title: Histopathological evaluation of liver biopsy specimens in children with chronic hepatitis B.
abstract: BACKGROUND
  Histopathological evaluation of the liver remains important diagnostic tool.
  
  
  OBJECTIVE
  The aim of this study was to assess inflammatory activity, fibrosis and their correlation to the expression of viral antigens in the liver of children with chronic hepatitis B (CHB) before antiviral treatment.
  
  
  METHODS
  The study included 190 liver biopsies of children aged 1.5-18 (mean 7.46+/-4.05 years) with CHB. The histopathological examination was based on the modified Knodell system. Additionally, immunomorphological analysis was performed in 125 specimens to detect HBsAg and HBcAg.
  
  
  RESULTS
  Necroinflammatory activity was scored for mild in 109 children and moderate in 49. Fibrosis was scored for S1 in 90, S2 in 58 and S3-S4 in seven cases. Positive correlation between grading and staging was observed (chi(2)=77.65, p=0.000002). HBsAg was detected in 62 specimens, while HBcAg was found in the nuclei of 108 samples with cytoplasmic expression in 35-28% cases. No correlation of HBsAg expression to histopathological lesions was established whereas partial correlation of HBcAg expression with inflammatory infiltrate was confirmed.
  
  
  CONCLUSIONS
  Progression of liver injury in children with CHB varies in severity. Necroinflammatory activity correlates with fibrosis. Expression of viral antigens is independent of histological changes, however confirms the etiology of liver disease.
authors.affiliation: Department of Infectious Diseases and Child Neurology, III Chair of Pediatrics, University of Medical Sciences, ul. Szpitalna 27/33, 60-572 Poznań, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Mozer-Lisewska
authors.forename: Wojciech
authors.initials: W
authors.lastname: Słuzewski
authors.forename: Anna
authors.initials: A
authors.lastname: Mania
authors.forename: Bozena
authors.initials: B
authors.lastname: Walewska-Zielecka
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Bujnowska
authors.forename: Arleta
authors.initials: A
authors.lastname: Kowala-Piaskowska
authors.forename: Magdalena
authors.initials: M
authors.lastname: Figlerowicz