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 Primary Biliary Cholangitis Scoring System (2013) Grading (Necroinflammatory Activity) 
  Score
  Criterion 
  CA (Cholangitis Activity)
  
  0 (no activity)
  No cholangitis but mild damage to the bile ducts may be present. 
  1 (mild activity)
  One evident chronic cholangitis in the specimen (i.e., nonspecific chronic cholangitis surrounded by mild to moderate lymphoplasmacytic inflammation ). 
  2 (moderate activity)
  Two or more bile ducts with evident chronic cholangitis (i.e., nonspecific chronic cholangitis surrounded by mild to moderate lymphoplasmacytic inflammation ). 
  3 (marked activity)
  One or more foci of chronic nonsuppurative destructive cholangitis in the specimen (i.e., marked epithelial injury with adjacent marked lymphoplasmacytic inflammation or granuloma; florid duct lesion). 
  
   
  HA (Hepatitis Activity)
   
  0 (no activity)
  No interface hepatitis and no or minimal lobular hepatitis 
  1 (mild activity))
  Interface hepatitis affecting 10 continuous hepatocytes at a limiting plate in 1 portal tract or fibrous septa and mile to moderate lobular hepatitis. 
  
  2 (moderate activity)
  Interface hepatitis affecting 10 continuous hepatocytes at a limiting plate in 2 or more portal tracts or fibrous septa and mile to moderate lobular hepatitis. 
  3 (marked activity)
  Interface hepatitis affecting 20 continuous hepatocytes at limiting plates in moree than half of the portal tracts and moderate lobular hepatitis or bridging/zonal necrosis. 
 Staging (Chronicity Score) 
  Score
  Criterion 
  Fibrosis
  
  0
  No fibrosis or fibrosis limited to portal tracts. 
  1
  Portal fibrosis with periportal fibrosis or incomplete septal fibrosis. 
  2
  Bridging fibrosis with variable lobular disarray. 
  3
  Cirrhosis with regenerative nodules and extensive fibrosis. 
  
   
  Bile Duct Loss
   
    0
  No bile duct loss. 
  1
  Bile duct loss in less than one-third of portal tracts. 
  
    2
  Bile duct loss in one-third to two-thirds of portal tracts. 
      3
  Bile duct loss in more than two-thirds of portal tracts.
   
   
  Deposition of Orcein-Positive Granules
   
    0
  No deposition of granules. 
  1
  Deposition of granules in a couple of Zone 1 hepatocytes in less than one-third of portal tracts. 
  
    2
  Deposition of granules in a variable number of Zone 1 hepatocytes in one-third to two-thirds of portal tracts. 
      3
  Deposition of granules in most Zone 1 hepatocytes in more than two-thirds of portal tracts. 
 Reference: Kakuda Y et al. Evaluation of a new histologic staging and grading system for primary biliary cirrhosis in comparison with classical systems. Hum Pathol 2013; 44:1107-1117. Last Modified: Sun May 10 2020 5:55 PM EDT 
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