Histochemical and immunohistochemical evaluation of the role of stellate cells, iron deposition and steatosis in induction of fibrosis in chronic hepatitis C patients

Chronic hepatitis C virus infection, affecting more than 170 million people worldwide. It is a leading cause of progressive liver fibrosis, liver cirrhosis and hepatocellular carcinoma (HCC). Egypt has a high prevalence rate of HCV with many routes of transmission. The Egyptian Ministry of Health estimated that more than half a million people are newly infected each year.Hepatic stellate cells (HSCs) play an important role in development of fibrosis and its progression to cirrhosis. They are activated and acquire a myofibroblastic phenotype, contributing to excessive extracellular matrix deposition. Activated HSCs lose lipid DROPlets stored in their cytoplasm, proliferate and gain the abundance of microfilaments that consist mainly of α-smooth muscle actin (α-SMA).This study included forty cases of chronic hepatitis C patients (mean age 38.75± 10) referred to Pathology Department, Faculty of Medicine, Zagazig University during the period from January 2011 to December 2011. Thirty patients were males (mean age 37.7±9.77) and ten patients were females (mean age 41.7±10.6). The study also included ten normal rats as a control group. The 41-50 age group of patients constituted the largest number of cases 35%.In this study the main pathological lesions were portal inflammation (100%) with dense lymphoid aggregates in 65% of cases, interface hepatitis (87.5%), steatosis (57.5%), lobular inflammation (20%) and bile duct damage in 25%, while confluent necrosis and bridging necrosis were not common findings and were observed only in 12.5% and 20% respectively in the studied cases.Stage I fibrosis (F1) according to METAVIR scoring system was the predominant stage in the studied cases (35%), while stage III (S3) according to Ishak scoring system was the predominant stage (22.5%).Grading of the 40 cases studied using METAVIR score, 25% in grade 1, 40% in grade 2 and 35% in grade 3 (severe inflammation). This work shows a significant correlation between grade of necro-inflammatory activity and stage of fibrosis according to the simple METAVIR scoring system (p< 0.001).Steatosis was found in 57.5% of cases. It was haphazardly distributed within the lobules and it was of a mixed micro- and macrovesicular nature. No significant correlation was found between grade of steatosis and grade of necro-inflammatory activity (p =0.35). On the other hand, a significant correlation existed between grade of steatosis and stage of fibrosis according to METAVIR scoring (p=0.0004) and Ishak scoring (p= 0.0175).Hepatic iron deposits were observed in 37.5% of cases; all of them were of mild to moderate degree with no severe iron deposits. Iron deposits appeared in hepatocytes in 62.5% of cases and in Kupffer cells only in 37.5% of cases. There was no correlation observed between iron deposits and fibrosis score of .