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Evaluating Activity and Fibrosis in Chronic Hepatitis
Dr. Carmen Espinoza

Proposed to be use in the LSU Health care center.

Definition.-Chronic hepatitis clinically is a persistent inflammation of the liver for more than 6 months, with symptoms and/or biochemical abnormalities. Histologically is a combination of inflammatory cell infiltrate, hepatocyte death, atrophy, regeneration and fibrosis. The diagnosis of Hepatitis (see format of chronic hepatitis below) must be confirmed by specific immunostains in liver sections or by other Lab. Methods.

Report should be descriptive of all elements needed to evaluate activity and staging.

Stains needed for evaluation of liver biopsies.

1. H&E

2.Trichrome.- late fibrosis

3. Reticulin -collapse or early fibrosis

4. Iron- is frequently increased in chronic hepatitis C

1 and 2 obligatory

Format for diagnosis of Chronic hepatitis (AFIP Ref: ) (Modified).

Choose one term from each column

Chronic Hepatitis	B,	mild	activity, with	minimal fibrosis
	C,	moderate		periportal fibrosis
	D,	marked		bridging fibrosis (intact architecture)
	autoimmune,
	drug-induced,			incomplete cirrhosis
	etiology undetermined,			established cirrhosis

Example of final diagnosis: Liver, needle biopsy: Chronic hepatitis (H/O Hep. C), mild activity, with periportal fibrosis. Mild pericentral steatosis also present.

 Microscopic evaluation:

Note that numeric evaluation is to facilitate the evaluation of the biopsy and not to be reported.

Normal liver (Figs).

Activity refers to inflammation and hepatocyte death. Staging refers to degree of fibrosis.

Evaluation of activity

Periportal or periseptal interface hepatitis( peacemeal necrosis) (Figs).

Note: The circumference is important, not how far the inflammation extends into acinus.

Lobular necrosis(Focal lytic necrosis, apoptosis and focal inflammation) (Figs).

Evaluation of fibrosis (staging) (Figs).

Ref: Scheuer P: Classification of chronic viral hepatitis: a need for reassessment. J Hepatol 1991; 13:373-374

Note Steatosis both microvesicular and macrovesicular, and bile-duct damage may be reported, as well as presence of iron (Figs).

Simple algorithm for expressing activity of chronic Hepatitis C.

Base on Piecemeal necrosis (interface hepatitis) and lobular activity . Ref: Bedossa P, Poynard T. The METAVIR cooperative study group. An algorithm for the grading of activity in hepatitis C