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Histopathological Scoring Systems

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Clinical Hepatology

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Abbreviations

AFLD:

Alcoholic fatty liver disease

AIH:

Autoimmune hepatitis

AMA:

Anti-mitochondrial antibodies

ANA:

Anti-nuclear antibodies

Anti-LC1:

Antibodies to liver cytosol type 1

Anti-LKM1:

Antibodies to liver kidney microsome type 1

Anti-SLA/LP:

Antibodies to soluble liver antigen/liver pancreas

Anti-SMA:

Antibodies to smooth muscle antigen

AP:

Serum alkaline phosphatase

ASH:

Alcoholic steatohepatitis

ALT:

Serum alanine aminotransferase

AST:

Serum aspartate aminotransferase

CCC:

Cholangiocellular carcinoma (cholangiocarcinoma)

CK:

Cytokeratin

CMV:

Cytomegalovirus

EBV:

Epstein-Barr Virus

HBV:

Hepatitis B Virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C Virus

HDV:

Hepatitis D Virus

H & E:

Hematoxylin and eosin

HII:

Hepatic iron index

IgG:

Immunoglobulin G

LIC:

Liver iron content

MELD:

Model for End-stage Liver Disease

mHAI:

Modifi ed histological activity index

MPF:

Medium power field

NAFLD:

Non-alcoholic fatty liver disease

NAS:

NAFLD activity score

NASH:

Non-alcoholic steatohepatitis

pANCA:

Perinuclear anti-neutrophil cytoplas-mic antibodies

PAS:

Periodic Acid-Schiff

PBC:

Primary biliary cirrhosis

PSC:

Primary sclerosing cholangitits

RAI:

Rejection activity index

SSS:

Semiquantitative Scoring System

References

  1. Alla V, Bonkovsky HL (2005) Iron in nonhemochromatotic liver disorders. Semin Liver Dis 25: 461–72

    Article  CAS  PubMed  Google Scholar 

  2. Alvarez F, Berg PA, Bianchi FB, et al (1999) International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 31: 929–38

    Article  CAS  PubMed  Google Scholar 

  3. Angulo P, Larson DR, Therneau TM, et al (1999) Time course of histological progression in primary sclerosing cho-langitis. Am J Gastroenterol 94: 3310–3

    Article  CAS  PubMed  Google Scholar 

  4. Arima M, Terao H, Kashima K, et al (2004) Regression of liver fi brosis in cases of chronic liver disease type C: quantitative evaluation by using computed image analysis. Intern Med 43: 902–10

    Article  PubMed  Google Scholar 

  5. Batts KP, Ludwig J (1995) Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 19: 1409–17

    CAS  Google Scholar 

  6. Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fi brosis in chronic hepatitis C. Hepatology 38: 1449–57

    PubMed  Google Scholar 

  7. Bedossa P, Poynard T (1996) An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 24: 289–93

    Article  CAS  PubMed  Google Scholar 

  8. Blakolmer K, Jain A, Ruppert K, et al (2002) Chronic liver allograft rejection in a population treated primarily with tac-rolimus as baseline immunosuppression: long-term follow-up and evaluation of features for histopathological staging. Transplantation 69: 2330–6

    Article  Google Scholar 

  9. Blakolmer K, Seaberg EC, Batts K, et al (1999) Analysis of the reversibility of chronic liver allograft rejection implications for a staging schema. Am J Surg Pathol 23: 1328–39

    Article  CAS  PubMed  Google Scholar 

  10. Blumberg RS, Chopra S, Ibrahim R, et al (1988) Primary hepatocellular carcinoma in idiopathic hemochromatosis after reversal of cirrhosis. Gastroenterology 95: 1399–402

    CAS  PubMed  Google Scholar 

  11. Brunt EM, Janney CG, Di Bisceglie AM, et al (1999) Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94: 2467–74

    Article  CAS  PubMed  Google Scholar 

  12. Burak KW, Angulo P, Lindor KD (2003) Is there a role for liver biopsy in primary sclerosing cholangitis? Am J Gastroenterol 98: 1155–8

    Article  PubMed  Google Scholar 

  13. Castera L, Vergniol J, Foucher J, et al (2005) Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fi brosis in chronic hepatitis C. Gastroenterology 128: 343–50

    Article  PubMed  Google Scholar 

  14. Chevallier M, Guerret S, Chossegros P, et al (1994) A histo-logical semiquantitative scoring system for evaluation of hepatic fi brosis in needle liver biopsy specimens: Comparison with morphometric studies. Hepatology 20: 349–55

    Article  CAS  PubMed  Google Scholar 

  15. Christoffersen P, Eghoje K (1973) Mallory bodies in liver biopsies from chronic alcoholics. A comparative morphological, biochemical, and clinical study of two groups of chronic alcoholics with and without Mallory bodies. Scand J Gastroenterol 8: 341–6

