EBV hepatitis
Epstein-Barr virus (EBV) hepatitis is an uncommon, almost always self-limited disease in immunocompetent patients. Accurate diagnosis is imperative for appropriate clinical management.
Synopsis
dense portal mononuclear infiltrate
- mature lymphocytes, large atypical lymphocytes, plasmocytes, plasmacytoid lymphocytes, histiocytes
lobular perisinusoidal mononuclear infiltrate (single-file array)
numerous and enlarged Kupffer cells (sometimes forming small granulomatoid clusters)
uncommon epithelioid granulomas
uncommon fibrin ring lipogranulomas
hepatocytic lesions
- mild hepatocytic swelling
- focal hepatocytic necrosis
- numerous hepatocytic mitosis
- exceptional diffuse hepatocytic injury
- exceptional massive hepatic necrosis
uncommon canalicular cholestasis
uncommon hepatocytic steatosis
Variants
severe EBV hepatitis in immunocompromised
- numerous immunoblasts, plasmacytoid lymphocytes and plasmocytes
- mild bile duct damage
- periportal confluent necrosis
Diagnosis
EBV detected by polymerase chain reaction (PCR) for EBV DNA
in situ hybridization (ISH) for EBV early RNA (EBER)
NB: Immunohistochemistry for EBV latent membrane proteins (LMPs) apparently has no utility in the diagnosis of EBV hepatitis.
Differential diagnosis
hepatic lymphomas
hepatic leukemias
extramedullary hematopoiesis
References
Suh N, Liapis H, Misdraji J, Brunt EM, Wang HL. Epstein-Barr virus hepatitis: diagnostic value of in situ hybridization, polymerase chain reaction, and immunohistochemistry on liver biopsy from immunocompetent patients. Am J Surg Pathol. 2007 Sep;31(9):1403-9. PMID: #17721196#