Modified HAI Grading:
Necroinflammatory Scores |
Periportal or Periseptal Interface Hepatitis
(piecemeal necrosis)
(A) |
Score |
Confluent Necrosis
(B) |
Score |
Focal (spotty) Lytic Necrosis, Apoptosis, and Focal
Inflammation*
(C) |
Score |
Portal Inflammation
(D) |
Score |
Absent |
0 |
Absent |
0 |
Absent |
0 |
None |
0 |
Mild (focal, few portal areas) |
1 |
Focal confluent necrosis |
1 |
One focus or less per 10x objective |
1 |
Mild, some or all portal areas |
1 |
Mild/moderate (focal, most portal areas) |
2 |
Zone 3 necrosis in some areas |
2 |
Two to four foci per 10x objective |
2 |
Moderate, some or all portal areas |
2 |
Moderate (continuous around <50% of tracts
or septa) |
3 |
Zone 3 necrosis in most areas |
3 |
Five to ten foci per 10x objective |
3 |
Moderate/marked, all portal areas |
3 |
Severe (continuous around >50% of tracts
or septa) |
4 |
Zone 3 necrosis + occasional portal-central
(P-C) bridging |
4 |
More than ten foci per 10x objective |
4 |
Marked, all portal areas |
4 |
|
Zone 3 necrosis + multiple P-C bridging |
5 |
References
- Ishak K, et al. Histological grading and staging of chronic hepatitis. J
Hepatol 1995;22:696-699.
- Knodell RG, et al. Formulation and application of a numerical scoring
system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology
1981;1(5):431-5
|
Panacinar or multiacinar necrosis |
6 |
Total Modified HAI = __/18 |
*Does not include diffuse sinusoidal
infiltration by inflammatory cells. |
- Additional features which should be noted but not scored:
- Bile-duct inflammation
and damage
- Lymphoid follicles
- Steatosis, mild moderate or marked
- Hepatocellular dysplasia, large- or small-cell
- Adenomatous hyperplasia
- Iron or copper
overload
- Intracellular inclusions (eg. PAS-positive globules, Mallory bodies)
|
- Immunohistochemical findings
- Information on viral antigens, lymphocyte subsets or other features, when available,
should be recorded and may be semi-quantitatively expressed
|
Modified Staging:
architectural changes, fibrosis and cirrhosis* |
Change |
Score |
No fibrosis |
0 |
Fibrous expansion of some portal areas, with
or without short fibrous septa |
1 |
Fibrous expansion of most portal areas, with
or without short fibrous septa |
2 |
Fibrous expansion of most portal areas with
occasional portal to portal (P-P) bridging |
3 |
Fibrous expansion of portal areas with marked
bridging [portal to portal (P-P) as well as portal to central (P-C)] |
4 |
Marked bridging (P-P and/or P-C) with
occasional nodules (incomplete cirrhosis) |
5 |
Cirrhosis, probable or definite |
6 |
References
- Ishak K, et al. Histological grading and staging of chronic hepatitis. J
Hepatol 1995;22:696-699.
- Knodell RG, et al. Formulation and application of a numerical scoring
system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology
1981;1(5):431-5
|
*Additional features which should
be noted but not scored: Intra-acinar fibrosis, perivenular ('chicken wire' fibrosis)
and phlebosclerosis of terminal hepatic venules. |