Laparoscopical and histological abnormalities of the liver in chronic HBs ag (hepatitis B surface antigen) carriers.

Previously, I have reported the laparoscopical and histological findings of 16 chronic HBs Ag carriers in whom the time of HBV infection could be assumed, HBs Ag in the sera persisted for at least 6 months, and laparoscopy with liver biopsy was performed. In these carriers, no abnormal results of liver function tests were found and early history of hepatitis was unknown. Besides these 16 HBs Ag carriers, I have encountered 15 chronic HBs Ag carriers in whom the time of HBV infection could be assumed, HBs Ag in the sera persisted for at least six months, and laparoscopy with liver biopsy was performed. In these carriers, no early history of hepatitis could be found and normal results of liver function tests were observed at least at the time of the first laparoscopy with liver biopsy, but blood chemical analyses resulted in slightly abnormal values at rare intervals during the clinical observations after the first laparoscopy with liver biopsy. In six cases of 15 chronic HBs Ag carriers, laparoscopy revealed a white liver; in four cases, a multicolored liver and in the remaining five cases, a nodulated liver. Histology of the white liver in six cases showed chronic persistent hepatitis (CPH) in three cases, chronic aggressive hepatitis (CAH) in one case and chronic persistent hepatitis with fatty metamorphisis in two cass. Histology of the nodulated liver showed liver cirrhosis in five cases. Histology of the multicolored livers showed CAH in all four cases. The question remains unanswered as to how such morphological alterations of the liver developed in these chronic HBs Ag carriers with normal liver chemistries.