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EBV hepatitis

Tuesday 6 April 2004

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