Feingewebliche Befunde an der Leber klinisch gesunder Australia-Antigen-(HB-Ag-)Tr�ger

Detection of HBsAg containing cells in liver biopsies by different stains and classification of positively reacting ground-glass hepatocytes

The diagnostic significance of orcein, aldehydthionine, and chromotrope anilinblue stains for the demonstration of HBsAg containing hepatocytes was investigated in 602 unselected liver biopsies. Five types of specifically stained ground-glass hepatocytes (GGH) were distinguished: Type I showed a positive staining reaction of the cytoplasmic periphery (marginal GGH), type II a diffuse staining of the total cytoplasm (diffuse GGH). Type III contained round or oval globular positive cytoplasmic masses (globular GGH). Type IV showed only very small round, drop-like or sickle-shaped positive structures (spotty GGH). The GGH with fatty changes were designated as type V. In all carriers and patients with minimal hepatitis GGH, mostly type I and II, appeared in extensive clusters within the lobules. In chronic persistent hepatitis, there were moderately numerous, partly grouped, partly disseminated ground-glass hepatocytes of type II and III. In chronic active hepatitis there were only a few GGH of type IV. In acute viral hepatitis, there were no typical GGH, however, positively stained phagocytes were seen. The intracellular antigen localization and the intralobular distribution of GGH are considered to be the result of an immune reaction. Single so-called 'metabolic' GGH sometimes showed similar pictures. However, they could usually be distinguished from virus containing GGH because of their granular cytoplasmic structure and a lower staining intensity in the applied stains. Among the three stains the orcein stain yielded the best results. In some cases with HBsAg-positive chronic active hepatitis virus infection could not be proved by means of staining.

[The characterization of clinically healthy hepatitis-b-surface-antigen (HBsAg)-carriers. Clinical, biochemical, histiological and immunological investigations in 129 case of a prospective study (author's transl)]

129 blood donors found to be HBsAg-positive on routine testing were studied for evidence of hepatic disease. Twelve had already lost the antigen from the serum when histologically examined. None of these has had clinical or histological evidence of inflammatory liver disease. Two of the 129 patients showed mild icteric hepatitis, cleared the antigen during the follow up and became anti-HBs positive. The remaining 115 patients who appeared clinically healthy and who had no history of previous icteric liver disease remained HBsAg positive during a mean follow up period of 17.3 +/- 3.0 months. Forty patients from these had a normal liver histology and 37 mild to distinct steatosis but no signs of inflammatory liver disease. 11 patients a mild nonspecific mesenchymal activity but no focal necrosis, 16 patients had mild infiltration in portal tracts and a few necrotic parenchymal cells with mesenchymal reaction, 6 patients had chronic persistent hepatitis, 4 chronic aggressive hepatitis, and 1 definite posthepatic cirrhosis.

Demonstration of hepatitis B surface antigen by orcein staining in paraffin sections of cirrhotic liver

Blood and liver from 44 and 30 patients, died in cirrhosis and other diseases, respectively were tested for the presence of HBSAg. Blood samples obtained at autopsy and in seven cirrhosis cases also before death were tested for HBSAg by counter-electrophoresis. Detection of HBSAg in hepatocytes was carried out in paraffin sections by the modified orcein staining technique of Shikata et al. Ten of 14 HBSAg seropositive and 2 of 30 HBSAg seronegative cirrhotic patients had orcein positive hepatocytes, which were not found in any liver specimen from the 30 non-cirrhotic seronegative patients. The orcein positive substance localized in the cytoplasm of hepatocytes, less often it was also seen in a few Kupffer cells. The hepatocellular carcinoma cells present in part of the livers studied did not contain any orcein positive substance. Histological changes in the cirrhotic livers showed morphological indication of the presence of HBSAg, except on staining with orcein. The modified orcein staining technique is a simple, handy procedure for use in any routine pathological laboratory and has the additional advantage of detecting HBSAg also in stored paraffin blocks.

Chronic carriers of hepatitis B antigen (HBsAg). Histological, biochemical, and immunological findings in 31 voluntary blood donors

Among 289 HBsAg carriers detected by the Montreal Red Cross Blood Transfusion Service and seen by our group, 31 submitted voluntarily to liver biopsy. These 31 carriers have now been followed for 10-33 months (mean: 23) and all remained positive for HBsAg. 15 of these 31 subjects had lived in institutions during infancy or childhood and none were drug users. Histological examinations revealed 24 cases of chronic persistent hepatitis (CPH), 2 cases of chronic aggressive hepatitis, 2 with steatosis, and 3 with normal liver. On repeated determination, 16 of the 31 subjects had at least one elevated transaminase level. Transaminases levels could not be correlated with the histological diagnosis. 4 cases had positive antinuclear antibodies, all in the CPH group, a finding that could not be correlated with any clinical, biological, or histological findings. The search for other autoantibodies and the immunoglobulin determinations were totally unrewarding. Thus, it appears that chronic HBsAg carriers in Montreal voluntary blood donors often have chronic hepatitis, usually persistent, occasionally aggressive; liver biopsy still remains the most useful approach in the evaluation of these HBsAg carriers. The HBsAg-carrier state seems to be well tolerated, but further long-term studies are needed to understand the natural history of this condition.

The ground glass hepatocyte as a diagnostic hint

One hundred seven women 18–65 years old were studied who were referred for suspected central nervous system disease not related to the pituitary gland or hypothalamus. High-resolution, direct, coronal, contrast-enhanced computed tomography (CT) was used to examine the size, shape, and density of the normal pituitary gland. There were three major conclusions: (1) the height of the normal gland can be as much as 9 mm; (2) the superior margin of the gland may bulge in normal patients; and (3) both large size and convex contour appear to be associated with younger age. It was also found that serum prolactin levels do not appear to correlate with the CT appearances. Both low- and high-density areas were seen within the gland, and may be due to either tumors, cysts, infarcts, or metastases. Noise artifacts inherent in high-detail, thin-section, soft-tissue scanning may be a limiting factor in defining reproducible patterns in different parts of the normal pituitary gland.