Liver pathology of hepatitis C, beyond grading and staging of the disease

Table 1 Liver histology in hepatitis C infection

Histological features of acute hepatitis C
Cholestatic injury
	Bile duct injury (Poulsen Christofferson lesion)
	Bile duct injury (Poulsen Christofferson lesion)
	Cholangiolar proliferation (mild)
Hepatocytic injury
	Lobular necroinflammation with disarray
	Steatosis
	Sinusoidal inflammation
Histological features of chronic hepatitis C
Portal changes
	Portal lymphoid aggregates/reactive lymphoid follicles
	Interface hepatitis
	Bile duct damage
	Isolated clusters of hepatocytes in portal tracts
	Phlebitis
Lobular injury
	Necroinflammation
	Steatosis
	Multinucleation and nuclear pleomorphism
	Sinusoidal cell hyperplasia
	Microgranulomas
Fibrosis
Preneoplastic changes
	Large cell change
	Small cell change
	Iron free foci

Table 2 Various staging systems for assessment of fibrosis in chronic hepatitis

Score	System
Ishak modification of Knodell staging system (1995)[53]
0	No fibrosis
1	Fibrous expansion of some portal areas with or without short fibrous septa
2	Fibrous expansion of most portal areas with or without short fibrous septa
3	Fibrous expansion of most portal areas with occasional portal to portal (P-P)
4	Fibrous expansion of portal areas with marked P-P and portal-central bridging
5	Marked bridging with occasional nodules (incomplete cirrhosis)
6	Cirrhosis, probable or definite (Bridging fibrosis with nodule formation)
METAVIR system (1996)[54]
F0	No fibrosis
F1	Portal fibrosis without septa
F2	Portal fibrosis with rare fibrous septa
F3	Numerous septae without cirrhosis
F4	Cirrhosis
Scheuer system (1991)[52]
0	No fibrosis
1	Enlarged, fibrotic portal tracts
2	Periportal or portal-portal septa but intact architecture
3	Fibrosis with architectural distortion but no obvious cirrhosis
4	Probable or definite cirrhosis
Batts and Ludwig (1995)[51]
0	No fibrosis (normal connective tissue)
1	Portal fibrosis (Fibrous portal expansion)
2	Periportal fibrosis (Periportal or rare portal-portal septa)
3	Septal fibrosis (Fibrous septa with architectural distortion; no obvious cirrhosis)
4	Cirrhosis