[Histological changes of hepatocytes as a possible sign for carrier state of HB-antigen (author's transl)]

Immunohistochemical patterns of hepatitis B surface antigen (HBsAg) in patients with hepatitis, renal homografts recipients and normal carriers

A series of 180, Bouin-fixed and paraffin embedded liver biopsies obtained from 147 patients was investigated for the presence of hepatitis B surface antigen (HBs) by histochemical and indirect immunofluorescence techniques. A comparison between orcein staining and Masson's trichrome preparations for ground glass hepatocytes, showed that immunofluorescence was both the more reliable and the more specific method for detection of HBsAg in liver tissue. The ability to perform this technique on paraffin sections facilitates systematic studies and allows retrospective work-up. IF-HBs positive hepatocytes were found in approximately two thirds of all HBs-positive patients in their serum, but never seen in HBs-negative patients. HBs-positive cells were observed in healthy chronic carriers and in all forms of chronic hepatitis, but never in acute HBs-positive hepatitis. In patients treated with chronic hemodialysis and in renal homograft recipients, the incidence of positive cells was higher than in the chronic hepatitis groups; this could be correlated with the duration of antigenemia at the time of biopsy.

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.

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.