The pathology of hepatitis A in man

Abstract

ABSTRACT— Liver biopsies from 17 patients with serologically established hepatitis A were examined by light microscopy. Biopsies were taken from 2 to 27 weeks after onset of symptoms. All showed acute hepatitis, usually with centrilobular lesions but also commonly with a striking portal and periportal inflammatory reaction, resembling that seen in chronic active hepatitis. The infiltrate was rich in plasma cells. Centrilobular cholestasis was common and occasionally severe. Neither cholestasis nor the periportal lesion appeared to be related to patient age or to the timing of liver biopsy. All patients made a full recovery and none developed chronic liver disease. The histological changes differed from those reported in children and in chimpanzees in the presence of centrilobular lesions, but resembled them in that the latter two groups also had periportal lesions. These lesions may lead to a false impression of impending chronicity if the aetiology of the hepatitis is not known at the time of liver biopsy.

Changing Concepts of the Evolution of Chronic Hepatitis and the Role of Piecemeal Necrosis

“…Nevertheless, at present most pathologists agree that periportal piecemeal necrosis suggests eventual transition to chronic hepatitis (21). An exception is hepatitis A in which severe periportal necrosis is common but is never followed by chronic hepatitis (22). There is considerable argument whether necrosis bridging central and portal canals has prognostic significance.…”

Clinicopathologic Analysis of the Liver Explant with Severe Hepatitis A Virus Infection

“…Furthermore, previous studies have primarily focused on the pathology of HAV hepatitis in liver biopsy specimens before progression to liver failure. 3,5,6,8 The most consistently observed features in explanted livers were minimal to severe hepatocyte necrosis with predominant distribution in zone 1 and 2, and unremarkable portal inflammation. The previous studies of liver biopsies reported less conspicuous parenchymal changes, prominent portal inflammation with predominantly plasma cell infiltration, moderate to severe cholestasis and periportal hepatocyte necrosis.…”

“…The previous studies of liver biopsies reported less conspicuous parenchymal changes, prominent portal inflammation with predominantly plasma cell infiltration, moderate to severe cholestasis and periportal hepatocyte necrosis. 3,5,9 The histopathologic differences might be attributable to multiple factors leading to diverse clinical severity.…”

“…1 Young children may carry antibodies to HAV without overt clinical features, while the possibility of developing symptomatic hepatitis is greater in adults than children, and the rates of hospitalization and complications appear to be higher in adults. 2,3 HAV hepatitis is usually a self-limiting disease, but rarely results in a serious condition, fulminant hepatic failure (FHF) that may be followed by death. 1 Although FHF develops in less than 1% of cases with HAV infection, 4 it carries a mortality of 30%, in contrast to the fatality rate of 0.01-0.03% in previously reported HAV infection cases.…”

Acute and chronic viral hepatitis

“…polymerase) protein. 188,189 In the rare fulminant form of hepatitis A, the histological features are those of panlobular necrosis, with microvesicular fatty change in surviving hepatocytes noted in some cases (Fig. X antigen may be found in tumour cells in the absence of other viral proteins.…”