Case 39.  
Hepatitis B virus infection, replicative carrier (34 y-o M)
         
   
Liver biopsy from a patient with mild liver dysfunction
   
         
   
Key words : 
hepatitis B virus, chronic hepatitis, replicative carrier, groundglass hepatocyte    
     
 
     
Irregular portal fibrosis with piecemeal necrosis and mild lobular inflammation is seen (HE).   Membrananous-type HBs antigen localization is typical of HBV replicative carrier (immunostaining).
     
 
     
Nuclear localization of HBc antigen is seen in the replicative carrier (immunostaining).   HBV-DNA expression corresponds to the area with HBc antigen localization (in situ hybridization by ALP coloration).
     
 
     
"Sanded nuclei" (nuclear inclusions) are seen in HBV-replicative hepatocytes (HE, high power).   Electron micrograph of the sanded nucleus, containing numbers of small core particles (25 nm in size)
     
 
     
Reference case 39A
Groundglass hepatocytes in a non-replicative carrier, a 23 year-old male (HE). Eosinophilic cytoplasmic inclusions are pathognomonic of an HBs carrier state. HBc and HBe antigens are usually undetectable in these cases.
  Reference case 39A
HBs antigen localization in the groundglass hepatocytes (immunostaining). The groundglass hepatocytes show marked accumulation of HBs antigen in the cytoplasm.
     
 
     
Reference case 39A
Electron micrograph of the groundglass hepatocyte. Abnormal accumulation of filamentous HBs antigen in the cisterna of smooth endoplasmic reticula characterizes the groundglass hepatocyte.
  Reference case 39B
Lethal fulminant type B hepatitis seen in a 19 y-o female (HE). In this case, no hepatocytes remain at autopsy. The widened portal triad reveals increase of pseudobile ducts.