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Histopathologic diagnosis of chronic viral hepatitis

Year 2016, Special Issue :2 Gastroenterology and Hepatology Viral Hepatitis, 18 - 28, 01.08.2016
https://doi.org/10.5472/MMJsi.2901.05

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

  • Scheuer PJ, Lefkowitch JH. Chronic hepatitis. In: Scheuer
  • PJ, Lefkowitch JH, eds. Liver Biopsy Interpretation, 7th ed.
  • Elsevier Saunders, 2005: 145-170.
  • Theise ND, Bodenheimer HC, Ferrell LD. Acute and chronic
  • viral hepatitis. In: Burt AD, Portmann BC, Ferrell L, eds.
  • MacSween’s Pathology of the Liver, 6th ed. Edinburg
  • Churchill-Livingstone-Elsevier, 2012:361-402.
  • Hytiroglou P. Hepatitis B and C. In: Saxena R, ed. Practical
  • Hepatic Pathology, 1th ed. Elsevier Saunders, 2011: 215-234.
  • Yerian LM, Lamps LW. Acute and chronic infectious
  • hepatitis. In: Odze DR, Goldblum JR, eds. Surgical Pathology
  • of the GI Tract, Liver, Biliary Tract, and Pancreas, 3rd ed.
  • Philedelphia: Elsevier Saunders, 2015:1228-1261.
  • Guido M, Mangia A, Faa G. Chronic viral hepatitis: The
  • histology report. Dig Liver Dis 2011;43:S331-S343.
  • De Groote J, Desmet VJ, Gedigk P, et al. A classification of
  • chronic hepatitis. Lancet 1968;2:262-8.
  • Ludwig J, McFarlane IG, Rakela J and the International
  • Working Party. Terminology of chronic hepatitis. Am J
  • Gastroenterol 1995;90:181-9.
  • Crawford JM, Burt AD. Anatomy, pathophysiology and basic
  • mechanisms of disease. In: Burt AD, Portmann BC, Ferrell
  • L, eds. MacSween’s Pathology of the Liver, 6th ed. Edinburg
  • Churchill-Livingstone-Elsevier, 2012: 1-77.
  • Theise ND. Liver biopsy assessment in chronic viral hepatitis
  • a personal, practical approach. Modern Pathol 2007;20:S3-
  • S14.
  • Schattenberg JM, Galle PR, Schuchmann M. Apoptosis in
  • liver disease. Liver Int 2006;26:904-11.
  • Hano H, Takasaki S, Endo Y, Harada T, Komine K, Koike
  • Y. Histologic reassessment of the role of bridging fibrosis
  • in the angioarchitectural features associated with lobular
  • distortion of the liver in chronic viral hepatitis. Hepatol Res
  • 46:E70-8.
  • Friedman SL. Mechanisms of hepatic fibrogenesis.
  • Gastroenterol 2008;134:1655-69.
  • Iwaisako K, Brenner DA, Kisseleva T. What’s new in liver
  • fibrosis? The origin of myofibroblasts in liver fibrosis. J
  • Gastroenterol Hepatol 2012;27(suppl 2):65-68.
  • Wanless IR, Huang WY. Vascular disorders. In: Burt AD
  • Portmann BC, Ferrell L, eds. MacSween’s Pathology of
  • the Liver, 6th ed. Edinburg: Churchill-Livingstone-Elsevier
  • 601-43.
  • Elpek GÖ. Angiogenesis and liver fibrosis. World J Hepatol
  • 7:377-91.
  • Chen W, Rock JB, Yearsley MM, Ferrell LD, Frankel WL.
  • Different collagen types show distinct rates of increase from
  • early to late stages of hepatitis C-related liver fibrosis. Human
  • Pathol 2014;45:160-5.
  • Garcia-Tsao G, Iredale J, Pinzani. Now there are many (stages)
  • where before there was one: in search of a pathophysiological
  • classification of cirrhosis. Hepatology 2010;51:1445-9.
  • Wanless IR, Nakashima E, Sherman M. Regression of human
  • cirrhosis. Arch Pathol Lab Med 2000;124:1599-1607.
  • Friedman SL. Fibrogenic cell reversion underlies fibrosis
  • regression in liver. Proc Natl Acad Sci 2012;109:9230-1.
  • Mani H, Kleiner DE. Liver biopsy findings in chronic
  • hepatitis B. Hepatology 2009;49:S61-S71.
  • Biazar T, Yahyapour Y, Roushan H, et al. Relationship
  • between hepatitis B DNA viral load in the liver and its
  • histology in patients with chronic hepatitis B. Caspian J
  • Intern Med 2005;6:209-12.
  • Tachtatzis PM, Marshall A, Arvinthan A, et al. Chronic
  • hepatitis B virus infection: the relation between hepatitis
  • B antigen expression, telomere length, senescence
  • inflammation and fibrosis. PLoS One 2015;10:e0127511.
  • Fiel MI. Pathology of chronic hepatitis B and chronic hepatitis