    CAS  PubMed  Google Scholar 

  16. Crawford AR, Lin XZ, Crawford JM (1998) The normal adult human liver biopsy: a quantitative reference standard. Hepatology 28: 323–31

    Article  CAS  PubMed  Google Scholar 

  17. Demetris A, Adams D, Bellamy C, et al (2000) Update of the International Banff Schema for Liver Allograft Rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An International Panel. Hepatology 31: 792–9

    Article  CAS  PubMed  Google Scholar 

  18. Demetris AJ, Murase N, Lee RG, et al (1997) Chronic rejection. A general overview of histopathology and pathophysi-ology with emphasis on liver, heart and intestinal allografts. Ann Transplant 2: 27–44

    CAS  Google Scholar 

  19. Desmet VJ, Gerber M, Hoofnagle JH, et al (1994) Classifi cation of chronic hepatitis: diagnosis, grading and staging. Hepatology 19: 1513–20

    Article  CAS  PubMed  Google Scholar 

  20. Deugnier YM, Turlin B, Powell LW, et al (1993) Differentiation between heterozygotes and homozygotes in genetic hemochromatosis by means of a histological hepatic iron index: a study of 192 cases. Hepatology 17: 30–4

    Article  CAS  PubMed  Google Scholar 

  21. Diehl AM, Goodman Z, Ishak KG (1988) Alcohollike liver disease in nonalcoholics. A clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology 95: 1056–62

    CAS  PubMed  Google Scholar 

  22. Dienstag JL (2002) The role of liver biopsy in chronic hepatitis C. Hepatology 36: S152–60

    Article  PubMed  Google Scholar 

  23. Edmondson HA, Peters RL, Reynolds TB, et al (1963) Sclerosing hyaline necrosis of the liver in the chronic alcoholic. A recognizable clinical syndrome. Ann Intern Med 59: 646–73

    CAS  PubMed  Google Scholar 

  24. Falize L, Guillygomarc'h A, Perrin M, et al (2006) Reversibility of hepatic fi brosis in treated genetic hemochro-matosis: a study of 36 cases. Hepatology 44: 472–7

    Article  PubMed  Google Scholar 

  25. Fellows IW, Stewart M, Jeffcoate WJ, et al (1988) Hepatocellular carcinoma in primary haemochromatosis in the absence of cirrhosis. Gut 29: 1603–6

    Article  CAS  PubMed  Google Scholar 

  26. Forrest EH, Evans CD, Stewart S, et al (2005) Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score. Gut 54: 1174–9

    Article  CAS  PubMed  Google Scholar 

  27. Freese DK, Snover DC, Sharp HL, et al (1991) Chronic rejection after liver transplantation: a study of clinical, histopatho-logical and immunological features. Hepatology 13: 882–91

    Article  CAS  PubMed  Google Scholar 

  28. Ghany MG, Kleiner DE, Alter H, et al (2003) Progression of fi brosis in chronic hepatitis C. Gastroenterology 124: 97–104

    Article  PubMed  Google Scholar 

  29. Goh J, Callagy G, McEntee G, et al (1999) Hepatocellular carcinoma arising in the absence of cirrhosis in genetic haemochromatosis: three case reports and review of literature. Eur J Gastroenterol Hepatol 11: 915–9

    Article  CAS  PubMed  Google Scholar 

  30. Goldin RD, Goldin JG, Burt AD, et al (1996) Intra-observer and inter-observer variation in the histopathological assessment of chronic viral hepatitis. J Hepatol 25: 649–54

    Article  CAS  PubMed  Google Scholar 

  31. Grant A, Neuberger J (1999). Guidelines on the use of liver biopsy in clinical practice. British Society of Gastro-enterology. Gut 45(Suppl 4): IV1–IV11

    Article  PubMed  Google Scholar 

  32. Gressner AM (1991) Liver fi brosis: perspectives in patho-biochemical research and clinical outlook. Eur J Clin Chem Clin Biochem 29: 293–311

    CAS  PubMed  Google Scholar 

  33. Gruttadauria S, Vasta F, Mandala L, et al (2005) Basiliximab in a triple-drug regimen with tacrolimus and steroids in liver transplantation. Transplant Proc 37: 2611–3

    Article  CAS  PubMed  Google Scholar 

  34. Harrison RF, Hubscher SG (1991) The spectrum of bile duct lesions in end-stage primary sclerosing cholangitis. Histopathology 19: 321–7

    Article  CAS  PubMed  Google Scholar 

  35. 34a. Hennes EM, Zeniya M, Czaja AJ, et al (2008) Simplifi ed criteria for the diagnosis of autoimmune hepatitis. Hepatology 48: 169–76

