HISTOPATHOLOGY OF THE LIVER IN CHILDREN WITH CHRONIC HEPATITIS-C VIRAL-INFECTION

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.