  • C. Clin Liver Dis 2019;14:555.
  • Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ.
  • Classification of chronic hepatitis: diagnosis, grading and
  • staging. Hepatology 1994;19:1513-20.
  • Knodell RG, Ishak KG, Black WC, et al. Formulation and
  • application of a numerical scoring system for assessing
  • histological activity in asymptomatic chronic active hepatitis.
  • Hepatology 1981;1:431-5.
  • Hübscher SG. Histological grading and staging in chronic
  • hepatitis: clinical applications and problems. J Hepatol
  • 29:1015-22.
  • Ishak K, Baptista A, Bianchi L, et al. Histological grading
  • and staging of chronic hepatitis. J Hepatol 1995;22:696-9.
  • Scheuer PJ. Classification of chronic viral hepatitis: a need
  • for reassessment. J Hepatol 1991;13:372-4.
  • Batts KP, Ludwig J. Chronic hepatitis: an update on
  • terminology and reporting. Am J Surg Pathol 1995;19:1409-
  • Bedossa P, Poynard T and the French METAVIR Cooperative
  • Study Group. An algorithm for grading activity in chronic
  • hepatitis C. Hepatology 1996;24:289-93.
  • Goldin RD, Goldin JG, Burt AD, Dhillon PA, Wyatt J
  • Patel N. Intra-observer and inter-observer variation in the
  • histopathological assessment of chronic viral hepatitis. J
  • Hepatol 1996;25:649-54.
  • Rousselet MC, Michalak S, Dupre F, et al. Sources of
  • variability in histological scoring of chronic viral hepatitis.
  • Hepatology 2005;41:41:257.
  • Paterson AL, Allison ME, Brais R, Davies SE. Any value in a
  • specialist review of liver biopsies? Conclusions of a four-year
  • review. Histopathology 2016 Jan 30. [Epub ahead of print]
  • Kutami R, Girgrah N, Wanless IR, et al. The Laennec
  • grading system for assessment of hepatic fibrosis: validation
  • by correlation with wedged hepatic vein pressure and clinical
  • features. Hepatology 2000;32:407A.
  • Hytiroglu P, Snover DC, Alves V, et all. Beyond “Cirrhosis”
  • A proposal from international liver pathology subgroup. Am
  • J Clin Pathol 2012;137:5-9.
  • Kim SU, Oh HJ, Wanless IR, Lee S, Han H, Park YN. The
  • Laennec staging system for histological sub-classification of
  • cirrhosis is useful for stratification of prognosis in patients
  • with liver cirrhosis. J Hepatol 2012;57:556-63.
  • Kim SU, Cho MY, Baik SK, et al. Histological subclassification
  • of cirrhosis using the Laennec fibrosing scoring
  • system correlates with clinical stage and grade of portal
  • hypertension. J Hepatol 2011;55:1004-9.
  • Narciso-Schiavon JL, Freire FC, Suarez MM, et al.
  • Antinuclear antibody positivity in patients with chronic
  • hepatitis C; clinically relevant or an epiphenomenon? Eur J
  • Gastroenterol Hepatol 2009;21:440-6.
  • Li BA, Liu J, Hou J, et al. Autoantibodies in Chinese patients
  • with chronic hepatitis B: prevalence and clinical associations.
  • World J Gastroenterol 2015;21:283-91.
  • Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith
  • AD. Liver biopsy. Hepatology 2009;49:1017-43.
  • Cholongitas E, Senzolo M, Standish R, et al. A systematic
  • review of the quality of liver biopsy specimens. Am J Clin
  • Pathol 2006;125:710-21.
  • Colloredo G, Guidon M, Sonzogni A, Leandro G. Impact of
  • liver biopsy size on histological evaluation of chronic viral
  • hepatitis: the smaller the sample, the milder the disease. J
  • Hepatol 2003;39:239-44..
  • Schiano TD, Azeem S, Bodian CA, et al. Importance
  • of specimen size in accurate needle biopsy evaluation of
  • patients with chronic hepatitis C. Clin Gastroenterol Hepatol
  • 3:930-5.
  • Bedossa P, Dargere D, Paradis V. Sampling variability of
  • liver fibrosis in chronic hepatitis C. Hepatol 2003;38:1449.
  • Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Eng J Med
  • 344:495-500.
  • Skripenova S, Trainer T, Krawitt E, Blaszyk H. Variability
  • of grade and stage in simultaneous paired liver biopsies in
  • patients with hepatitis C. J Clin Pathol 2007;60:321-4.

