Hepatitis B

Hepatitis B is a relatively common medical liver disease caused by the hepatitis B virus.

General

• May lead to hepatocellular carcinoma without cirrhosis.
• High prevalence.
• Diagnosis is by serology - details of serologic testing are in the medical liver disease article.
• A vaccination is available and done routinely in a many jurisdictions.

Associated pathology:

• Polyarteritis nodosa (PAN).
• Membranoproliferative glomerulonephritis.
• Membranous nephropathy.

Microscopic

Features:

• Lobular inflammation - this is non-specific finding.
  • Hepatocyte necrosis:
    • Necrotic hepatocytes look a lot like neutrophils - however:
      • Cytoplasm is more pink.
      • Round apoptotic bodies.
• Ground glass hepatocytes - important.

DDx:

• Hepatitis C.
• Autoimmune hepatitis.
• Primary biliary cirrhosis without granulomas.
• Drug reaction.

Image

• 

  GGH - high mag. (WC)

Hepatitis B. Metavir activity index 3. Piecemeal necrosis 2. Lobular necrosis 2. Fibrosis stage 3. Portal triads, expanded, inflamed and without sharp edges. Inflammation amid hepatocytes. (TL 40X). Reticulin with bridging necrosis (TR 100X). Reticulin with extensive piecemeal necrosis (ML 100X). PAS without diastase with extensive piecemeal necrosis (MR 100X). Trichrome with bridging, no nodules or extensive bridging on slides as a whole (BL 100X). Ground glass hepatocytes (BR 400X).

Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis). A fragmented specimen shows apparent nodules [black arrows] (Row 1 Left 20X). Inflammatory cells extending from band suggest piecemeal necrosis [green arrows]; inflammatory foci apart from band denote spotty necrosis [blue arrows] (Row 1 Right 200X). Reticulin stain shows piecemeal necrosis as black lines about hepatocyte clusters at band [blue arrows], regeneration as more than one cell thick cords [green arrows] and hepatocyte rosettes [magenta arrows] (Row 2 Left 200X). On PAS without diastase, piecemeal necrosis can be seen as pink hepatocyte cytoplasmic fragments amid inflammatory cells [arrows]. (Row 2 Right 200X). The nodules seen at low power are confirmed to be collagen bounded, but the appreciation can be made frustrated by intense inflammation (Row 3 Left 100X). Examination elsewhere shows a definite nodule pair amid fibrosis [green arrows]; note on the right the fibrous band extending from the portal triad [black arrow] with sinusoids being far more often perpendicular to the triad than they were in the regenerative nodules to the surrounding bands (Row 3 Right 100X).

IHC

• Hepatitis B +ve.

See also

• Medical liver disease.