Chronic viral hepatitis B and C: an argument against the conventional classification of chronic hepatitis.
The classification of chronic hepatitis distinguishing benign chronic persistent hepatitis from severe chronic active hepatitis was constructed without knowledge of well-defined aetiological factors. Better understanding of the different hepatitis-viruses has shed new light on this subject. Chronic viral hepatitis B and C each show typical histological patterns. The validity of the conventional classification has been evaluated by a comparative study of chronic viral hepatitis B and C. 130 biopsies from 110 patients with chronic hepatitis C (CH-C) proven serologically by antibodies (second generation testing) were compared with 105 biopsies from 73 patients with chronic hepatitis B (CH-B). These were scored semi-quantatively. In CH-C, lymphoid follicles and/or aggregates were found in 88.5%, fatty degeneration in 51%, bile duct lesions in 46.2%, and Mallory body-like material in the hepatocytes in 9.2%. The portal lymphocytic infiltration generally predominated over the necro-inflammatory lesions of the parenchyma. Chronic persistent hepatitis (defined by the presence of portal hepatitis) was present exclusively in CH-C. Chronic lobular hepatitis was found exclusively in CH-B. We conclude that the histological criteria described for CH-C are highly suggestive of the diagnosis, that the artificial subdivision of chronic hepatitis into CPH and CAH is obsolete and that the histological assessment of chronic hepatitis should consist of a grading of inflammatory activity (minimal, mild, moderate, severe) and staging of fibrosis (extent of distortion of architecture). The final diagnosis should be based on the demonstration of the aetiological agent.
Schmid
M
M
Department of Pathology, University of Zürich, Switzerland.
Flury
R
R
Bühler
H
H
Havelka
J
J
Grob
P J
PJ
Heitz
P U
PU
D002908:Chronic Disease; D003937:Diagnosis, Differential; D005355:Fibrosis / Q000473:pathology; D006505:Hepatitis / Q000473:pathology; D006509:Hepatitis B / Q000175:diagnosis / Q000473:pathology*; D006526:Hepatitis C / Q000175:diagnosis / Q000473:pathology*; D006525:Hepatitis, Viral, Human / Q000145:classification*; D006801:Humans; D008099:Liver / Q000473:pathology