NAS pathological Control HF score factors Steatosis 0 (0.67%) 2 (42.24%) Inflammation 0 (no foci) 2 (2-4 foci/field) Ballooning 1 (rare) 2 (many) Fibrosis 0 (no fibrosis) 3 (bridging fibrosis) NAS value 1 9 NASH NAS pathological HF + CoPP HF + CoPP + SnMP score factors Steatosis 1 (10.28%) 2 (33.05%) Inflammation 1 (<2 foci/field) 2 (2-4 foci/field) Ballooning 1 (rare) 2 (many) Fibrosis 0 (no fibrosis) 2 (perisinusoidal and portal fibrosis
) NAS value 3 8 NASH
Histopathological liver changes in biliary atresia include ductular reaction, portal fibrosis
, and bile plugs.
Trichrome stain shows portal fibrosis
with fibrous septa that bridge and partially enclose nodules.
A single expert hepatopathologist reviewed all liver biopsies and utilized the scoring system established by Brunt and colleagues  for grading and staging of steatohepatitis (staging of fibrosis is as follows: Stage 0, no fibrosis, Stage 1, zone 3 perisinusoidal fibrosis, Stage 2, as above with portal fibrosis
, Stage 3, as above with bridging fibrosis, and Stage 4, cirrhosis).
The difference may be due to aetiology of varices as the other study included patients with cirrhosis, non-cirrhotic portal fibrosis
, extrahepatic portal vein obstruction and hepatic venous outflow obstruction compared to our study which included patients only with cirrhosis due to chronic HCV infection.
Considering fibrosis stage, SVR rate was 100% (9) for minimum fibrosis, 73.3% (15) for portal fibrosis
, 55% (20) for bridging fibrosis, and 46% (50) for cirrhosis.
Clinical features of the study group (n = 137) Clinical features * n (%) EVR 64 (66.7) SVR 30 (48.4) Viral load>400 92 (78.0) METAVIR Activity Score Mild 19 (30.2) Mild to moderate 2 (3.2) Moderate 23 (36.5) Severe 19 (30.2) Fibrosis stage No fibrosis 1 (1.5) Portal fibrosis
without septa 6 (8.8) Portal fibrosis
with few septa 9 (13.2) Numerous septa without cirrhosis 10 (14.7) Cirrhosis 13 (19.1) Other ([dagger]) 29 (42.7) Note: EVR = early virological response; SVR = sustained virological response.
The staging of fibrosis involves a 5-stage scoring system: F0 (chronic hepatitis without fibrosis); FI (portal fibrosis
without septae); F2 (portal fibrosis
with rare septae); F3 (many septae without cirrhosis); or F4 (cirrhosis).
Fibrosis stages were assessed using the Scheuer scoring system on a scale of S0 to S4 as follows: S0, no fibrosis; S1, portal fibrosis
without septa; S2, portal fibrosis
with few septa; S3, numerous septa without cirrhosis; and S4, cirrhosis.
Liver biopsy was done which showed mild portal chronic hepatitis with lymphocytic infiltration (Fig: 1), cholestasis (Fig: 2), mild portal fibrosis
(Fig: 3), negative for bile duct damage (Fig: 4), negative for cytoplasmic inclusion.
Hepatitis activity (HAI) index and portal fibrosis
score were determined by modified Ishak scoring system on histopathological examination of the patients who underwent biopsy (7).
The key histological features were moderate to severe interface hepatitis with marked portal lympho-plasmacytic infiltrate in excess of lobular inflammation, and irregular portal fibrosis
. Six patients showed cirrhosis.
* hepatic fibrosis was evaluated using the Metavir fibrosis score, which ranged from 0-4 (0: no fibrosis, 1: portal fibrosis
without septa, 2: portal fibrosis
with few septa, 3: numerous septa without cirrhosis, 4: cirrhosis)
Portal hypertension associated with portal fibrosis
was reported in nine patients who were found to have high arsenic level in their liver in Chandigarh, India.
Six of 14 patients with perisinusoidal fibrosis and 6 of 13 with portal fibrosis