Tuesday, May 17, 2016

Viral hepatitis - A histologic clue to the causative virus

Viral hepatitis is predominantly caused by hepatotropic viruses, although others like EBV, CMV are also implicated in the causation. Though serological markers serve as a gold standard for diagnosis, the following histologic clues help a pathologist to suspect the causative virus.

HAV - The portal tracts show a large amount of plasma cell infiltrates.

HBV - Presence of Ground Glass cytoplasm

HCV- Lymphoid aggregates in the portal tracts with macrovesicular steatosis of hepatocytes (most marked with Type 3)
Steatosis in zone 1 is mainly due to HCV while steatosis in zone 3 is mainly due to metabolic causes or alcohol.
EBV - Beads on a string pattern of sinusoidal infiltrates of Atypical lymphocytes.

CMV- Formation of microabscesses with intracytoplasmic and intranuclear inclusions.

Herpes virus- Nonzonal punched out necrosis with nuclear ground glass (Cowdry A) inclusions.

Thus, a good pathological suspicion would add to the confirmatory serological reports.

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