Liver Biopsies in Hepatitis C

Posted by e-Medical PPT
Hepatitis C
RNA Flaviviridae virus with 6 genotypes
– 75% type 1
– 15% type 2
– <5% type 3
Many subtypes and propensity to mutate lead to high rate of chronic infection
60-85% chronic HCV infection rate
20% of chronic infection develop cirrhosis in 10-20 years
Exacerbated by HIV co-infection
12,000 deaths annually in US

What the Clinician Needs?
How much active inflammation
How much injury of the liver has resulted in fibrosis
Is there any other disease

Grading Systems
Scheuer System
Grade: degree of inflammation, piecemeal or bridging necrosis
Grade 0:  no / minimal inflammation
Grade 1:  portal inflammation or lobular inflammation without necrosis
Grade 2:  mild periportal inflammation and piecemeal necrosis or focal hepatocellular necrosis
Grade 3:  moderate periportal inflammation and piecemeal necrosis or severe focal cell damage
Grade 4:  severe periportal inflammation and piecemeal necrosis or bridging necrosis

Stage: degree of fibrosis
Stage 0:  no fibrosis
Stage 1:  enlarged fibrotic portal tracts
Stage 2:  periportal fibrosis or portal to portal septa, without architectural distortion
Stage 3:  bridging fibrosis with architectural distortion, no obvious cirrhosis
Stage 4:  cirrhosis (probable or definite

Surgical Pathology Report
Chronic viral hepatitis C with mild activity and periportal fibrosis (Batts&Ludwig system)
   - Mild scattered steatosis
   - Mild stainable hepatocellular iron

What mimics chronic viral hepatitis with differential diagnosis of portal inflammation
Hepatitis C
Hepatitis B
Autoimmune hepatitis
Wilson’s disease
Drug induced hepatitis

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