Page 446 - Concise Pathology for Exam Preparation ( PDFDrive )

15 Diseases of the Hepatobiliary System and Pancreas 431

2. Chronic lobular hepatitis (CLH)
(a) Uncommon disease with evidence of hepatitis B or hepatitis C virus infection.
(b) Antinuclear antibodies, antismooth muscle antibodies and antimitochondrial anti-
bodies in some patients.
(c) Live biopsy shows features similar to acute viral hepatitis.
3. Chronic active hepatitis (CAH)
(a) Both portal tracts and parenchyma are involved.
(b) Lobular architecture is distorted.
(c) Portal tract inflammation spills over into surrounding parenchyma.
(d) ‘Piecemeal necrosis’ and ‘bridging hepatic necrosis’ seen.
(e) Regenerative nodules develop and later progress to cirrhosis.
New classification of chronic hepatitis is based on:
1. Cause of hepatitis
2. Histological activity or grade
3. Degree of progression or stage
Grading of chronic hepatitis is based on the histopathological evidence of inflamma-
tion and necrosis. Proportionate to the severity of following factors, a severity score (mild,
moderate or severe) is as signed.
1. Periportal necrosis including piecemeal necrosis and/or bridging necrosis
2. Intralobular necrosis
3. Portal inflammation
4. Fibrosis
Staging of chronic hepatitis is based on the degree of fibrosis (stage 0 with no fibrosis
to stage 4 with cirrhosis).
Morphological Features (Fig. 15.4)
• Hepatocyte injury and regeneration.
• Sinusoidal cells show reactive changes.
• Portal inflammation with or without spillover in the adjacent parenchyma is seen.
• Spillover of inflammation in the adjacent parenchyma causes necrosis of adjacent hepa-
tocytes (interface hepatitis).
• Fibrosis (portal, periportal and bridging) may follow.

Chronic inflammatory cells
Spotty parenchymal
inflammation Interface hepatitis Periportal inflammation

Periportal
fibrosis

Fatty change

Central vein
FIGURE 15.4. Section from chronic hepatitis showing portal inflammation with spillover in
the adjacent parenchyma.

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