- Aims: Liver cirrhosis is defined as a breakdown of liver architecture, lobular zonation, and hepatocellular polarization. Currently there is no histologic grading system of liver cirrhosis. The current study was aimed to design the conceptual basis of a new histologic classification system of liver cirrhosis, reflecting the progress of the cirrhotic liver disease and its relation to established clinical grading systems.
- Methods: 104 liver samples with various grades of cirrhosis. Slides were stained immunohistochemically with four antibodies to visualize Glutamine Synthetase (GS) illustrating lobular zonation, Cluster of differentiation 10 (CD10) illustrating bile canaliculi, Cluster of differentiation 34 (CD34) illustrating sinusoidal vascularization, and Alpha-smooth muscle actin (α-SMA) illustrating activated stellate cells. The grading system suggested by this study were based on the semi-quantitative analysis of the signal distribution of each marker. Then, the correlation of the histologic grading system with established clinical grading systems like Child-Pugh, MELD scores.
- Results: Loss of zonation was detected by the presence of GS- hepatocytes at the edges of regenerative nodules in 50.96% of samples as grade III using the GS-grading system. Loss of polarization, which corresponds to low-grade CD10 staining distribution in 34.16% of samples as grade III using the CD10-grading system. Breakdown of tissue architecture that is marked by the neovascularization of sinusoids was detected by CD34 signal distribution in 12.5% as high grade (IV) using the CD34 grading system. Moreover, sinusoidal fibrosis was detected by α-SMA signal distribution in 20.20% as grade IV using the α- SMA grading system. The morphological changes were also correlated to some clinical parameters and clinical scores.
- Conclusion: This study lays a base to the grading system that allows a tissue-based assessment of liver cirrhosis and its correlation with the clinical severity of cirrhosis.