
40. Wanless IR, Huang WY. Vascular disorders. In: Burt AD
41. Portmann BC, Ferrell L, eds. MacSween’s Pathology of
42. the Liver, 6th ed. Edinburg: Churchill-Livingstone-Elsevier
43. 601-43.
44. Elpek GÖ. Angiogenesis and liver fibrosis. World J Hepatol
45. 7:377-91.
46. Chen W, Rock JB, Yearsley MM, Ferrell LD, Frankel WL.
47. Different collagen types show distinct rates of increase from
48. early to late stages of hepatitis C-related liver fibrosis. Human
49. Pathol 2014;45:160-5.
50. Garcia-Tsao G, Iredale J, Pinzani. Now there are many (stages)
51. where before there was one: in search of a pathophysiological
52. classification of cirrhosis. Hepatology 2010;51:1445-9.
53. Wanless IR, Nakashima E, Sherman M. Regression of human
54. cirrhosis. Arch Pathol Lab Med 2000;124:1599-1607.
55. Friedman SL. Fibrogenic cell reversion underlies fibrosis
56. regression in liver. Proc Natl Acad Sci 2012;109:9230-1.
57. Mani H, Kleiner DE. Liver biopsy findings in chronic
58. hepatitis B. Hepatology 2009;49:S61-S71.
59. Biazar T, Yahyapour Y, Roushan H, et al. Relationship
60. between hepatitis B DNA viral load in the liver and its
61. histology in patients with chronic hepatitis B. Caspian J
62. Intern Med 2005;6:209-12.
63. Tachtatzis PM, Marshall A, Arvinthan A, et al. Chronic
64. hepatitis B virus infection: the relation between hepatitis
65. B antigen expression, telomere length, senescence
66. inflammation and fibrosis. PLoS One 2015;10:e0127511.
67. Fiel MI. Pathology of chronic hepatitis B and chronic hepatitis
68. C. Clin Liver Dis 2019;14:555.
69. Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ.
70. Classification of chronic hepatitis: diagnosis, grading and
71. staging. Hepatology 1994;19:1513-20.
72. Knodell RG, Ishak KG, Black WC, et al. Formulation and
73. application of a numerical scoring system for assessing
74. histological activity in asymptomatic chronic active hepatitis.
75. Hepatology 1981;1:431-5.
76. Hübscher SG. Histological grading and staging in chronic
77. hepatitis: clinical applications and problems. J Hepatol
78. 29:1015-22.
79. Ishak K, Baptista A, Bianchi L, et al. Histological grading
80. and staging of chronic hepatitis. J Hepatol 1995;22:696-9.
81. Scheuer PJ. Classification of chronic viral hepatitis: a need
82. for reassessment. J Hepatol 1991;13:372-4.
83. Batts KP, Ludwig J. Chronic hepatitis: an update on
84. terminology and reporting. Am J Surg Pathol 1995;19:1409-
85. Bedossa P, Poynard T and the French METAVIR Cooperative
86. Study Group. An algorithm for grading activity in chronic
87. hepatitis C. Hepatology 1996;24:289-93.
88. Goldin RD, Goldin JG, Burt AD, Dhillon PA, Wyatt J
89. Patel N. Intra-observer and inter-observer variation in the
90. histopathological assessment of chronic viral hepatitis. J
91. Hepatol 1996;25:649-54.
92. Rousselet MC, Michalak S, Dupre F, et al. Sources of
93. variability in histological scoring of chronic viral hepatitis.
94. Hepatology 2005;41:41:257.
95. Paterson AL, Allison ME, Brais R, Davies SE. Any value in a
96. specialist review of liver biopsies? Conclusions of a four-year
97. review. Histopathology 2016 Jan 30. [Epub ahead of print]
98. Kutami R, Girgrah N, Wanless IR, et al. The Laennec
99. grading system for assessment of hepatic fibrosis: validation
100. by correlation with wedged hepatic vein pressure and clinical
101. features. Hepatology 2000;32:407A.
102. Hytiroglu P, Snover DC, Alves V, et all. Beyond “Cirrhosis”
103. A proposal from international liver pathology subgroup. Am
104. J Clin Pathol 2012;137:5-9.
105. Kim SU, Oh HJ, Wanless IR, Lee S, Han H, Park YN. The
106. Laennec staging system for histological sub-classification of
107. cirrhosis is useful for stratification of prognosis in patients
108. with liver cirrhosis. J Hepatol 2012;57:556-63.
109. Kim SU, Cho MY, Baik SK, et al. Histological subclassification
110. of cirrhosis using the Laennec fibrosing scoring
111. system correlates with clinical stage and grade of portal
112. hypertension. J Hepatol 2011;55:1004-9.
113. Narciso-Schiavon JL, Freire FC, Suarez MM, et al.
114. Antinuclear antibody positivity in patients with chronic
115. hepatitis C; clinically relevant or an epiphenomenon? Eur J
116. Gastroenterol Hepatol 2009;21:440-6.
117. Li BA, Liu J, Hou J, et al. Autoantibodies in Chinese patients
118. with chronic hepatitis B: prevalence and clinical associations.
119. World J Gastroenterol 2015;21:283-91.
120. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith
121. AD. Liver biopsy. Hepatology 2009;49:1017-43.
122. Cholongitas E, Senzolo M, Standish R, et al. A systematic
123. review of the quality of liver biopsy specimens. Am J Clin
124. Pathol 2006;125:710-21.
125. Colloredo G, Guidon M, Sonzogni A, Leandro G. Impact of
126. liver biopsy size on histological evaluation of chronic viral
127. hepatitis: the smaller the sample, the milder the disease. J
128. Hepatol 2003;39:239-44..
129. Schiano TD, Azeem S, Bodian CA, et al. Importance
130. of specimen size in accurate needle biopsy evaluation of
131. patients with chronic hepatitis C. Clin Gastroenterol Hepatol
132. 3:930-5.
133. Bedossa P, Dargere D, Paradis V. Sampling variability of
134. liver fibrosis in chronic hepatitis C. Hepatol 2003;38:1449.
135. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Eng J Med
136. 344:495-500.
137. Skripenova S, Trainer T, Krawitt E, Blaszyk H. Variability
138. of grade and stage in simultaneous paired liver biopsies in
139. patients with hepatitis C. J Clin Pathol 2007;60:321-4.