    Article  PubMed  Google Scholar 

  36. Hiramatsu K, Aoyama H, Zen Y, et al (2006) Proposal of a new staging and grading system of the liver for primary biliary cirrhosis. Histopathology 49: 466–78

    Article  CAS  PubMed  Google Scholar 

  37. Hubscher SG, Buckels JA, Elias E, et al (1991) Vanishing bile-duct syndrome following liver transplantation–is it reversible? Transplantation 51: 1004–10

    Article  CAS  PubMed  Google Scholar 

  38. International Panel (1997) Banff schema for grading liver allograft rejection: an international consensus document. Hepatology 25: 658–63

    Article  Google Scholar 

  39. International Working Party (1995) Terminology for hepatic allograft rejection. Hepatology 22: 648–54

    Google Scholar 

  40. Ishak K, Baptista A, Bianchi L, et al (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22: 696–9

    Article  CAS  PubMed  Google Scholar 

  41. Ishak KG (2000) Pathologic features of chronic hepatitis. A review and update. Am J Clin Pathol 113: 40–55

    Article  CAS  Google Scholar 

  42. Ishak KG, Zimmerman HJ (1995) Morphologic spectrum of drug-induced hepatic disease. Gastroenterol Clin North Am 24: 759–86

    CAS  PubMed  Google Scholar 

  43. Kaji K, Nakanuma Y, Sasaki M, et al (1995) Hemosiderin deposition in portal endothelial cells: a novel hepatic hemo-siderosis frequent in chronic viral hepatitis B and C. Hum Pathol 26: 1080–5

    Article  CAS  PubMed  Google Scholar 

  44. Kleiner DE, Brunt EM, Van Natta M, et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41: 1313–21

    Article  PubMed  Google Scholar 

  45. Knodell RG, Ishak KG, Black WC, et al (1981) Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1: 431–5

    Article  CAS  PubMed  Google Scholar 

  46. LaRusso NF, Shneider BL, Black D, et al (2006) Primary sclerosing cholangitis: summary of a workshop. Hepatology 44: 746–64

    Article  Google Scholar 

  47. Locke GR, Therneau TM, Ludwig J, et al (1996) Time course of histological progression in primary biliary cirrhosis. Hepatology 23: 52–6

    Article  PubMed  Google Scholar 

  48. Ludwig J, Dickson ER, McDonald GS (1978) Staging of chronic nonsuppurative destructive cholangitis (syndrome of primary biliary cirrhosis). Virchows Arch A Pathol Anat Histol 379: 103–12

    Article  CAS  PubMed  Google Scholar 

  49. Ludwig J, Wiesner RH, Batts KP, et al (1987) The acute vanishing bile duct syndrome (acute irreversible rejection) after orthotopic liver transplantation. Hepatology 7: 476–83

    Article  CAS  PubMed  Google Scholar 

  50. Marcellin P, Asselah T, Boyer N (2002) Fibrosis and disease progression in hepatitis C. Hepatology 36: S47–56

    Article  PubMed  Google Scholar 

  51. Masseroli M, Caballero T, O'Valle F, et al (2000) Automatic quantifi cation of liver fi brosis: design and validation of a new image analysis method: comparison with semi-quantitative indexes of fi brosis. J Hepatol 32: 453–64

    Article  CAS  PubMed  Google Scholar 

  52. Miele L, Forgione A, Gasbarrini G, et al (2007) Noninvasive assessment of fi brosis in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Transl Res 149: 114–25

    Article  CAS  PubMed  Google Scholar 

  53. Nakanuma Y, Ohta G (1983) Quantitation of hepatic granu-lomas and epithelioid cells in primary biliary cirrhosis. Hepatology 3: 423–7

    Article  CAS  PubMed  Google Scholar 

  54. Neil DA, Hubscher SG (2002) Histologic and biochemical changes during the evolution of chronic rejection of liver allografts. Hepatology 35: 639–51

    Article  PubMed  Google Scholar 

  55. Neuberger J (1999) Incidence, timing, and risk factors for acute and chronic rejection. Liver Transpl Surg 5: S30–6

    CAS  PubMed  Google Scholar 

  56. Neuschwander-Tetri BA, Caldwell SH (2003) Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology 37: 1202–19

    Article  PubMed  Google Scholar 

  57. Nyfors A, Poulsen H (1976) Liver biopsies from psoriatics related to methotrexate therapy. 1. Findings in 123 consecutive non-methotrexate treated patients. Acta Pathol Microbiol Scand [A] 84: 253–61

    CAS  Google Scholar 

  58. Nyfors A, Poulsen H (1977) Morphogenesis of fi brosis and cirrhosis in methotrexate-treated patients with psoriasis. Am J Surg Pathol 1: 235–43

    Article  CAS  PubMed  Google Scholar 

  59. Orrego H, Blake JE, Blendis LM, et al (1987) Prognosis of alcoholic cirrhosis in the presence and absence of alcoholic hepatitis. Gastroenterology 92: 208–14

