Liver biopsy in hepatitis C.

The advent of more specific and sensitive assays for the diagnosis of hepatitis C has provided better definition of the histopathology of this disease and its differentiation from other forms of hepatitis. The following features have been found to be characteristic but not pathognomonic: lymphoid follicles in the portal tracts, bile duct lesions, fatty metamorphosis and Mallory body-like condensations in the cytoplasm of the hepatocytes. It has been suggested that the virus genotype may be correlated with different histopathologies. A better understanding of chronic hepatitis C has led to a more flexible and accurate terminology of chronic hepatitis, including the grade of necroinflammatory activity and the stage of fibrosis. Both seem to be of prognostic value in the course of chronic hepatitis C. Recurrence of hepatitis C in the graft after liver transplantation may have a different histopathologic pattern with progressive fibrosis, conspicuous cholestasis and pronounced hepatocellular necrosis. Histopathology grade and stage of liver damage in chronic hepatitis C is not reflected by serum aminotransaminase level or serological status.