UPDATED TERMINOLOGY OF
CHRONIC HEPATITIS.
DRAFT COPY ONLY.
(Procedure 161).
Harris G. Yfantis, M.D.
Chief, Gastrointestinal Pathology Section.
http://www.netautopsy.org/axsop/axsop161.htm


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United States Government Work, uncopyrighted, public-domain, DRAFT COPY ONLY. This document does not necessarily represent the views or policies of any United States Government agency. This document is provided "as is", without warranty of any kind, express or implied, including but not limited to the warranties of merchantability, fitness for a particular purpose and non-infringement. In no event shall the authors be liable for any claim, damages or other liability, whether in an action of contract, tort or otherwise, arising from, out of, or in connection with the document or the use or other dealings made with the document.

See also: Gastrointestinal Pathology: 181, 182, 183, 184.



PRINCIPLE OF THE TEST.

      Handling and processing a liver needle biopsy specimen.



SPECIMEN REQUIRED.

      Formalin-fixed liver core needle biopsy specimen, along with a filled-out Tissue Examination Form (U. S. Standard Form 515, USSF515).



REAGENTS, INSTRUMENTATION.

      Not applicable.



STEP-BY-STEP DESCRIPTION.

      1. The biopsy specimen should be received in a solution of 10% neutral buffered formalin. If the specimen is not received in formalin, it should be promptly placed in formalin and allowed to fix for at least three hours.

2. A gross description of the tissue is performed and dictated, including the number of tissue fragments and the dimensions of each tissue fragment. The specimen is then processed per the protocol for processing of all biopsy specimens.

3. All relevant clinical information should be obtained at the time of signout, such as is available in CPRS, by clicking on REPORTS, and then clicking on PROCEDURES. If additional clinical information is needed, then attempts to contact the resident or attending who performed the biopsy should be made.

4. MICROSCOPIC GRADING AND STAGING is to be reported as follows: First, a written description of etiology; followed by a descriptive degree of activity; followed by a written, descriptive degree of fibrosis.
Example: Chronic hepatitis B, C, autoimmune, etc.; minimal, mild, moderate, or marked activity; with no, minimal, periportal or bridging fibrosis, or probable, incomplete, or established cirrhosis.

      5. Second, a numerical score for both grade and stage are provided, based on the classification published by Ludwig and Batts (1994, 1995):
GRADE 0: no activity: only portal inflammation, no interface hepatitis.

GRADE 1: minimal activity: spotty lobular necrosis and minimal interface hepatitis.

GRADE 2: mild activity: mild interface hepatitis and mild lobular necrosis.

GRADE 3: moderate activity: mild interface hepatitis and moderate lobular inflammation; or moderate interface hepatitis and mild or moderate lobular inflammation.

GRADE 4: severe activity: mild interface hepatitis and marked lobular necrosis; or moderate interface hepatitis and marked lobular inflammation; or marked interface hepatitis with mild, moderate, or marked lobular inflammation.

STAGE 0: No fibrosis.

STAGE 1: Portal fibrosis.

STAGE 2: Periportal fibrosis, with occasional septa and bridges (one or two).

STAGE 3: Extensive bridging fibrosis, with multiple bridges.

STAGE 4: Cirrhosis.




REFERENCES.


1. Ishak KG.
Pathologic features of chronic hepatitis. A review and update.
Am J Clin Pathol. 2000 Jan;113(1):40-55. Review.
PMID: 10631857.
PubMed Entry

2. Goodman ZD.
Chronic hepatitis. 23 Annual Armed Forces Institute of Pathology Course in Hepatopathology 2003: The Interpretation of Liver Biopsies.
Course syllabus, pgs. 13-18.

3. Bedossa P, Poynard T.
An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group.
Hepatology. 1996 Aug;24(2):289-293.
PMID: 8690394
PubMed Entry

4. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, Desmet V, Korb G, MacSween RN, et al.
Histological grading and staging of chronic hepatitis.
J Hepatol. 1995 Jun;22(6):696-699. Review.
PMID: 7560864.
PubMed Entry

5. Goodman ZD, Ishak KG.
Histopathology of hepatitis C virus infection.
Semin Liver Dis. 1995 Feb;15(1):70-81. Review.
PMID: 7597446.
PubMed Entry

6. Batts KP, Ludwig J.
Chronic hepatitis. An update on terminology and reporting.
Am J Surg Pathol. 1995 Dec;19(12):1409-1417.
PMID: 7503362.
PubMed Entry

7. Laurent-Puig P, Dussaix E, Altman C, Laval C, Stuyver L, Wilber JC, Babany G, Chopineau S, Bedossa P, Brocheriou I, et al.
Host and viral characteristics affecting the response to interferon therapy in chronic hepatitis C.
Eur J Gastroenterol Hepatol. 1995 Apr;7(4):335-340.
PMID: 7541297.
PubMed Entry

8. Bedossa P, Voigt JJ.
Classification of chronic hepatitis. [French] Ann Pathol. 1995;15(5):316-318. PMID: 8540916.
PubMed Entry

9. Ludwig J, Batts KP, Moyer TP, Poterucha JJ.
Advances in liver biopsy diagnosis.
Mayo Clin Proc. 1994 Jul;69(7):677-678. Review.
PMID: 8015333.
PubMed Entry

10. Ishak KG.
Chronic hepatitis: morphology and nomenclature.
Mod Pathol. 1994 Aug;7(6):690-713. Review.
PMID: 7991529.
PubMed Entry