The histopathology of chronic hepatitis c - are there any characteristic morphologic features?

Abstract

The hepatitis C virus (HCV) is the major cause of posttransfusion hepatitis, and has a high prevalence in intravenous drug users. HCV infection carries a high risk of chronicity and is associated with hepatocellular carcinoma. Archival liver biopsy material was retrieved and reviewed from patients with chronic hepatitis and HCV antibodies. The biopsy samples were formalin fixed, paraffin embedded, and stained with standard liver stains and immunoperoxidase stain for cytokeratin. 25 liver samples from 24 patients were studied. The histological features ranged from lobular inflammation only (12%), to cirrhosis (12%). The majority showed combined lobular and portal tract inflammation and could be further subcategorised by the degree of portal inflammation. Specific features observed within the lobule included lymphocytic infiltration with lobules (88%), fatty change (60%), and acidophil bodies (64%). Characteristic portal changes included lymphocyte infiltration (88%) in most cases with follicle formation, degenerate bile ducts (72%), piecemeal necrosis (84%), and portal tract granulomas (36%). Chronic HCV infection is characterised by lobular and portal tract inflammation. Fatty change, lymphoid follicles, and bile duct lesions are generally not seen in other types of viral hepatitis. The features are not only of practical diagnostic significance, but may also suggest different evolution and pathogenesis.