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Chronic viral hepatitis B and C: an argument against the conventional classification of chronic hepatitis

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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for CH-C are highly suggestive of the diagnosis, that the artificial subdivision of chronic hepatitis into CPH and CAH is obsolete and that the histological assessment of chronic hepatitis should consist of a grading of inflammatory activity (minimal, mild, moderate, severe) and staging of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.

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Authors and Affiliations

  1. Department of Pathology, University of Zürich, Schmelzbergstrasse 12, CH-8091, Zürich, Switzerland

    M. Schmid, R. Flury & P. U. Heitz

  2. Medical Clinic, City Hospital Waid, Zürich, Switzerland

    H. Bühler & J. Havelka

  3. Clinical Immunology Division, Department of Internal Medicine, University of Zürich, Zürich, Switzerland

    P. J. Grob

Authors
  1. M. Schmid
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  2. R. Flury
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  3. P. U. Heitz
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  4. H. Bühler
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  5. J. Havelka
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  6. P. J. Grob
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Schmid, M., Flury, R., Heitz, P.U. et al. Chronic viral hepatitis B and C: an argument against the conventional classification of chronic hepatitis. Vichows Archiv A Pathol Anat 425, 221–228 (1994). https://doi.org/10.1007/BF00196143

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  • DOI: https://doi.org/10.1007/BF00196143

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