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Liver and intrahepatic bile ducts-nontumor

Viral hepatitis

Hepatitis B virus (HBV)


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 16 February 2014, last major update May 2012
Copyright: (c) 2004-2014, PathologyOutlines.com, Inc.

General
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● Usually subclinical disease, but may lead to fulminant hepatic failure, chronic liver disease and cirrhosis
● Lifetime risk for hepatocellular carcinoma is 40% for men and 15% for women
● Spread by acutely infected patients or chronic viral carriers through intimate / sexual contact, intravenous drug abuse, contaminated blood or infected instruments, maternal to infant via delivery
● Causes 40% of hepatitis cases in US
Carrier: antigenemia > 6 months, normal ALT and AST, no symptoms; occurs in 10%
● Immunostains may be helpful for chronic disease
Fibrosing cholestatic hepatitis: unusual presentation of Hepatitis B virus in liver allograph recipients

Virology
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● Due to Hepadnavirus
● Intact virus is known as Dane particle
● Has 28 nm central nucleocapsid core enclosed by outer surface envelope; core contains DNA genome with DNA polymerase, hepatitis B core antigen and hepatitis B e antigen
● Viral envelope contains hepatitis B surface antigen


Drawing of virion

Hepatitis B surface antigen (HBsAg): carries no particularly useful clinical information, but is first serum marker of active infection
Hepatitis B core antigen (HBcAg): present in hepatocyte nuclei, not serum; indicates active replication of virus, patient is infective

Gross images
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Atrophic liver due to fulminant hepatitis

Micro description
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Acute - ground glass hepatocytes (finely granular eosinophilic cytoplasm consisting of spherules and tubules of HBsAg) with central ballooning degeneration

Micro images
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Lobular disarray

       
Acidophil bodies


Submassive necrosis


Ground glass hepatocytes in asymptomatic carrier


Moderate portal inflammation


Portal inflammation with minimal interface hepatitis


Portal fibrosis with minimal inflammation (trichrome)

   
Severe with marked portal inflammation and piecemeal necrosis


Immunostain for surface antigen


Immunostain for core antigen (in nuclei)

Positive stains
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● Immunostains for HBsAg or HBcAg or orcein stain (highlights HBsAg)

Additional references
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Clin Liver Dis 2010;14:555, Hepatology 2009;49:S61

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


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