Histology and virus expression in the liver: A prognostic puzzle in chronic hepatitis B |
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Authors: | Massimo Rugge Maria Guido Flavia Bortolotti Mauro Cassaro Paolo Cadrobbi Franco Noventa Giuseppe Realdi |
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Affiliation: | (1) Istituto di Anatomia Patologica Cattedra di Istochimica Patologica, Universita degli Studi di Padova, Via A. Gabelli 61, I-35121 Padua, Italy;(2) Istituto di Medicina Clinica. Cattedra di Patologia Medica, Universita degli Studi di Padova, Padua, Italy;(3) Divisione di Malattie Infettive Ospedale Civile di Padova, Padua, Italy;(4) Istituto di Clinica Medica Universita degli Studi di Sassari, Sassari, Italy |
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Abstract: | Summary Forty chronic untreated paediatric carriers of hepatitis B virus (HBV) infection, with no other causes of liver disease, were biopsied on presentation, when the disease was in the active viral replication phase. After a period ranging from 1 to 13 years, all patients underwent a control biopsy. At the time of the last biopsy, 31 of the patients were anti-HBe positive, whereas 9 persisted in the active replication phase. In this latter phase, necrotic and inflammatory lesions and the presence of nuclear HBcAg were found significantly more frequently than when replication had terminated. The necrotic and inflammatory lesions detected in the first biopsy of patients who subsequently underwent antiHBe seroconversion were significantly more severe than in patients failing to reach seroconversion. All patients who maintained viral replication showed generalized nuclear reactivity for HBcAg on presentation; such reactivity was also found in 16 of 31 (52%) patients who reached anti-HBeAg seroconversion. All these cases had piecemeal necrosis (PMN) in the biopsy. PMN may therefore be considered as a positive prognostic factor in that it identifies those patients who may seroconvert with significant remission of liver disease |
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Keywords: | Chronic hepatitis B virus Piecemeal necrosis Immunohistochemistry Liver |
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