    CAS  PubMed  Google Scholar 

  60. Pappo O, Ramos H, Starzl TE, et al (1995) Structural integrity and identifi cation of causes of liver allograft dysfunction occurring more than 5 years after transplantation. Am J Surg Pathol 19: 192–206

    Article  CAS  PubMed  Google Scholar 

  61. Pares A, Caballeria J, Bruguera M, et al (1986) Histological course of alcoholic hepatitis. Infl uence of abstinence, sex and extent of hepatic damage. J Hepatol 2: 33–42

    CAS  Google Scholar 

  62. Piccinino F, Sagnelli E, Pasquale G, et al (1986) Complications following percutaneous liver biopsy. A multi-centre retrospective study on 68,276 biopsies. J Hepatol 2: 165–73

    Article  CAS  PubMed  Google Scholar 

  63. Pradat P, Alberti A, Poynard T, et al (2002) Predictive value of ALT levels for histologic fi ndings in chronic hepatitis C: a European collaborative study. Hepatology 36: 973–7

    PubMed  Google Scholar 

  64. Ringe B, Moritz M, Zeldin G, et al (2005) What is the best immunosuppression in living donor liver transplantation? Transplant Proc 37: 2169–71

    Article  CAS  PubMed  Google Scholar 

  65. Roenigk HH, Jr., Auerbach R, Maibach HI, et al (1982) Methotrexate guidelines — revised. J Am Acad Dermatol 6: 145–55

    Article  PubMed  Google Scholar 

  66. Roenigk HH, Jr., Auerbach R, Maibach HI, et al (1988) Methotrexate in psoriasis: revised guidelines. J Am Acad Dermatol 19: 145–56

    Article  PubMed  Google Scholar 

  67. Roenigk HH, Jr., Bergfeld WF, St Jacques R, et al (1971) Hepatotoxicity of methotrexate in the treatment of psoriasis. Arch Dermatol 103: 250–61

    Article  PubMed  Google Scholar 

  68. Rubin E, Schaffner F, Popper H (1965) Primary biliary cirrhosis. Chronic non-suppurative destructive cholangitis. Am J Pathol 46: 387–407

    CAS  Google Scholar 

  69. Rubio CA, Porwit A (1988) Quantitation of fi brosis in liver biopsies. Anal Quant Cytol Histol 10: 107–9

    CAS  PubMed  Google Scholar 

  70. Sandrin L, Fourquet B, Hasquenoph JM, et al (2003) Transient elastography: a new noninvasive method for assessment of hepatic fi brosis. Ultrasound Med Biol 29: 1705–13

    Article  PubMed  Google Scholar 

  71. Scheuer P (1967) Primary biliary cirrhosis. Proc R Soc Med 60: 1257–60

    CAS  PubMed  Google Scholar 

  72. Scheuer PJ (1991) Classifi cation of chronic viral hepatitis: a need for reassessment. J Hepatol 13: 372–4

    Article  CAS  PubMed  Google Scholar 

  73. Scheuer PJ, Williams R, Muir AR (1962) Hepatic pathology in relatives of patients with haemochromatosis. J Pathol Bacteriol 84: 53–64

    Article  CAS  PubMed  Google Scholar 

  74. Schirmacher P, Fleig WE, Tannapfel A, et al (2004) Bioptic diagnosis of chronic hepatitis. Results of an evidence-based consensus conference of the German Society of Pathology, of the German Society for Digestive and Metabolic Diseases and of Compensated Hepatitis (HepNet). Pathology 25: 337–48

    CAS  Google Scholar 

  75. Sebagh M, Blakolmer K, Falissard B, et al (2002) Accuracy of bile duct changes for the diagnosis of chronic liver allograft rejection: reliability of the 1999 Banff schema. Hepatology 35: 117–25

    Article  PubMed  Google Scholar 

  76. Sebagh M, Debette M, Samuel D, et al (1999) “Silent” presentation of veno-occlusive disease after liver transplantation as part of the process of cellular rejection with endothelial predilection. Hepatology 30: 1144–50

    Article  CAS  PubMed  Google Scholar 

  77. Siddique I, El-Naga HA, Madda JP, et al (2003) Sampling variability on percutaneous liver biopsy in patients with chronic hepatitis C virus infection. Scand J Gastroenterol 38: 427–32

    Article  CAS  PubMed  Google Scholar 

  78. Sorensen TI, Orholm M, Bentsen KD, et al (1984) Prospective evaluation of alcohol abuse and alcoholic liver injury in men as predictors of development of cirrhosis. Lancet 8397: 241–4

    Article  Google Scholar 

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Longerich, T., Schirmacher, P. (2010). Histopathological Scoring Systems. In: Clinical Hepatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-93842-2_29

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