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Difference between revisions of "Hepatitis B"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Ground_glass_hepatocytes_high_mag_cropped_2.jpg | |||
| Width = | |||
| Caption = Ground glass hepatocytes in chronic hepatitis B. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = lobular inflammation - hepatocyte necrosis, +/-[[ground glass hepatocytes]] | |||
| Subtypes = | |||
| LMDDx = [[hepatitis C]], [[autoimmune hepatitis]], [[primary biliary cirrhosis]] without [[granulomas]], [[drug-induced liver disease|drug reaction]] | |||
| Stains = [[Shikata stain]] +ve (not sensitive) | |||
| IHC = hepatitis B +ve | |||
| EM = | |||
| Molecular = HBV DNA present (serum) | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Staging = | |||
| Site = [[liver]] - see ''[[medical liver disease]]'' | |||
| Assdx = [[cirrhosis]], [[hepatocellular carcinoma]], [[polyarteritis nodosa]] (PAN), [[membranoproliferative glomerulonephritis]], [[membranous nephropathy]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common - especially in Asia | |||
| Bloodwork = HBs Ag, HBs Ab, HBe Ag, HBe Ab - see ''[[Medical_liver_disease#Hepatitis_B]]'' | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = other hepatitides - viral and non-viral | |||
| Tx = prevention through vaccination, medical treatments (pegylated interferon and nucleoside analogues) | |||
}} | |||
'''Hepatitis B''' is a relatively common [[medical liver disease]] caused by the ''hepatitis B virus''. | '''Hepatitis B''' is a relatively common [[medical liver disease]] caused by the ''hepatitis B virus''. | ||
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*May lead to [[hepatocellular carcinoma]] without [[cirrhosis]]. | *May lead to [[hepatocellular carcinoma]] without [[cirrhosis]]. | ||
*High prevalence. | *High prevalence. | ||
*Diagnosis is by serology. | *Diagnosis is by serology - details of serologic testing are in the ''[[Medical_liver_disease#Hepatitis_B|medical liver disease article]]''. | ||
*A vaccination is available and done routinely in a many jurisdictions.<ref>{{Cite journal | last1 = Leuridan | first1 = E. | last2 = Van Damme | first2 = P. | title = Hepatitis B and the need for a booster dose. | journal = Clin Infect Dis | volume = 53 | issue = 1 | pages = 68-75 | month = Jul | year = 2011 | doi = 10.1093/cid/cir270 | PMID = 21653306 }}</ref> | *A vaccination is available and done routinely in a many jurisdictions.<ref name=pmid21653306>{{Cite journal | last1 = Leuridan | first1 = E. | last2 = Van Damme | first2 = P. | title = Hepatitis B and the need for a booster dose. | journal = Clin Infect Dis | volume = 53 | issue = 1 | pages = 68-75 | month = Jul | year = 2011 | doi = 10.1093/cid/cir270 | PMID = 21653306 }}</ref> | ||
*Medical treatments available for chronic infection - pegylated interferon and nucleoside analogue therapies.<ref>{{Cite journal | last1 = Su | first1 = TH. | last2 = Kao | first2 = JH. | title = Unmet Needs in Clinical and Basic Hepatitis B Virus Research. | journal = J Infect Dis | volume = 216 | issue = suppl_8 | pages = S750-S756 | month = Nov | year = 2017 | doi = 10.1093/infdis/jix382 | PMID = 29156048 }}</ref><ref name=pmid28052634>{{Cite journal | last1 = Chen | first1 = GF. | last2 = Wang | first2 = C. | last3 = Lau | first3 = G. | title = Treatment of chronic hepatitis B infection-2017. | journal = Liver Int | volume = 37 Suppl 1 | issue = | pages = 59-66 | month = Jan | year = 2017 | doi = 10.1111/liv.13309 | PMID = 28052634 }}</ref> | |||
Associated pathology | ===Associated pathology=== | ||
*[[Polyarteritis nodosa]] (PAN). | *[[Polyarteritis nodosa]] (PAN). | ||
*[[Membranoproliferative glomerulonephritis]]. | *[[Membranoproliferative glomerulonephritis]]. | ||
*[[Membranous nephropathy]]. | *[[Membranous nephropathy]]. | ||
*[[Cirrhosis]]. | |||
*[[Hepatocellular carcinoma]]. | |||
==Microscopic== | ==Microscopic== | ||
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*[[Primary biliary cirrhosis]] without [[granulomas]]. | *[[Primary biliary cirrhosis]] without [[granulomas]]. | ||
*[[Drug-induced liver disease|Drug reaction]]. | *[[Drug-induced liver disease|Drug reaction]]. | ||
**Pseudo-Lafora bodies in patients on disulfiram (anatabuse) can result in [[ground glass hepatocytes]]. | |||
===Image=== | ===Image=== | ||
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Image:Ground_glass_hepatocytes_high_mag_cropped_2.jpg | GGH - high mag. (WC) | Image:Ground_glass_hepatocytes_high_mag_cropped_2.jpg | GGH - high mag. (WC) | ||
