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Morphologic features of extrahepatic manifestations of hepatitis C virus infection.

Ko HM, Hernandez-Prera JC, Zhu H, Dikman SH, Sidhu HK, Ward SC, Thung SN - Clin. Dev. Immunol. (2012)

Bottom Line: The most documented of these entities is mixed cryoglobulinemia.Other HCV-associated entities include porphyria cutanea tarda, lichen planus, necrolytic acral erythema, membranous glomerulonephritis, diabetic nephropathy, B-cell non-Hodgkin lymphomas, insulin resistance, sialadenitis, sicca syndrome, and autoimmune thyroiditis.This paper highlights the histomorphologic features of these processes, which are typically characterized by chronic inflammation, immune complex deposition, and immunoproliferative disease in the affected organ.

View Article: PubMed Central - PubMed

Affiliation: The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA. mabel.ko@mssm.edu

ABSTRACT
Cirrhosis and hepatocellular carcinoma are the prototypic complications of chronic hepatitis C virus infection in the liver. However, hepatitis C virus also affects a variety of other organs that may lead to significant morbidity and mortality. Extrahepatic manifestations of hepatitis C infection include a multitude of disease processes affecting the small vessels, skin, kidneys, salivary gland, eyes, thyroid, and immunologic system. The majority of these conditions are thought to be immune mediated. The most documented of these entities is mixed cryoglobulinemia. Morphologically, immune complex depositions can be identified in small vessels and glomerular capillary walls, leading to leukoclastic vasculitis in the skin and membranoproliferative glomerulonephritis in the kidney. Other HCV-associated entities include porphyria cutanea tarda, lichen planus, necrolytic acral erythema, membranous glomerulonephritis, diabetic nephropathy, B-cell non-Hodgkin lymphomas, insulin resistance, sialadenitis, sicca syndrome, and autoimmune thyroiditis. This paper highlights the histomorphologic features of these processes, which are typically characterized by chronic inflammation, immune complex deposition, and immunoproliferative disease in the affected organ.

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Porphyria cutanea tarda: subepidermal bulla and festooning of the dermal papilla are prominent. There is no significant inflammatory infiltrate (hematoxylin-eosin, original magnification ×100).
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fig6: Porphyria cutanea tarda: subepidermal bulla and festooning of the dermal papilla are prominent. There is no significant inflammatory infiltrate (hematoxylin-eosin, original magnification ×100).

Mentions: The prevalence of HCV infection in patients with porphyria cutanea tarda (PCT) varies according to region [9, 27]. The prevalence is higher in southern Europe (65%–91%) compared to northern Europe (8–17%). In Australia and New Zealand, the prevalence is about 20%; while, in the United States, the prevalence is reported to be 50–75% [27]. PCT results from decreased activity of the uroporphyrinogen decarboxylase enzyme; however, the mechanism that links this phenomena to chronic HCV infection is unknown. In most cases, HCV exposure and liver dysfunction precede the onset of PCT, suggesting that the HCV infection may uncover an existing porphyrin metabolism defect in susceptible patients. Histologically, PCT is characterized by cell poor subepidermal bulla with increased hyaline material in the vessel walls and basement membrane. The hyaline material is reactive in PAS-diastase-resistant staining [9]. The dermal papillae are rigid with festooning (Figure 6).


Morphologic features of extrahepatic manifestations of hepatitis C virus infection.

Ko HM, Hernandez-Prera JC, Zhu H, Dikman SH, Sidhu HK, Ward SC, Thung SN - Clin. Dev. Immunol. (2012)

Porphyria cutanea tarda: subepidermal bulla and festooning of the dermal papilla are prominent. There is no significant inflammatory infiltrate (hematoxylin-eosin, original magnification ×100).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3420144&req=5

fig6: Porphyria cutanea tarda: subepidermal bulla and festooning of the dermal papilla are prominent. There is no significant inflammatory infiltrate (hematoxylin-eosin, original magnification ×100).
Mentions: The prevalence of HCV infection in patients with porphyria cutanea tarda (PCT) varies according to region [9, 27]. The prevalence is higher in southern Europe (65%–91%) compared to northern Europe (8–17%). In Australia and New Zealand, the prevalence is about 20%; while, in the United States, the prevalence is reported to be 50–75% [27]. PCT results from decreased activity of the uroporphyrinogen decarboxylase enzyme; however, the mechanism that links this phenomena to chronic HCV infection is unknown. In most cases, HCV exposure and liver dysfunction precede the onset of PCT, suggesting that the HCV infection may uncover an existing porphyrin metabolism defect in susceptible patients. Histologically, PCT is characterized by cell poor subepidermal bulla with increased hyaline material in the vessel walls and basement membrane. The hyaline material is reactive in PAS-diastase-resistant staining [9]. The dermal papillae are rigid with festooning (Figure 6).

Bottom Line: The most documented of these entities is mixed cryoglobulinemia.Other HCV-associated entities include porphyria cutanea tarda, lichen planus, necrolytic acral erythema, membranous glomerulonephritis, diabetic nephropathy, B-cell non-Hodgkin lymphomas, insulin resistance, sialadenitis, sicca syndrome, and autoimmune thyroiditis.This paper highlights the histomorphologic features of these processes, which are typically characterized by chronic inflammation, immune complex deposition, and immunoproliferative disease in the affected organ.

View Article: PubMed Central - PubMed

Affiliation: The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA. mabel.ko@mssm.edu

ABSTRACT
Cirrhosis and hepatocellular carcinoma are the prototypic complications of chronic hepatitis C virus infection in the liver. However, hepatitis C virus also affects a variety of other organs that may lead to significant morbidity and mortality. Extrahepatic manifestations of hepatitis C infection include a multitude of disease processes affecting the small vessels, skin, kidneys, salivary gland, eyes, thyroid, and immunologic system. The majority of these conditions are thought to be immune mediated. The most documented of these entities is mixed cryoglobulinemia. Morphologically, immune complex depositions can be identified in small vessels and glomerular capillary walls, leading to leukoclastic vasculitis in the skin and membranoproliferative glomerulonephritis in the kidney. Other HCV-associated entities include porphyria cutanea tarda, lichen planus, necrolytic acral erythema, membranous glomerulonephritis, diabetic nephropathy, B-cell non-Hodgkin lymphomas, insulin resistance, sialadenitis, sicca syndrome, and autoimmune thyroiditis. This paper highlights the histomorphologic features of these processes, which are typically characterized by chronic inflammation, immune complex deposition, and immunoproliferative disease in the affected organ.

Show MeSH
Related in: MedlinePlus