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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Hepatitis A virus (HAV)

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


● Fecal-oral transmission via contaminated food or water
● Associated with overcrowding or poor sanitation
● Usually children (asymptomatic or symptomatic without jaundice)
● In adults, infection more severe with malaise and jaundice for 7-10 days
● Rarely causes massive hepatic necrosis and acute liver failure; fatal in < 0.5% of cases
● May cause acute cholestatic hepatitis with bile ductular proliferation, neutrophils around ducts, cholestasis, hepatocyte ballooning, pseudo-glands around bile plugs
● Does not produce chronic disease or carrier state in immunocompetent patients
● Causes 50% of hepatitis cases in US; effective vaccine available


● Due to Picornavirus, 27 nm virion with single stranded RNA

Drawing of virion


● Serum IgM anti-HAV is more reliable than immunostains

Micro description

● Periportal inflammation and necrosis, ballooning degeneration, apoptosis
● Cholestasis and increased portal and periportal plasma cells are relatively specific for hepatitis A
● Acidophil bodies or cytolysis are present (collapse of reticulin network where cells have disappeared with appearance of macrophage aggregates)
● Bridging necrosis if severe hepatitis
● Also interface hepatitis (inflammatory infiltrate spills over into adjacent parenchyma to cause necrosis of periportal hepatocytes)
● Relative sparing of centrilobular hepatocytes

Micro images

Portal and periportal inflammation with some ballooning degeneration

Lobular inflammation

Confluent necrosis (PAS)

Acidophil bodies and hydropic degeneration

With marked cholestasis

Differential diagnosis

● Chronic hepatitis with moderate/severe activity (fibrosis present)

Additional references

Liver 1982;2:53, Am J Clin Pathol 1984;81:162

End of Liver and intrahepatic bile ducts-nontumor > Viral hepatitis > Hepatitis A virus (HAV)

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