The liver biopsy in acute hepatitis due to hepatitis B virus is likely to show all of the following, except -
High-Yield Explanation
Ground glass hepatocytes are large hepatocytes containing surface antigen. Their cytoplasm is ground glass in appearance
These cells are seen in chronic hepatitis (not acute hepatitis)
Ground glass hepatocytes can be identified histochemically with orcein or aldehyde fuchsin stain.
Pathological features of acute viral hepatitis
1. Panlobular infiltration of mononuclear cells
This mononuclear infiltration primarily consists of → Lymphocytes, Plasma cells, Eosinophils Inflammatory infiltrate may spill over into the adjacent parenchyma to cause necrosis of periportal hepatocytes → interface hepatitis, can occur in both acute and chronic hepatitis.
2. Hepatic cell damage - It consists of
(a) Hepatic cell necrosis - The necrosis is usually focal or interzonal. Sometimes severe necrosis such as bridging or subacute hepatic necrosis occurs.
(b) Ballooning of cells - Damaged cells show diffuse swelling known as ballooning degeneration.
(c) Acidophilic degeneration of hepatocytes - In this single necrotic liver cell has coagulated pink cytoplasm and it shows pyknosis or karyolysis. These are called councilman bodies.
(d) Cell dropout
3. Hyperplasia of kupffer cells
4. Variable degree of cholestasis with brown pigmentation of hepatocytes.
5. Hepatic cell regeneration - It is indicated by increased mitotic figures, rosette or pseudoacinar formation and multi nucleated cells.
6. Lobular disarray → Loss of normal lobular architecture.
Note that these morphological lesions are similar in all types of viral hepatitis.
A few histological changes may be indicative of a particular type of virus.
1. In hepatitis C the histological lesion is characterized by -
The relative paucity of inflammation
A marked increase in activation of sinusoidal lining cells.
Presence of lymphoid aggregates
Presence of fat → Macrovesicular steatosis
Bile duct lesions.
2. In Hepatitis D → Macrovesicular steatosis occurs.
3. In Hepatitis E → Marked cholestasis occurs.