Although the epidemiology natural history and pathological aspects of
chronic hepatitis C are well-defined in the adult population, little i
s known about the characteristics of chronic hepatitis C infection in
children. Reports on the histological features and progression of hepa
titis C in children are scarce, and consist primarily of multicenter s
tudies in Japanese and European children. Given the geographic variati
ons in viral genotype and the association of pathology with genotype,
whether the Japanese and European studies can be extended to the North
American populations is unclear. We report the histopathology of the
liver in 40 children with chronic hepatitis C infection treated in a s
ingle North American institution. The children included 19 males and 2
1 females ranging in age from 2.0 to 18.6 years at the time of liver b
iopsy (mean +/- SD: 11.4 +/- 4.3 years). Our findings indicate that th
e characteristic histopathological lesions of chronic hepatitis C infe
ction, including sinusoidal lymphocytosis, steatosis, portal lymphoid
aggregates/follicles, and bile duct epithelial damage, occur with appr
oximately the same frequencies in children as have been reported in ad
ults. Necroinflammatory activity was generally mild. Portal fibrosis w
as present in 78% of the specimens, including fibrous portal expansion
(26%), bridging fibrosis (22%), bridging fibrosis with architectural
distortion (22%), and cirrhosis (8%). Centrilobular pericellular fibro
sis, which has not been previously reported in the context of chronic
hepatitis C infection in adults or children, was also a prominent feat
ure in our series, occurring with a similar frequency as steatosis or
portal lymphoid aggregates/follicles. Our data suggest that in spite o
f mild histological necroinflammatory activity in general, the stage o
f fibrosis in children can be severe in spite of relatively short dura
tion of infection.