Theise Neil D
Department of Pathology, Beth Israel Medical Center of Albert Einstein College of Medicine, New York, NY, USA.
Mod Pathol. 2007 Feb;20 Suppl 1:S3-14. doi: 10.1038/modpathol.3800693.
The terminology for assessment of chronic viral hepatitis in liver biopsy specimens has become confusing with the proliferation of grading and staging schemes that have paralleled the rise of the hepatitis C epidemic and the importance of mixed viral infections. This review represents a personal approach to the interpretation of these biopsy specimens, aiming at clarifying and simplifying the important points for the general pathologist confronted by these diagnostic dilemmas. The most commonly used schemes-Ishak modification of the Knodell 'hepatic activity index', Scheuer, Metavir, Batts-Ludwig classifications-are presented with evaluation of their pros and cons. Which scheme is selected is less important than the consistent use of a single scheme and the clear naming of that scheme in pathology reports. The importance and clinical implications of identifying severe necroinflammatory activity in the form of 'confluent necrosis' is discussed. Pathologists must also be clear about assessing concomitant diseases, in particular, alcoholic or non-alcoholic fatty liver disease, and be aware that grading/staging schemes for chronic hepatitis do not apply to mixed disease conditions. Other important features to be evaluated in all chronic hepatitis biopsy specimens include iron (which may represent hereditary hemochromatosis or secondary uptake) and neoplasia-associated changes, namely large cell change and small cell change; these findings and their clinical import are updated and reviewed. Sample approaches to composing useful diagnostic reports are also presented.
随着与丙型肝炎流行的增加以及混合病毒感染的重要性并行的分级和分期方案的激增，肝活检标本中慢性病毒性肝炎的评估术语变得混乱。本综述代表了一种个人对这些活检标本的解读方法，旨在为面临这些诊断难题的普通病理学家澄清并简化要点。文中介绍了最常用的方案——Knodell肝活动指数的Ishak改良法、Scheuer法、Metavir法、Batts-Ludwig分类法，并对其优缺点进行了评估。选择哪种方案不如在病理报告中始终如一地使用单一方案并明确命名该方案重要。文中讨论了以“融合性坏死”形式识别严重坏死性炎症活动的重要性和临床意义。病理学家还必须清楚地评估伴随疾病，特别是酒精性或非酒精性脂肪性肝病，并意识到慢性肝炎的分级/分期方案不适用于混合疾病情况。所有慢性肝炎活检标本中要评估的其他重要特征包括铁（可能代表遗传性血色素沉着症或继发性摄取）和肿瘤相关变化，即大细胞变化和小细胞变化；对这些发现及其临床意义进行了更新和综述。还介绍了撰写有用诊断报告的示例方法。
