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Case 39.
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Hepatitis B virus infection, replicative carrier (34 y-o M) |  |
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Liver biopsy from a patient with mild liver dysfunction
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Key words :
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hepatitis B virus, chronic hepatitis, replicative carrier, groundglass hepatocyte | ||||
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| 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). | |
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| 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). | |
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| "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) | |
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| 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. |
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| 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. |
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