الفهرس 
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Abstract
In the present work, 66 biopsies of chronic liver disease recieved at the Pathology Depatrment, Ain Shams Uiversity, during the years 1983-1986 were studied. These cases comprised 40 retrospective blocks and 26 fresh biopsies. Serum smaples were collected and investigated from the 26 cases from which fresh specimens were provided. Out of the 66 cases, 62 were needle biopsis while 4 were wedge
biopsies.
Thirty two cases were schistosomal hepatic lesion: 10 cases were pure schistosomiasis, 2 cases schistosomiasis with chronic persistent hepatitis, 2 cases schistosomiasis with chronic active hepatitis, 15 cases schistosomiasis with established cirrhosis. Ten cases showed chronic persistent hepatitis, 11 cases chronic active hepatitis, 3 cases active cirhosis, 2 cases established cirrhosis, one case of congenital hepatic fibrosis, one biopsy of glycogen storage disease, 2 cases of large bile duct obstruction, one case of neonatal hepatitis, one case of chronic venous congestion and 2 cases of non-sepcific reactive hepatitis.
All the cases were stained histochemically-by Shikata’s orcein stain, victoria blue stain - and immunohistochemicallY by immunoperoxidase technique - using PAP method - for the demonstration of HBAg. By the orcein stain, 19 cases (28.7%) showed HBBAg as intracytoplasmic purplish brown colour
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against the beige cytoplasmic background. The antigen was predominently in the hepatocytes and only occasionally in Kupffer cells. It was distributed very randomly in the liver lobules. The intensity of orcein positive staining varied from strong (11 cases), moderate (4 cases) to weak (4 cases). It was the stain for choice to demonstrate HBilkg as it was cheap, easy to prepare, simple, rapid technique, stable stain and there was no false positivity.
Victoria blue staining of the 66 cased, revealed 19 positive cases (28.7%) for HB8Ag. They were the same cases that showed positivity by orcein stain. The antigen appeared homogenously blue intracytoplasmic against a red cytoplasm and nucleus.
There was a good contrast of colour to evaluate positive cases yet, victoria blue stain is time consuming in preparation and staining techinque.
Immunoperoxidase techinque ”Dako” Kits revealed 21 cases (31.8%) positive for HB,Ag 19 cases were the same that showed positivity with orcein and victoria blue. The antigen appeared as dense red cytoplasmic staining against blue staining of the cytoplasm.
So, the sensitivity of immunoperoxidase techinque was higher than histochemical methods by 3% but it is very expensive, and a tedious technique. The specificity of histochemical and immunoperoxidase techinques was equal.
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The incidence of HB,Ag was 31.8% in chronic liver diseases. The incidence of HB,Ag was higher in cases showing chronic active hepatitis (46%), than in those of chronic persistent hepatitis (8%).
A higher percentage of positivity was demonstarted in cases showing cirrhosis (43%) than in cases showing chronic hepatitis (28%).
The incidence of microscopic lesion indicative of chronic hepatitis in patients with schistosomal hepatic involvement correlated directly with the presence of HBV infection in the tissue. Also 75% of the cases of schistosomiasis that had cirrhosis showed HBV infection indicating post-hepatic aetiology.
Anti - S agent were tested in the sera of 26 cases by compatitive enyzme linked radioimmunoassay ”ABBUT” Kit. 6 cases (23%) were positive indicating 8-infection, of which 5 cases were HB,Ag, positive. One cases was anti-8 positive but HB,Ag negative may be diagnosis of HBV was missed as we did not evaluate presence of HB,Ag or anti-HB, in sera. Cases that showed 8-infection were 3 cases of CAH, 2 of shcistosomiasis with active cirrhosis and one cases of established cirrhosis indicating progressive liver disease.
All the cases were stained with Luna stain to detect Novel Inclusion body in cirrhotic cases while other cases were used as control. Out of the 23 cases of cirrhosis 5
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cases (22%) showed positivity of NIB. It appeared as red intracytoplasmic inclusion against a blue background. Cases tha showed NIB with Luna did not give positive results for NIB with orcein or victoria blue. The five cases that showed NIB, were HBAg negative. None of the cases that showed NIB, give serum positive results for anti-8 agent. The case that showed schistosomiasis with cirrhosis and HB,Ag negative but NIB positive could possibily be related to infection with some virus other than HBV as non-A, non-B virus.
CONCLUSION
-There is high incidence of HBAg in chronic liver diseases
-HBV has a role in the parenchymatous changes occuring in
•
schistosomiasis.
-Comparative studies between., histochemical and
immunoperoxidase technique for the detection of HBAg in paraffin sections, revealed that orcein is the stain for choice as its sensitivity nearly equal that of immunoperoxidase technique, but orcein is easier than victoria blue and immunoperoxidase to prepare, to use as routine stain, cheap and showed no false positivity.
-S - agent is hepatotropic infectious agent which is
present with HBV infection. It is associated with progressive liver disease.
NIB is detected in cirrhotic liver as intracytoplasmic inclusion. It is stained by Luna stain, not by Orcein or Victoria blue stain. Occurrence of NIB was not related to HB,Ag.