Histopathologic diagnosis of chronic viral hepatitis

Year 2016, Special Issue :2 Gastroenterology and Hepatology Viral Hepatitis, 18 - 28, 01.08.2016
https://doi.org/10.5472/MMJsi.2901.05

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

  • Scheuer PJ, Lefkowitch JH. Chronic hepatitis. In: Scheuer
  • PJ, Lefkowitch JH, eds. Liver Biopsy Interpretation, 7th ed.
  • Elsevier Saunders, 2005: 145-170.
  • Theise ND, Bodenheimer HC, Ferrell LD. Acute and chronic
  • viral hepatitis. In: Burt AD, Portmann BC, Ferrell L, eds.
  • MacSween’s Pathology of the Liver, 6th ed. Edinburg
  • Churchill-Livingstone-Elsevier, 2012:361-402.
  • Hytiroglou P. Hepatitis B and C. In: Saxena R, ed. Practical
  • Hepatic Pathology, 1th ed. Elsevier Saunders, 2011: 215-234.
  • Yerian LM, Lamps LW. Acute and chronic infectious
  • hepatitis. In: Odze DR, Goldblum JR, eds. Surgical Pathology
  • of the GI Tract, Liver, Biliary Tract, and Pancreas, 3rd ed.
  • Philedelphia: Elsevier Saunders, 2015:1228-1261.
  • Guido M, Mangia A, Faa G. Chronic viral hepatitis: The
  • histology report. Dig Liver Dis 2011;43:S331-S343.
  • De Groote J, Desmet VJ, Gedigk P, et al. A classification of
  • chronic hepatitis. Lancet 1968;2:262-8.
  • Ludwig J, McFarlane IG, Rakela J and the International
  • Working Party. Terminology of chronic hepatitis. Am J
  • Gastroenterol 1995;90:181-9.
  • Crawford JM, Burt AD. Anatomy, pathophysiology and basic
  • mechanisms of disease. In: Burt AD, Portmann BC, Ferrell
  • L, eds. MacSween’s Pathology of the Liver, 6th ed. Edinburg
  • Churchill-Livingstone-Elsevier, 2012: 1-77.
  • Theise ND. Liver biopsy assessment in chronic viral hepatitis
  • a personal, practical approach. Modern Pathol 2007;20:S3-
  • S14.
  • Schattenberg JM, Galle PR, Schuchmann M. Apoptosis in
  • liver disease. Liver Int 2006;26:904-11.
  • Hano H, Takasaki S, Endo Y, Harada T, Komine K, Koike
  • Y. Histologic reassessment of the role of bridging fibrosis
  • in the angioarchitectural features associated with lobular
  • distortion of the liver in chronic viral hepatitis. Hepatol Res
  • 46:E70-8.
  • Friedman SL. Mechanisms of hepatic fibrogenesis.
  • Gastroenterol 2008;134:1655-69.
  • Iwaisako K, Brenner DA, Kisseleva T. What’s new in liver
  • fibrosis? The origin of myofibroblasts in liver fibrosis. J
  • Gastroenterol Hepatol 2012;27(suppl 2):65-68.
  • Wanless IR, Huang WY. Vascular disorders. In: Burt AD
  • Portmann BC, Ferrell L, eds. MacSween’s Pathology of
  • the Liver, 6th ed. Edinburg: Churchill-Livingstone-Elsevier
  • 601-43.
  • Elpek GÖ. Angiogenesis and liver fibrosis. World J Hepatol
  • 7:377-91.
  • Chen W, Rock JB, Yearsley MM, Ferrell LD, Frankel WL.
  • Different collagen types show distinct rates of increase from
  • early to late stages of hepatitis C-related liver fibrosis. Human
  • Pathol 2014;45:160-5.
  • Garcia-Tsao G, Iredale J, Pinzani. Now there are many (stages)
  • where before there was one: in search of a pathophysiological
  • classification of cirrhosis. Hepatology 2010;51:1445-9.
  • Wanless IR, Nakashima E, Sherman M. Regression of human
  • cirrhosis. Arch Pathol Lab Med 2000;124:1599-1607.
  • Friedman SL. Fibrogenic cell reversion underlies fibrosis
  • regression in liver. Proc Natl Acad Sci 2012;109:9230-1.
  • Mani H, Kleiner DE. Liver biopsy findings in chronic
  • hepatitis B. Hepatology 2009;49:S61-S71.
  • Biazar T, Yahyapour Y, Roushan H, et al. Relationship
  • between hepatitis B DNA viral load in the liver and its
  • histology in patients with chronic hepatitis B. Caspian J
  • Intern Med 2005;6:209-12.
  • Tachtatzis PM, Marshall A, Arvinthan A, et al. Chronic
  • hepatitis B virus infection: the relation between hepatitis
  • B antigen expression, telomere length, senescence
  • inflammation and fibrosis. PLoS One 2015;10:e0127511.
  • Fiel MI. Pathology of chronic hepatitis B and chronic hepatitis
  • C. Clin Liver Dis 2019;14:555.
  • Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ.
  • Classification of chronic hepatitis: diagnosis, grading and
  • staging. Hepatology 1994;19:1513-20.
  • Knodell RG, Ishak KG, Black WC, et al. Formulation and
  • application of a numerical scoring system for assessing
  • histological activity in asymptomatic chronic active hepatitis.
  • Hepatology 1981;1:431-5.
  • Hübscher SG. Histological grading and staging in chronic
  • hepatitis: clinical applications and problems. J Hepatol
  • 29:1015-22.
  • Ishak K, Baptista A, Bianchi L, et al. Histological grading
  • and staging of chronic hepatitis. J Hepatol 1995;22:696-9.
  • Scheuer PJ. Classification of chronic viral hepatitis: a need
  • for reassessment. J Hepatol 1991;13:372-4.
  • Batts KP, Ludwig J. Chronic hepatitis: an update on
  • terminology and reporting. Am J Surg Pathol 1995;19:1409-
  • Bedossa P, Poynard T and the French METAVIR Cooperative
  • Study Group. An algorithm for grading activity in chronic
  • hepatitis C. Hepatology 1996;24:289-93.
  • Goldin RD, Goldin JG, Burt AD, Dhillon PA, Wyatt J
  • Patel N. Intra-observer and inter-observer variation in the
  • histopathological assessment of chronic viral hepatitis. J
  • Hepatol 1996;25:649-54.
  • Rousselet MC, Michalak S, Dupre F, et al. Sources of
  • variability in histological scoring of chronic viral hepatitis.
  • Hepatology 2005;41:41:257.
  • Paterson AL, Allison ME, Brais R, Davies SE. Any value in a
  • specialist review of liver biopsies? Conclusions of a four-year
  • review. Histopathology 2016 Jan 30. [Epub ahead of print]
  • Kutami R, Girgrah N, Wanless IR, et al. The Laennec
  • grading system for assessment of hepatic fibrosis: validation
  • by correlation with wedged hepatic vein pressure and clinical
  • features. Hepatology 2000;32:407A.
  • Hytiroglu P, Snover DC, Alves V, et all. Beyond “Cirrhosis”
  • A proposal from international liver pathology subgroup. Am
  • J Clin Pathol 2012;137:5-9.
  • Kim SU, Oh HJ, Wanless IR, Lee S, Han H, Park YN. The
  • Laennec staging system for histological sub-classification of
  • cirrhosis is useful for stratification of prognosis in patients
  • with liver cirrhosis. J Hepatol 2012;57:556-63.
  • Kim SU, Cho MY, Baik SK, et al. Histological subclassification
  • of cirrhosis using the Laennec fibrosing scoring
  • system correlates with clinical stage and grade of portal
  • hypertension. J Hepatol 2011;55:1004-9.
  • Narciso-Schiavon JL, Freire FC, Suarez MM, et al.
  • Antinuclear antibody positivity in patients with chronic
  • hepatitis C; clinically relevant or an epiphenomenon? Eur J
  • Gastroenterol Hepatol 2009;21:440-6.
  • Li BA, Liu J, Hou J, et al. Autoantibodies in Chinese patients
  • with chronic hepatitis B: prevalence and clinical associations.
  • World J Gastroenterol 2015;21:283-91.
  • Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith
  • AD. Liver biopsy. Hepatology 2009;49:1017-43.
  • Cholongitas E, Senzolo M, Standish R, et al. A systematic
  • review of the quality of liver biopsy specimens. Am J Clin
  • Pathol 2006;125:710-21.
  • Colloredo G, Guidon M, Sonzogni A, Leandro G. Impact of
  • liver biopsy size on histological evaluation of chronic viral
  • hepatitis: the smaller the sample, the milder the disease. J
  • Hepatol 2003;39:239-44..
  • Schiano TD, Azeem S, Bodian CA, et al. Importance
  • of specimen size in accurate needle biopsy evaluation of
  • patients with chronic hepatitis C. Clin Gastroenterol Hepatol
  • 3:930-5.
  • Bedossa P, Dargere D, Paradis V. Sampling variability of
  • liver fibrosis in chronic hepatitis C. Hepatol 2003;38:1449.
  • Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Eng J Med
  • 344:495-500.
  • Skripenova S, Trainer T, Krawitt E, Blaszyk H. Variability
  • of grade and stage in simultaneous paired liver biopsies in
  • patients with hepatitis C. J Clin Pathol 2007;60:321-4.
There are 139 citations in total.

