A 32-year-old man comes to the clinic due to several months of fatigue and weight loss. The patient has no significant medical history. He drinks 1 or 2 alcoholic beverages daily and has used intravenous recreational drugs in the past. He is sexually active with his girlfriend. The patient has a maternal aunt with hypothyroidism, but his family history is otherwise unremarkable. Temperature is 36.7 C (98 F), blood pressure is 110/70 mm Hg, pulse is 65/min, and respirations are 18/min. Physical examination is normal. A liver biopsy is obtained, and light microscopy reveals large hepatocytes filled with finely granular, homogeneous, pale pink cytoplasm. Which of the following is the most likely diagnosis?

Question

A 32-year-old man comes to the clinic due to several months of fatigue and weight loss.  The patient has no significant medical history.  He drinks 1 or 2 alcoholic beverages daily and has used intravenous recreational drugs in the past.  He is sexually active with his girlfriend.  The patient has a maternal aunt with hypothyroidism, but his family history is otherwise unremarkable.  Temperature is 36.7 C (98 F), blood pressure is 110/70 mm Hg, pulse is 65/min, and respirations are 18/min.  Physical examination is normal.  A liver biopsy is obtained, and light microscopy reveals large hepatocytes filled with finely granular, homogeneous, pale pink cytoplasm.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Hepatitis B infection, one of the most common causes of hepatic injury in the United States, is frequently transmitted sexually or via percutaneous inoculation (eg, intravenous drug use). A distinct histopathologic manifestation of chronic infection is the accumulation of hepatitis B surface antigen within infected hepatocytes. This results in the appearance of a finely granular, homogeneous, pale eosinophilic cytoplasm (ground-glass hepatocytes). Other nonspecific morphologic changes include hepatocyte necrosis, apoptosis, steatosis, and mononuclear portal inflammation (lymphocytes, macrophages). Acidophil (Councilman) bodies, deeply eosinophilic globules that represent shrunken apoptotic hepatocytes, can be seen in a variety of liver diseases. (Choices A and E) Hepatic steatosis is characterized by the accumulation of large and small vesicles of fat within hepatocytes. It can be due to significant alcohol ingestion (>15 drinks/week for men, >10 drinks/week for women) or obesity (nonalcoholic steatohepatitis). Mallory bodies may be seen in alcohol-induced steatohepatitis; they are characterized by clumped, amorphous, eosinophilic intracytoplasmic inclusions made up of tangled intermediate filaments. (Choice B) Hemochromatosis is characterized by the deposition of iron in the liver, which appears as yellow-brown hemosiderin granules in the cytoplasm. Cirrhosis and portal hypertension can result if the condition is left untreated. (Choice D) A liver infected with hepatitis C virus commonly has lymphoid aggregates within the portal tracts and focal areas of macrovesicular steatosis; however, ground-glass hepatocytes are more specific for hepatitis B infection. Educational objective: Hepatitis B infection causes the hepatocellular cytoplasm to fill with hepatitis B surface antigen. These inclusions are highly specific for hepatitis B infection and have a finely granular, pale eosinophilic, ground-glass appearance. __________ References: Liver biopsy findings in chronic hepatitis B. (http://www.ncbi.nlm.nih.gov/pubmed/19399798)

A 32-Year-Old Man Comes to the Clinic Due to Several