Histological Findings of Autoimmune Hepatitis

Abstract

Histology of autoimmune hepatitis (AIH), chronic active hepatitis, is characterized by portal inflammation with interface hepatitis. Although the basic histology of AIH is similar to that of virus-related chronic hepatitis, hepatitic changes are usually prominent in AIH compared with chronic viral hepatitis. Clinicopathological diagnosis of AIH requires exclusion of other causes of liver disease, including hepatitis virus, alcohol, drugs, metabolic disorders, and other autoimmune diseases. At present, some criteria systems considering clinicopathological findings are proposed to categorize patients as having either "definite" or "probably/atypical" AIH. Among the pathological items of a simplified AIH scoring system of the International AIH Group, in addition to evident chronic hepatitis with interface hepatitis and hepatic rosette formation, emperipolesis, indicating the close immunological interaction of lymphocytes and hepatocytes, is noted but is sometimes difficult to evaluate. In addition to classical AIH, showing chronic active hepatitis, some AIH patients show a clinically acute hepatitis-like clinical course.These patients have mostly acute exacerbation from chronic active AIH, but acute-onset AIH cases, which histologically exhibit diffuse lobular hepatitis and/or confluent necrosis including perivenular zonal necrosis (zone 3 necrosis, centrizonal necrosis), are also encountered.

Acute presentation of autoimmune hepatitis: a multicentre study with detailed histological evaluation in a large cohort of patients

“…Emperipolesis was defined as engulfment of lymphocytes by hepatocytes; the engulfed lymphocytes morphologically remain intact and are surrounded by hepatocyte cytoplasm with a halo (figure 1). Engulfment of plasma cells by hepatocytes was excluded from this analysis 41 47. Perivenular necroinflammatory activity was defined as centrilobular injury, other than CN, with prominent hepatocellular necrosis and mononuclear inflammation, including spotty/focal necrosis (figure 1).…”

Histopathological analysis of autoimmune hepatitis with “acute” presentation: Differentiation from drug‐induced liver injury

“…Engulfment of plasma cells by hepatocytes was excluded from the present analysis. 45,46 Perivenular necroinflammatory activity was defined as centrilobular injury other than CN, with prominent hepatocellular necrosis and mononuclear inflammation, including spotty/focal necrosis. 47,48 All scores obtained in the histological evaluations were compared between the AP-AIH and DILI groups.…”

Occurrence, diagnosis and management of hepatic fibrosis and cirrhosis: An updated literature review

“…Various types of chronic injury may lead to liver fi brosis, such as auto-immune destruction of hepatocytes, metabolic diseases, alcohol abuse, congenital abnormalities, drugs and viral hepatitis [13,14]. Since alcoholism is an important deathleading factor among patients with cirrhosis and liver cancers, the association between alcohol and mortality of patients with hepatopathy is obvious [15,16].…”