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Modified Hepatic Activity Index

Modified HAI Grading: Necroinflammatory Scores
Periportal or Periseptal Interface Hepatitis (piecemeal necrosis)
Score Confluent Necrosis
Score Focal (spotty) Lytic Necrosis, Apoptosis, and Focal Inflammation*
Score Portal Inflammation
Absent 0 Absent 0 Absent 0 None 0
Mild (focal, few portal areas) 1 Focal confluent necrosis 1 One focus or less per 10x objective 1 Mild, some or all portal areas 1
Mild/moderate (focal, most portal areas) 2 Zone 3 necrosis in some areas 2 Two to four foci per 10x objective 2 Moderate, some or all portal areas 2
Moderate (continuous around <50% of tracts or septa) 3 Zone 3 necrosis in most areas 3 Five to ten foci per 10x objective 3 Moderate/marked, all portal areas 3
Severe (continuous around >50% of tracts or septa) 4 Zone 3 necrosis + occasional portal-central (P-C) bridging 4 More than ten foci per 10x objective 4 Marked, all portal areas 4
Zone 3 necrosis + multiple P-C bridging 5 References

  1. Ishak K, et al. Histological grading and staging of chronic hepatitis. J Hepato/1995;22:696-699.
  2. Knodell RG, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1(5):431-5

Modified Staging Chart

Scoring Chart
Panacinar or multiacinar necrosis 6
Total Modified HAI = __/18

Does not include diffuse sinusoidal infiltration by inflammatory cells.

Additional features which should be noted but not scored:
  • Bile Duct inflammation & damage
  • Lymphoid Follicles
  • Steatosis, mild, moderate or marked
  • Hepatocellular dysplasia, small or large cell
  • Adenomatous hyperplasia
  • Iron or copper overload
  • Intracellular inclusions

Immunohistochemical findings:

Information on viral antigens, lymphocyte subsets or other features, when available, should be recorded and may be semi-quantitatively expressed