Question on morphology of chirrosis due to HCV vs alcoholism

[microbe hunter]

This came up in a discussion today, and my professor didn't know if a pathologist could tell the difference under the microscope between HCV-induced chirrosis or Alcoholic chirrosis. Can anyone weigh in? Thanks.

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[djmd]

Sure.

Do serology or PCR for Hep C virus.
That would do it. (well serology would show that they had at one point HCV) (it is just me or is that more confusing that just HepC)



The pattern of injury is overlapping, and the are some features with favor one over the other, but it is generally tricky.

 

[DarksideAllstar]

As someone who hasn't seen a ton of liver bxs, I was under the impression that the presence of PMNs points more towards alcoholic cirrhosis. Maybe I misunderstood and am confusing the morphologies of hepatitis and cirrhosis--not sure. Any takers on clearing this up?

EDIT: Seems like I did confuse the two (alcoholic hep has PMNs, while HCV-induced hep--at least chronic-- doesn't). Path outlines doesn't specifically say how to distinguish the etiologies of cirrhosis based on microscopy alone.

 

[deleted113029]

correct me if i'm wrong, but i thought cirrhosis is cirrhosis is cirrhosis. alcoholic and HCV hepatic injury can be distinguished IF caught early, but once they progress to cirrhosis no one can tell them apart.

 

[superdevil]

i'm not sure about "under the microscope", but from a gross specimen alcoholic cirrhosis is usually micronodular, while HCV cirrhosis is usually macronodular. (at least i think, the memory ain't so good anymore...)

 

[DarksideAllstar]

correct me if i'm wrong, but i thought cirrhosis is cirrhosis is cirrhosis. alcoholic and HCV hepatic injury can be distinguished IF caught early, but once they progress to cirrhosis no one can tell them apart.

Its a moot point at the stage of cirrhosis, I agree. The etiology is gonna be determined by the history and serologies anyway. I think that your presumption is correct (see my previous post).

i'm not sure about "under the microscope", but from a gross specimen alcoholic cirrhosis is usually micronodular, while HCV cirrhosis is usually macronodular. (at least i think, the memory ain't so good anymore...)

I think that most scenarios involving the determination of the cause of hepatitis will revolve around looking at core bxs, hence I think why most of our posts have been focused on the morphology rather than gross path. BTW, I used to have the same signature for my account. Great movie (and quite true for me also).

 

[deleted113029]

Its a moot point at the stage of cirrhosis, I agree. The etiology is gonna be determined by the history and serologies anyway. I think that your presumption is correct (see my previous post).

you're right. i also thought ground glass hepatocytes were related to viral hepatitis...time to review Robbins before July.

 

[yaah]

Many HCV patients are also alcoholics. There is a lot of overlap anyway, and that complicates things further. In general, if someone is HCV positive and they are likely to have been positive for years, that will be the etiology clinically. And many of these individuals may have NASH as well, or other possible etiologies.

Yes, classically pure alcoholic cirrhosis will be finely micronodular and very firm, whereas classic HCV has slightly larger nodules.

The above points are accurate though: Cirrhosis is cirrhosis. Don't much matter at that point as long as there isn't ongoing damage occurring.

 

[Anna Plastic]

Many HCV patients are also alcoholics.

I think the cart may be leading the horse there a bit--it may be safer to say that HCV infection is common in alcoholics. The presence of chronic alcoholism creates an inflammatory state which predisposes to, and exacerbates, HCV infection--even in alcoholics without classic risk factors for viral hepatitis like IVDA or transfusion.

A good review article on the topic, for those curious:
http://pubs.niaaa.nih.gov/publications/arh25-4/245-254.htm

 

[yaah]

Well, all I was saying is that the two conditions often coexist and this complicates determination of the etiology of cirrhosis in many conditions.

 

[Byronsgoat]

This came up in a discussion today, and my professor didn't know if a pathologist could tell the difference under the microscope between HCV-induced chirrosis or Alcoholic chirrosis. Can anyone weigh in? Thanks.

If my notes are correct:

Alcohol = central-portal bridging fibrosis
Viral = portal-portal bridging fibrosis

Morphologically you can tell the difference. This is per our GI pathologist who lectured on the subject this morning.

 

[yaah]

Once it gets to full cirrhosis good luck.