Laparoscopic an histologic abnormalities of the liver in chronic asymptomatic hepatitis B surface antigen carriers

In most cases, Hepatitis B surface antigen (HBs Ag) in sera can be incidentally detected in patients with liver diseases at the time of medical examinations. It is rather difficult to assume how long HBs Ag has persisted in the sera of these patients before the medical examination. However, we have encountered 16 asymptomatic HBs Ag carriers in whom the time of HBV infection can be estimated, HBs Ag in sera persisted for at least 6 months (actually up to 5 years), and laparoscopy with liver biopsy was performed. In 11 out of these 16 asymptomatic HBs Ag carriers, laparoscopy revealed a white liver and in the remaining five cases, a multicolored liver. Histology of the white liver showed minimal inflammatory changes of the liver in two cases, chronic persistent hepatitis in eight cases and chronic aggressive hepatitis in one case. Histology of the multicolored liver including transitional change to the nodulated liver in five case showed chronic aggressive hepatitis in two cases and liver cirrhosis in three cases. The question remains open as to how such morphological alterations of the liver developed in these asymptomatic HBs Ag carriers with normal liver chemistries although none of these 16 cases developed overt acute hepatitis, either of type A or non A non B, 6 to 21 months after the assumed HBV infection.