Abstract
Liver biopsies undertaken for the grading and staging of chronic viral hepatitis were formerly a significant staple in the pathologist’s workload, chiefly due to the prevalence of chronic hepatitis C. Since the advent of direct-acting antiviral agents and sustained viral responses with cure of hepatitis C viral infections, this component of the daily sign-out has greatly diminished. Nonetheless, the known aetiologic factors in chronic hepatitis, including hepatitis B virus (HBV), drugs (minocycline and nitrofurantoin, two common agents responsible for chronic drug-induced hepatitis), autoimmune hepatitis (AIH) and two metabolic disorders (alpha-1-antitrypsin deficiency and Wilson’s disease), are part of the competencies in histologic scoring for which pathologists are responsible. The success of worldwide HBV vaccination programmes has significantly diminished the prevalence of hepatitis D virus (delta virus), to approximately 8% (seen predominantly in intravenous drug abuser populations). Hepatitis E virus (HEV) infection due to genotype 3 is now a serious diagnostic concern in organ transplant recipients who may incur chronic HEV infection through acquisition of infected donor organs. HEV genotype 3 is a zoonotic agent in swine, bovine, camelid and avian species and can, via poorly or uncooked foods derived from these, be transmitted to humans. A recently ‘rediscovered’ histologic feature, the ‘hyaline droplet’ (a small, rounded eosinophilic droplet within sinusoidal Kupffer cells, which also stains positively with diastase-PAS (DPAS) stain), is an additional helpful diagnostic marker of AIH because it represents macrophage-ingested immunoglobulin. Seen in the context of portal/periportal lymphoplasmacytic interface hepatitis and/or the variant centrilobular form of AIH, pathologists should be aware of this lesion and give special attention to the DPAS stain in such cases. Multinucleated giant hepatocytes in adults are another histologic lesion in AIH.
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