Viral hepatitis on biopsy: acute and chronic
- Lesion
Acute hepatitis inflames the lobule; chronic hepatitis inflames the portal tracts and their edge, and slowly lays down scar.
What it is
Hepatitis, whatever its cause, produces two broad histologic pictures. Acute hepatitis is a lobular disease with scattered hepatocyte death, swelling and inflammation. Chronic hepatitis (more than six months) is centred on portal tracts, spills across the limiting plate (interface hepatitis) and causes progressive fibrosis. Pathologists report the grade (activity of inflammation) and the stage (amount of fibrosis). Clinically, viral infection can end as a carrier state, acute self-limited hepatitis, chronic hepatitis or acute liver failure.
Key facts
- Carrier state: virus present with little or no hepatitis, common in perinatal HBV.
- Acute self-limited hepatitis: incubation, prodrome, icteric phase, recovery.
- Chronic hepatitis: symptoms, biochemistry or serology for more than six months.
- Acute liver failure: massive necrosis, a small minority of cases (more often HBV, HAV in adults, HEV in pregnancy).
Step by step
- Virus infects hepatocytes; viral peptides are shown on MHC class I.
- Cytotoxic T cells and NK cells kill infected cells by apoptosis.
- In acute disease the attack is diffuse in the lobule and usually clears the virus.
- If the virus persists, inflammation settles in portal tracts and erodes the limiting plate.
- Repeated death at the interface activates stellate cells: portal, then bridging fibrosis.
- Bridging septa and regenerating nodules end in cirrhosis.
Acute versus chronic hepatitis
| Feature | Acute hepatitis | Chronic hepatitis |
|---|---|---|
| Main site | Lobule (parenchyma) | Portal tracts and their edge |
| Hepatocyte death | Scattered acidophil bodies; confluent or bridging necrosis if severe | Interface hepatitis (piecemeal loss at the limiting plate) |
| Inflammation | Lymphocytes and macrophages in the lobule; mild portal | Dense portal lymphocytes, plasma cells; lymphoid aggregates in HCV |
| Fibrosis | None (unless repeated or severe necrosis) | Portal, then bridging, then cirrhosis |
| Clues | Ballooning, cholestasis, Kupffer cell hypertrophy | Ground-glass cells (HBV), steatosis (HCV) |
Test yourself
Think of the answer, then tap the question to see it.
What is interface hepatitis?
Inflammation that crosses the limiting plate from the portal tract and kills periportal hepatocytes, a hallmark of chronic hepatitis.
What is the difference between grade and stage in a hepatitis biopsy?
Grade measures the activity of inflammation and necrosis; stage measures the extent of fibrosis up to cirrhosis.
Which cells mainly cause liver injury in viral hepatitis?
Cytotoxic T lymphocytes (with NK cells) that kill infected hepatocytes.
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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Viral Hepatitis (StatPearls (NCBI Bookshelf), 2024); Hepatitis: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.