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1. Chronic hepatitis B with moderate activity and complete cirrhotic changes. 2. Chronic sclerosing steatohepatitis, compatible with alcoholic or non-alcoholic steatohepatitis (ASH/NASH). Grading and Staging (Ishak et al (1995)): Grading: 9 (3+0+3+3) (out of max. 18) Staging: 6 (von max. 6) Grading and Staging (METAVIR): A2, F4
Haematoxylin & Eosin (H&E)
70 years
70-year old male patient with chronic HBV infection and known multifocal hepatocellular carcinoma.
Liver biopsy with irregular architecture. Severe portal inflammation (lymphocytes, plasma cells, neutrophils and eosinophils) and interface hepatitis. Severe portal fibrosis with bridging fibrosis and diffuse incomplete, focally complete nodular cirrhosis. Macrovesicular steatosis of 80% of hepatocytes.
CAB stain reveals some Mallory-bodies and chicken-wire fibrosis, which is a nonspecific but a frequent characteristic feature of alcoholic liver disease. Orcein stain shows HBs-Ag positivity (2% of hepatocytes).
In chronic liver disease the degree of inflammation is reported as grading, the degree of fibrosis is reported as staging. There are several different grading and staging systems available such as for example modified Ishak (1995) or METAVIR system.
Andrea Bodmer, University of Basel
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