A histological analysis of granulomatous hepatitis

Abstract

A study has been made of 33 cases of granulomatous hepatitis. Of these, 12 were eventually established as cases of sarcoidosis, nine as cases of tuberculosis, and four as examples of primary biliary cirrhosis. No clinical diagnosis was ever reached in six cases.Analysis of the histological features of these cases shows that the presence of caseation or of tubercle bacilli will only allow for the diagnosis of approximately 50% of cases of tuberculosis. Histological features which are suggestive of tuberculosis are a paucity of granulomata, a scantiness of giant cells, a relatively mild surrounding chronic inflammatory cell infiltrate, and an absence of reticulin. The granulomata are more likely to be due to sarcoidosis if they are numerous, contain many giant cells, are confined to the portal areas, and show a well marked surrounding non-specific chronic inflammatory cell infiltrate.Histological features of cases in which no clinical diagnosis was reached suggest that they are more likely to be due to sarcoidosis than to tuberculosis.

Hepatic granulomas: histological and molecular pathological approach to differential diagnosis–a study of 442 cases

“…Furthermore, with advances in immunological and virological testing and therapeutic options the spectrum of causative diseases and indication for biopsy has been changing. Hughes, Wagoner, Klatskin and Cunningham, who analysed hepatic granulomas in western countries, described sarcoidosis and TBC as the most common aetiologies (21–24). While PBC was underestimated until the early 1980s (4, 21–27), it is now the leading cause of hepatic granulomas in western countries (2, 3, 7, 20).…”

Hepatic granulomas in Turkey: A 6-year clinicopathological study of 35 cases

“…Primary biliary cirrhosis (PBC) has been reported as one of the most common causes of HGs in Western populations (2,3). On the other hand, the dominant worldwide cause of HGs is mycobacterial infections and sarcoidosis (6)(7)(8)(9)(10)(11). Hepatitis C Virus (HCV) has been recognized as a common cause of HGs for a few years (12).…”

Health hazard evaluation report: HETA-82-173-1325, Westinghouse Electric Corporation, St. Louis, Missouri.

“…Chromium can exist in bivalent, trivalent, and hexavalent forms. Trivalent compounds are gene.rally low in toxicity, while Cr+6 is irritating and · ulcerogenic (producing chrome ulcers of the skin or "chrome holes 11 ) .…”

“…include bacteria (brucellosis, granuloma inguinale, tularemia), rickettsia (Q fever), fungi {histoplasmosis), and parasites · (schistosoma mansoni). Drug-induced granulomatous hepatitis is well recognized14 and accounted for 29% of cases in one series.11 Fauci and Wolffl2 grouped cases associated with drugs, berylliosis and erythema nodosum, together as "hypersensitivity diseases 11 that cause granulomatous hepatitis. Agents involved include sulfonamides, penicillin, allopurinol, phenylbutazone, halothane, hydralazine, and methyldopa .…”