Hepatitis B

Published on 21/04/2017 by admin

Filed under Pathology

Last modified 21/04/2017

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 Typically transmitted vertically, parenterally, or sexually

Clinical Issues

• 10% of infected patients become chronically infected

image 400 million people worldwide have chronic HBV
• Symptoms include mild flu-like syndrome, nausea, vomiting, jaundice

image > 50% are asymptomatic
• Lifelong risk of developing cirrhosis &/or HCC
• Useful laboratory tests include serology for HBV viral antigens, anti-HBV antibodies, and HBV DNA viral load

Microscopic

• Acute hepatitis B

image Hepatocytic swelling, predominantly lobular inflammation, spotty necrosis
image Severe cases may show confluent and bridging necrosis, collapse of hepatocytic cords, hepatocytic regeneration
• Chronic hepatitis B

image Portal-based inflammation with variably present ground-glass hepatocytes, “sanded nuclei” in hepatocytes, variable fibrosis 

– Stage of fibrosis indicates disease progression and is important therapeutic and prognostic indicator
• Immunohistochemistry for HBcAG and HBsAG may be useful, but not invariably positive

Top Differential Diagnoses

• Hepatitis A, hepatitis C, autoimmune hepatitis, other viral infections (CMV, EBV)

image Histologic features may be very nonspecific, so correlation with history and serology is crucial
image
Ground-Glass Hepatocytes
Ground-glass hepatocytes image have glassy eosinophilic cytoplasm representing proliferation of smooth ER in response to HBsAg.

image
Sanded Nuclei
Hepatitis B-infected hepatocytes may have pale pink, finely granular intranuclear inclusions (sanded nuclei image ) representing nuclear accumulation of HBcAg. These may be hard to detect on routine H&E staining.
image
HBV, Acute
This case of acute HBV infection shows lobular disarray with marked hepatocyte swelling and lobular inflammation.
image
HBV, Chronic
This section shows interface hepatitis in chronic hepatitis B consisting of chronic inflammatory cells that extend beyond the limiting plate image into the periportal parenchyma.

TERMINOLOGY

Abbreviations

• Hepatitis B virus (HBV)

Synonyms

• Australia antigen: Hepatitis B surface antigen (HBsAg)

Definitions

• Infection by HBV

image Member of Hepadnaviridae family
image Genome comprises partially double-stranded DNA virus

ETIOLOGY/PATHOGENESIS

Infectious Agents

• Transmitted parenterally

image Vertical transmission: Mothers to newborn infants
image Horizontal transmission: Between young children
image Sexual contact
• Liver injury appears to be immune mediated

image HBV-specific T cells play key role in pathogenesis and viral clearance

CLINICAL ISSUES

Epidemiology

• Incidence

image 400 million people worldwide are chronically infected with HBV

Presentation

• Acute hepatitis B

image Symptoms include mild flu-like symptoms, nausea, vomiting, jaundice
– > 50% are asymptomatic
image < 1% develop fulminant liver failure leading to death or liver transplantation
image Serum HBsAg and anti-HBc virus IgM Ab positive
• Chronic hepatitis B

image Serum HBsAg positive and anti-HBc virus IgM Ab negative

Laboratory Tests

• Serology for HBV viral antigens: HBsAg, HBcAg, HBeAg
• Serology for anti-HBV antibodies: Anti-HBs, anti-HBc, anti-HBe
• Serum HBV DNA and viral load
• Elevated transaminases

Natural History

• 10% of infected individuals become chronically infected

• Life-long risk of developing cirrhosis &/or HCC in chronic hepatitis B
image Cirrhosis is not prerequisite for developing HCC
– HBV viral genome can act as oncoprotein and intergrade into host genome
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