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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Epstein Barr virus hepatitis (EBV)

Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 12 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.


● Affects immunocompetent and immunocompromised
● Usually acute self-limited disease resembling infectious mononucleosis; rarely causes hepatic failure and death in patients with immunodeficiency syndromes


● Elevated transaminase levels (80%), high EBV serum viral load; elevated bilirubin in only 7%
● In some cases, infiltrating CD8+ T cells, but not hepatocytes, are infected with EBV (Hum Pathol 2001;32:757)
● May cause polymorphic B cell hyperplasia or lymphoma in immunocompromised

Micro description

● Predominantly sinusoidal infiltrate of atypical T lymphocytes with minimal necrosis
● Presence of atypical lymphocytes may coincide with Downey cells in peripheral blood
● Associated with viral-associated hemophagocytic syndrome, with prominent erythrophagocytosis by sinusoidal Kupffer cells and portal histiocytes
● Variable mitotic figures and small epithelioid granulomas
● No bile duct injury or venulitis

Micro images

Prominent inflammation without hepatocyte necrosis

Hepatocyte regeneration with binucleated figures and mitotic activity

Positive stains

● EBV antigen, EBV encoded RNA (EBER)

Differential diagnosis

● CMV, hepatitis C, diphenylhydantoin drug reaction, sinus histiocytosis with massive lymphadenopathy (nodular, portal areas uninvolved)

Additional references

World J Gastroenterol 2010;16:4130, J Hepatol 2006;44:879, Am J Surg Pathol 2007;31:1403

End of Liver and intrahepatic bile ducts-nontumor > Viral hepatitis > Epstein Barr virus hepatitis (EBV)

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