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Chronic viral hepatitis B and C: an argument against the conventional classification of chronic hepatitis
Insights
Histological patterns of chronic hepatitis B and C differ significantly. Chronic persistent hepatitis is exclusive to hepatitis C, while chronic lobular hepatitis is exclusive to hepatitis B, making the old classification obsolete.
Area of Science:
- Hepatology
- Virology
- Pathology
Background:
- The traditional classification of chronic hepatitis into chronic persistent hepatitis (CPH) and chronic active hepatitis (CAH) predates the understanding of specific etiological factors.
- Advances in virology have identified distinct hepatitis B and C viruses, necessitating a re-evaluation of histological diagnostic criteria.
Purpose of the Study:
- To compare the histological features of chronic hepatitis C (CH-C) and chronic hepatitis B (CH-B).
- To assess the validity of the conventional classification of chronic hepatitis in light of viral etiology.
- To propose an updated histological assessment framework for chronic hepatitis.
Main Methods:
- A comparative study involving 130 biopsies from 110 CH-C patients and 105 biopsies from 73 CH-B patients.
- Serological confirmation of hepatitis C using second-generation antibody testing.
- Semi-quantitative scoring of histological features in liver biopsies.
Main Results:
- Distinct histological patterns were observed: CH-C showed lymphoid follicles (88.5%), fatty degeneration (51%), bile duct lesions (46.2%), and Mallory body-like material (9.2%).
- Portal lymphocytic infiltration predominated in CH-C, whereas chronic lobular hepatitis was exclusively found in CH-B.
- Chronic persistent hepatitis was exclusively identified in CH-C patients.
Conclusions:
- Histological criteria for CH-C are highly suggestive of the diagnosis.
- The subdivision into CPH and CAH is obsolete; histological assessment should focus on inflammatory grading and fibrosis staging.
- The etiological agent should be the basis for the final diagnosis of chronic hepatitis.
Abstract:
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.