By Eugene C Toy
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Additional resources for Case files. / Pathology
If anti-hepatitis C antibody is present, acute hepatitis C is diagnosed, but the test may be negative for several months. The hepatitis C polymerase chain reaction (PCR) assay, which becomes positive earlier in the disease course, often aids in the diagnosis. Acute hepatitis B infection is diagnosed by the presence of hepatitis B surface antigen (HBsAg) in the clinical context of elevated serum transaminase levels and jaundice. HBsAg later disappears when the antibody (anti-HBs) is produced (see Figure 3-2).
Councilman bodies are intensely eosinophilic bodies that may be seen in liver biopsy specimens from individuals with viral hepatitis. These Councilman bodies are in fact necrotic hepatocytes that have undergone T-cell induced apoptosis. These apoptotic cells are cleared rapidly, and there may not be as many present in a liver biopsy specimen as were originally present. PATHOLOGY PEARLS ❖ ❖ ❖ ❖ ❖ ❖ Most hepatitis viruses are RNA in etiology; hepatitis B is the only DNA hepatitis virus. Patients infected with hepatitis B rarely develop chronic hepatitis (only 5 to 10 percent of the time).
Possible complications: Hepatic failure, gastrointestinal bleeding, hepatocellular carcinoma. CLINICAL CORRELATION This patient had a blood transfusion in the early 1980s, before the discovery of and the institution of screening for hepatitis C virus. He had a long asymptomatic period and now has signs of advanced liver disease. His firm nodular liver probably represents cirrhosis, with scarring of the liver parenchyma along with regenerative nodules. His transaminases (ALT and AST) are only mildly elevated but these tests may be within normal limits, particularly early in the course of disease.
Case files. / Pathology by Eugene C Toy