</gallery> | </gallery> | ||
[[File:5 07686954470825 sl 1.png| HBV Modified HAI necroinflammatory score 5, Modified HAI fibrosis stage 2]] | |||
[[File:5 07686954470825 sl 2.png| HBV Modified HAI necroinflammatory score 5, Modified HAI fibrosis stage 2]] | |||
[[File:5 07686954470825 sl 3.png| HBV Modified HAI necroinflammatory score 5, Modified HAI fibrosis stage 2]] | |||
[[File:5 07686954470825 sl 4.png| HBV Modified HAI necroinflammatory score 5, Modified HAI fibrosis stage 2]] | |||
[[File:5 07686954470825 sl 5.png| HBV Modified HAI necroinflammatory score 5, Modified HAI fibrosis stage 2]] | |||
42 yo woman with bepatitis B virus, modified HAI necroinflammatory grade 5, modified HAI fibrosis stage 1. (would be Metavir activity index 1, fibrosis stage 1). A Triads (red arrows) are slightly cellular, without much interface inflammation, with occasional spots suggestive of spotty necrosis (black arrows). B. Triads, this one being the most expanded, show a mild infiltrate (HAI score 1) of lymphocytes and macrophages, with only a small amount present at the interface between triad and lobule. C. A maximum of two foci of spotty necrosis (arrows) were seen in a 10X field (HAI score 2). D. Occasional foci of zone 3 collapse (thick black lines, green arrows), HAI score 1, and piecemeal necrosis (blue arrows) HAI score 1, were seen. E. Trichrome shows portal fibrosis of most triads, but no bridges, or nodules (HAI stage 2). | |||
A. [[File:1 HBV 680x512px.tif|Portal triads, expanded, inflamed and without sharp edges. Inflammation amid hepatocytes. (40X).]] | |||
B. [[File:2 HBV 680x512px.tif|Reticulin with bridging necrosis (100X).]] | |||
<br> | |||
C. [[File:3 HBV 680x512px.tif|Reticulin with extensive piecemeal necrosis (100X).]] | |||
D. [[File:4 HBV 680x512px.tif|PAS without diastase with extensive piecemeal necrosis (100X).]] | |||
<br> | |||
E. [[File:5 HBV 680x512px.tif|Trichrome with bridging, no nodules or extensive bridging on slides as a whole (100X).]] | |||
F. [[File:6HBV 680x512px.tif|Ground glass hepatocytes (400X).]] | |||
Hepatitis B. Metavir activity index 3. Piecemeal necrosis 2. Lobular necrosis 2. Fibrosis stage 3. A. Portal triads, expanded, inflamed and without sharp edges. Inflammation amid hepatocytes. B. Reticulin with bridging necrosis. C. Reticulin with extensive piecemeal necrosis. D. PAS without diastase with extensive piecemeal necrosis. E. Trichrome with bridging, no nodules or extensive bridging on slides as a whole. F. Ground glass hepatocytes. | |||
A. [[File:1 HBV 2 680x512px.tif| Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis).]] | |||
B. [[File:2 HBV 2 680x512px.tif| Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis).]] | |||
<br> | |||
C. [[File:3 HBV 2 680x512px.tif| Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis).]] | |||
D. [[File:4 HBV 2 680x512px.tif| Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis).]] | |||
<br> | |||
E. [[File:5 HBV 2 680x512px.tif| Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis).]] | |||
F. [[File:6 HBV 2 680x512px.tif| Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis).]] | |||
Hepatitis B virus. Metavir activity index 3 {PMN 2 LN 2]. Metavir fibrosis stage 4 (advanced fibrosis/cirrhosis). A. A fragmented specimen shows apparent nodules [black arrows]. B. Inflammatory cells extending from band suggest piecemeal necrosis [green arrows]; inflammatory foci apart from band denote spotty necrosis [blue arrows]. C. 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]. D. On PAS without diastase, piecemeal necrosis can be seen as pink hepatocyte cytoplasmic fragments amid inflammatory cells [arrows]. E. The nodules seen at low power are confirmed to be collagen bounded, but the appreciation can be made frustrated by intense inflammation. F. 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. | |||
==Stains== | |||
*[[Shikata stain]] - hepatitis B surface antigen. | |||
**[[Sensitivity]] modest ~20% of serum positive stain positive.<ref name=pmid7822848>{{Cite journal | last1 = Ghosh | first1 = AK. | last2 = Dasgupta | first2 = A. | last3 = Raha | first3 = K. | last4 = Jana | first4 = A. | last5 = Majumdar | first5 = DN. | title = Hepatic histology in chronic liver disease in hepatitis B surface antigen positive cases. | journal = J Indian Med Assoc | volume = 92 | issue = 10 | pages = 333-5 | month = Oct | year = 1994 | doi = | PMID = 7822848 }}</ref> | |||
==IHC== | ==IHC== | ||
* | *Hepatitis B +ve. | ||
==See also== | ==See also== | ||