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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Hepatitis C virus (HCV)


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 12 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● 0.2% incidence in US, 170 million people infected worldwide
● 90% of non-A, non-B hepatitis cases, 75-95% of transfusion associated hepatitis cases are due to Hepatitis C

Causes and complications
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● 35% IV drug abuse, 15% household contact or heterosexual exposure, 5% blood transfusion, 45% unknown
● 50-80% develop chronic liver disease, 20% of these develop cirrhosis
● High risk for hepatocellular carcinoma, particularly with alcoholic cirrhosis (57% at 10 years)
● Acute liver failure is rare
● CD34+ sinusoidal endothelial cells are a risk factor for hepatocellular carcinoma in HCV associated chronic liver disease (Hum Pathol 2001;32:1363)
● In HIV+ patients, cirrhosis more common if CD4 < 200 cells/microL (Hum Pathol 2000;31:69)
Complications: deterioration of liver status with cirrhosis in 20% and improvement in 10% with chronic hepatitis C; also hepatocellular carcinoma

Virology
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● A flavivirus, enveloped RNA virus

Treatment
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● Long term interferon alpha causes regression of cirrhosis in 5-10% (Hum Pathol 2004;35:107)
● Interferon used in combination with ribavirin; orthotopic liver transplantation
● 10% have stainable iron; some hepatologists use iron content and location in patient management
● Occasionally may be due to mutation in gene for hereditary hemochromatosis (Arch Pathol Lab Med 2000;124:1632)

Poor prognostic factors
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● Necroinflammatory activity is associated with fibrosis progression (Hum Pathol 2001;32:904)
● Also alcohol consumption, advanced age at the time of infection, and immunocompromise

Post liver transplant
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● Recurrence of Hepatitis C (as opposed to reinfection, which is almost universal) associated with more single cell hepatocyte necrosis (acidophil bodies), bile duct damage, lymphoid aggregates, cholestasis, fibrous septum, viral load (HCV RNA) > 1.25 million viral equivalents/ml
● Recurrence may resemble cellular rejection
● Serial biopsies may be necessary (Hum Pathol 2002;33:277, Arch Pathol Lab Med 2000;124:1623, Mod Pathol 2002;15:897)
● HCV RNA levels are highest at time of active hepatocellular destruction (Mod Pathol 1999;12:1043)

Case reports
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● With coexisting diffuse large B cell lymphoma (Am J Surg Pathol 1999;23:1124)
● 55 year old man with coexisting hepatocellular carcinoma and diffuse large B cell lymphoma (Arch Pathol Lab Med 2000;124:1532)

Micro description
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● Predominantly sinusoidal lymphocytic infiltrate, often with lymphoid follicles that surround damaged bile ducts, often involvement of portal tracts
● Mallory’s hyaline, mild and focal macrovesicular steatosis, minimal necrosis
● Usually no/minimal plasma cells or eosinophils; may have irregular acidophil bodies
● Lymphoid aggregates are specific for hepatitis C, but only 50% sensitive

Micro images
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Portal lymphocytosis


Bile duct involvement


Portal-portal fibrosis


Immunostain


Hepatitis C with cirrhosis


Post-transplant at 1 week


Post-transplant at 6 weeks with apoptotic bodies

Recurrence post-transplant:

Acidophil bodies, lymphoid aggregate, fibrous septum, cellular rejection

Additional references
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Mod Pathol 2000;13:679 (post-transplant), Semin Liver Dis 2005 Feb;25:52, Am J Surg Pathol 2007;31:1754

End of Liver and intrahepatic bile ducts-nontumor > Viral hepatitis > Hepatitis C virus (HCV)


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