• Liver biopsy to grade and stage disease and exclude other liver diseases
Grade indicates degree of necroinflammatory activity
Stage indicates extent of fibrosis
– Stage drives treatment decisions as well
• Usually progressive disease, leading to cirrhosis, liver failure, risk of hepatocellular carcinoma
• Treatment
Standard therapy historically is pegylated interferon-α in combination with ribavirin
Newer drugs are highly effective with fewer side effects
• Laboratory tests
Anti-HCV antibodies
HCV RNA by PCR testing
Microscopic
• Variably dense portal lymphocytic infiltrates
Periportal interface activity
Portal lymphoid aggregates
Patchy steatosis
• Scattered lobular collections of inflammatory cells ± acidophil bodies
Portal Inflammation The inflammation in hepatitis C is typically portal-based and composed primarily of lymphocytes.
Portal/Periportal Fibrosis Trichrome stain demonstrates portal fibrous expansion as well as periportal fibrous extension . The periportal fibrous extension makes this biopsy a stage 2.
Lobular Inflammation A lobular collection of inflammatory cells is seen in a case of chronic hepatitis C virus (HCV) infection.
Interface Hepatitis Lymphocytes extending past the limiting plate and infiltrating surrounding hepatocytes is known as interface activity. Mild hepatocyte swelling, eosinophilia, and necrosis are often evident, reflecting the resultant hepatocyte injury.
TERMINOLOGY
Abbreviations
• Hepatitis C virus (HCV) infection
Definitions
• Hepatitis, usually chronic, secondary to HCV infection
ETIOLOGY/PATHOGENESIS
Infectious Agents
• Enveloped, single-stranded RNA virus of Flaviviridae family
• Inherent high mutation rate generates viral heterogeneity
6 viral genotypes and > 50 subtypes
– Vary in geography, mode of transmission, and response to treatment
• Virus is directly cytopathic and induces immune-mediated cellular injury
Modes of Transmission
• Blood transfusion, needlestick inoculation
• Perinatal exposure, probably occurs with low efficiency
• Efficiency of sexual transmission is controversial but probably low
CLINICAL ISSUES
Epidemiology
• Incidence
Worldwide seroprevalence of HCV antibodies (anti-HCV) estimated at 3%
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as well as periportal fibrous extension 
. The periportal fibrous extension makes this biopsy a stage 2.
is seen in a case of chronic hepatitis C virus (HCV) infection.
