fibrosis


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  • Descriptive for portal fibrosis

    • portal: mild = a few portals, moderate = over half
    • portal fibrosis with hepatocyte trapping
    • periportal
    • bridging
    • cirrhosis: regenerative nodules surrounded by fibrosis
      • macronodular: > 3 mm, seen in viral hepatitis, autoimmune hepatitis
      • micronodular: < 3 mm, seen in EtOH, AAT1, Wilson, hemochromatosis. But over time, turns into macronodular.
      • fragmented specimens associated with cirrhosis, esp with fibrous caps

  • Descriptive for pericellular fibrosis

    • aka: perisinusoidal fibrosis
    • seen in fatty liver disease
    • CHF can also have zone 3 pericellular and central vein fibrosis
    • mild = only apparent on trichrome
    • moderate = can be seen on H&E

  • Fibrosis regression

    • perforated/disrupted delicate fibrous bridges
    • isolated thick collagen bundles in lobules
    • delicate spikes of fibrosis extending from portal tracts
    • portal tract or central vein remnants (easier to see on trichrome)
    • short and broad fibrous bridges/adhesions

  • Batts-Ludwig

    • Grade (chronic hepatitis)
      • 0: none
      • 1: portal - patchy inflammation. Lobular - minimal necrosis.
      • 2: portal - mild inflammation, in some or all tracts. Lobular - mild hepatocellular damage
      • 3: portal - moderate inflammation in all portal tracts. Lobular - noticeable hepatocellular damage
      • 4: portal - severe inflammation, bridging necrosis. Lobular - diffuse hepatocellular damage
    • Stage (fibrosis/cirrhosis)
      • 0: none
      • 1: portal fibrosis
      • 2: periportal fibrosis, rare portal-portal septa
      • 3: bridging fibrosis
      • 4: cirrhosis (nodules)

  • Ddx

    • marked portal inflammation
    • bridging necrosis that has had time for hepatocytes to drop out mimicks fibrosis on trichrome
    • portal tract branch points (have vessels) vs true bridging fibrosis (no vessels, irregular)
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