Topic Highlight
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1357-1366
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1357
Liver pathology of hepatitis C, beyond grading and staging of the disease
Sadhna Dhingra, Stephen C Ward, Swan N Thung
Sadhna Dhingra, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Stephen C Ward, Swan N Thung, Division of Hepatopathology, Department of Pathology, The Mount Sinai Medical Center, New York, NY 10029, United States
Author contributions: Dhingra S wrote the first draft of the manuscript; Thung SN and Ward SC critically reviewed the manuscript and provided additional information to be added; Thung SN also provided the illustrations to support the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Swan N Thung, MD, Professor of Pathology, Director of Hepatopathology, Division of Hepatopathology, Department of Pathology, The Mount Sinai Medical Center, New York, Box 1194, 1468 Madison Ave., New York, NY 10029, United States.
Telephone: +1-212-2419139 Fax: +1-212-3489412
Received: April 29, 2015
Peer-review started: May 7, 2015
First decision: August 31, 2015
Revised: October 7, 2015
Accepted: November 30, 2015
Article in press: December 1, 2015
Published online: January 28, 2016

Liver biopsy evaluation plays a critical role in management of patients with viral hepatitis C. In patients with acute viral hepatitis, a liver biopsy, though uncommonly performed, helps to rule out other non-viral causes of deranged liver function. In chronic viral hepatitis C, it is considered the gold standard in assessment of the degree of necroinflammation and the stage of fibrosis, to help guide treatment and determine prognosis. It also helps rule out any concomitant diseases such as steatohepatitis, hemochromatosis or others. In patients with chronic progressive liver disease with cirrhosis and dominant nodules, a targeted liver biopsy is helpful in differentiating a regenerative nodule from dysplastic nodule or hepatocellular carcinoma. In the setting of transplantation, the liver biopsy helps distinguish recurrent hepatitis C from acute rejection and also is invaluable in the diagnosis of fibrosing cholestatic hepatitis, a rare variant of recurrent hepatitis C. This comprehensive review discusses the entire spectrum of pathologic findings in the course of hepatitis C infection.

Keywords: Hepatitis C, Liver pathology, Biopsy, Grading, Staging, Neoplasia

Core tip: The manuscript is a comprehensive review of liver pathology of hepatitis C infection. It delves into the historical literature and terminology of chronic viral hepatitis. It further focuses on the entire spectrum of histopathological findings related to different stages of hepatitis C infection. The diagnostic dilemmas in a post-transplantation setting such as recurrent hepatitis C, are also addressed. Relevant illustrations and tables support the histological descriptions. This article would be of educational benefit for pathologists as well as hepatologists.