Details

Subjects Clinical Sciences
Other ID JA38AV22GF
Journal Section Reviews
Authors

Çiğdem Ataizi Çelikel This is me

Publication Date August 1, 2016
Published in Issue Year 2016 Special Issue :2 Gastroenterology and Hepatology Viral Hepatitis

Cite

APA Çelikel, Ç. A. (2016). Histopathologic diagnosis of chronic viral hepatitis. Marmara Medical Journal, 29(2), 18-28. https://doi.org/10.5472/MMJsi.2901.05
AMA Çelikel ÇA. Histopathologic diagnosis of chronic viral hepatitis. Marmara Med J. August 2016;29(2):18-28. doi:10.5472/MMJsi.2901.05
Chicago Çelikel, Çiğdem Ataizi. “Histopathologic Diagnosis of Chronic Viral Hepatitis”. Marmara Medical Journal 29, no. 2 (August 2016): 18-28. https://doi.org/10.5472/MMJsi.2901.05.
EndNote Çelikel ÇA (August 1, 2016) Histopathologic diagnosis of chronic viral hepatitis. Marmara Medical Journal 29 2 18–28.
IEEE Ç. A. Çelikel, “Histopathologic diagnosis of chronic viral hepatitis”, Marmara Med J, vol. 29, no. 2, pp. 18–28, 2016, doi: 10.5472/MMJsi.2901.05.
ISNAD Çelikel, Çiğdem Ataizi. “Histopathologic Diagnosis of Chronic Viral Hepatitis”. Marmara Medical Journal 29/2 (August 2016), 18-28. https://doi.org/10.5472/MMJsi.2901.05.
JAMA Çelikel ÇA. Histopathologic diagnosis of chronic viral hepatitis. Marmara Med J. 2016;29:18–28.
MLA Çelikel, Çiğdem Ataizi. “Histopathologic Diagnosis of Chronic Viral Hepatitis”. Marmara Medical Journal, vol. 29, no. 2, 2016, pp. 18-28, doi:10.5472/MMJsi.2901.05.
Vancouver Çelikel ÇA. Histopathologic diagnosis of chronic viral hepatitis. Marmara Med J. 2016;29(2):18-2.