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Extra info for Biopsy Interpretation of the Liver
Virchows Arch A Pathol Anat Histopathol. 1987;411(6):553–559. (c) 2015 Wolters Kluwer. All Rights Reserved. 5 ACUTE AND CHRONIC VIRAL HEPATITIS This chapter considers the pathology of viral hepatitis. The term acute hepatitis is generally used to describe to any abrupt onset of liver disease. This may reflect a new injury or a flare of injury in an ongoing liver disease. Chronic hepatitis is formally defined as elevated enzymes for more than 6 months. GRADING AND STAGING BIOPSIES WITH CHRONIC VIRAL HEPATITIS As a surgical pathologist, a common liver biopsy you will encounter is one performed to determine the amount of inflammation (grade) and fibrosis (stage) in a patient with known chronic viral hepatitis C or B.
22). BRIDGING NECROSIS. The trichrome stain should also be interpreted cautiously in the setting of significant necrosis. Bridging necrosis can mimic bridging fibrosis on trichrome stain. Bridging necrosis in the setting of acute hepatitis that has lasted only a few days, for example from acetaminophen injury, is generally not a problem because the areas of necrosis will contain the dead hepatocytes. However, if there has been sufficient time for the hepatocytes to drop out and the liver sinusoidal connective tissue to condense (Fig.
6. One useful way to convey the amount of pericellular fibrosis is to use the terms mild if it is only seen on trichrome stain and moderate if can be readily seen on H&E stain. COMMON FIBROSIS STAGING PITFALLS Fibrosis Staging in Acute Hepatitis MARKEDLY INFLAMED PORTAL TRACTS. The presence of fibrosis can help refine the differential for an acute liver injury because the presence of fibrosis suggest a chronic liver disease with superimposed injury—either a flare of disease, for example, as can be seen with hepatitis B or autoimmune hepatitis, or a new superimposed injury on a chronic hepatitis.