## Histological Distinction: Hepatitis C vs Hepatitis B Cirrhosis ### Characteristic Features of Chronic Hepatitis C **Key Point:** Lymphoid aggregates and follicles (lymphoid nodules) in portal tracts are a hallmark histological feature of chronic hepatitis C and are present in approximately 50–60% of HCV cases. These are rarely seen in hepatitis B. ### Comparative Histopathology Table | Feature | Hepatitis C | Hepatitis B | | --- | --- | --- | | **Lymphoid aggregates/follicles** | Present in 50–60% (hallmark) | Absent or very rare | | **Ground-glass hepatocytes** | Absent | Present (HBsAg in ER) | | **Steatosis** | Common (especially genotype 3) | Uncommon | | **Interface hepatitis** | Mild to moderate | Moderate to severe | | **Bile duct proliferation** | Present (non-specific) | Present (non-specific) | | **Fibrosis pattern** | Periportal and bridging | Periportal and bridging | | **Cirrhosis appearance** | Micronodular | Macronodular (HBV more common) | ### Clinical Pearl **High-Yield:** Lymphoid aggregates in portal tracts are so characteristic of HCV that their presence strongly suggests hepatitis C over hepatitis B. These structures may even persist after successful antiviral therapy (SVR). **Mnemonic:** **LAGS** — **L**ymphoid **A**ggregates = **G**ood sign for **S**uspecting HCV. ### Immunohistochemistry Correlation - **HCV:** Lymphoid follicles stain for CD20 (B cells) and CD3 (T cells); organized germinal center-like structures. - **HBV:** Ground-glass hepatocytes are HBsAg-positive on immunostain (orcein or Victoria blue stain). ### Why Cirrhosis Develops Differently Both HBV and HCV cause cirrhosis through chronic inflammation and fibrosis, but the **immune response pattern** differs: - **HCV:** Robust but ineffective humoral and cellular response → lymphoid aggregates, steatosis, slower progression in some. - **HBV:** Immune-mediated hepatocyte injury → more aggressive interface hepatitis, ground-glass changes from viral replication.
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