Hepatic pathological features in naïve patients with chronic hepatitis C who have developed thyroid disorder

Abstract

Knowing the hepatic pathological features encountered in patients with chronic hepatitis C (CHC) and the fact that extrahepatic manifestations occur only in people with certain characteristics of the immune system, we tried to evaluate, qualitatively and semi-quantitatively, the liver pathological aspects encountered in 96 patients with CHC, previously untreated with Interferon (naïve), who showed or did not show signs of thyroid disorder (TD), hospitalized in the 2nd Medical Clinic of the Emergency County Hospital, Craiova, Romania, within a period of five years (2007-2012). Following hormonal, immunological, and thyroid ultrasound investigations, 14 (14.58%) of the 96 patients showed signs of TD. The main clinical forms of TD in the studied patients with CHC were autoimmune thyroiditis and subclinical hypothyroidism. In the patients with CHC with TD, we found mild chronic hepatitis in 14.28% of cases, the appearance of moderate chronic hepatitis was found in 71.42% patients, and the appearance of severe chronic hepatitis was found in 14.28% patients, while in the patients with CHC without TD we found chronic mild hepatitis in 62.19% of cases, the appearance of moderate chronic hepatitis was met in 32.92% patients, and the appearance of severe chronic hepatitis was found in 4.87% of patients. Mild and moderate fibrosis were found only in CHC patients without TD in a percentage of 25.6% and 65.85%, respectively, while severe fibrosis was found at 12.19% among CHC patients without TD and 92.85% among CHC patients with TD. The pathological aspect of liver cirrhosis was found only in those with TD (7.14%). In conclusion, the pathological features which define the liver necroinflammatory process, as encountered at the pathological examination in CHC patients with TD are the same as in any active chronic hepatitis, the differences being represented by the higher percentage of the periportal and the preseptal necrosis (piecemeal necrosis), as well as by the higher score of portal inflammation. In addition, the severe hepatic fibrosis and the histopathological appearance of the liver cirrhosis have only defined the cases of CHC with TD.

Figure 1

Nonspecific pathological features observed in patients with CHC: (A) Feature of piecemeal necrosis, with periportal and preseptal inflammation; (B) Aspect of portal inflammation (an inflammatory infiltrate consisting of lymphocytes, plasmocytes and polymorphonuclears inside the portal tracts); (C) Feature of bridging necrosis, when the hepatic necrosis becomes confluent or multilocular, and is associated with the presence of fibrous septa extending into the liver lobe; (D) Aspect of focal necrosis with nonspecific pathological alterations. HE staining: (A) ×100; (B–D) ×200. CHC: Chronic hepatitis C; HE: Hematoxylin–Eosin

Figure 2

Pathological features encountered in patients with CHC: (A) Histological aspect of CHC with mild activity – pathological aspect frequently encountered in patients with CHC without TD; (B) Histological aspect of CHC with severe activity – pathological aspect frequently encountered in patients with CHC with TD. HE staining: (A and B) ×100. CHC: Chronic hepatitis C; HE: Hematoxylin–Eosin; TD: Thyroid disorder

Figure 3

Pathological features of CHC associated with hepatic fibrosis: (A) CHC with mild fibrosis, aspect frequently showed in patients without TD; (B) CHC with severe fibrosis, feature frequently showed in patients with TD. Masson’s trichrome staining: (A and B) ×200. CHC: Chronic hepatitis C; TD: Thyroid disorder