Hepatitis C

 Estimated 3-4 million persons infected in United States






Etiology/Pathogenesis




• Common modes of transmission include blood transfusion, needle stick


Clinical Issues




• Presenting symptoms nonspecific (fatigue, anorexia, nausea)
image Many patients asymptomatic

• Liver biopsy to grade and stage disease and exclude other liver diseases
image Grade indicates degree of necroinflammatory activity

image Stage indicates extent of fibrosis
– Stage drives treatment decisions as well

• Usually progressive disease, leading to cirrhosis, liver failure, risk of hepatocellular carcinoma

• Treatment
image Standard therapy historically is pegylated interferon-α in combination with ribavirin

image Newer drugs are highly effective with fewer side effects

• Laboratory tests
image Anti-HCV antibodies

image HCV RNA by PCR testing


Microscopic




• Variably dense portal lymphocytic infiltrates 
image Periportal interface activity

image Portal lymphoid aggregates

image Patchy steatosis

• Scattered lobular collections of inflammatory cells ± acidophil bodies

image
Portal Inflammation
The inflammation in hepatitis C is typically portal-based and composed primarily of lymphocytes.


image
Portal/Periportal Fibrosis
Trichrome stain demonstrates portal fibrous expansion image as well as periportal fibrous extension image. The periportal fibrous extension makes this biopsy a stage 2.

image
Lobular Inflammation
A lobular collection of inflammatory cells image is seen in a case of chronic hepatitis C virus (HCV) infection.

image
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

image 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

Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hepatitis C
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