Diagnosis of Hepatic Granulomas: A Review<sup>1</sup>

Mills, Peter R.; Russell, Robin

doi:10.1177/014107688307600513

Cited by 15 publications

(10 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Epithelioid granulomas have been reported in 2-15% of unselected liver biopsies [11] . The etiological classification of diseases causing epithelioid-hepatic granulomas is broad ranging (infectious, hepatobiliary, neoplastic, idiopathic and drugrelated), but only a few diseases (primary biliary cirrhosis, sarcoidosis and Q-fever) can be linked directly to specific histological findings [12][13][14] . Therefore, it is possible that other rarer and less studied causes of granulomatous hepatitis, such as "BCG-itis", could present with more atypical histological characteristics, as depicted in our case.…”

Section: Discussionmentioning

confidence: 99%

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Kaklamanos

Hardavella²,

Trigidou³

et al. 2011

WJH

View full text Add to dashboard Cite

Bacillus Calmette-Guerin (BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer. BCG-induced disseminated infection, though rare, has been associated with the histological finding of epithelioid granulomas in different organs, including the liver. We report the case of an adult patient with multi-organ failure, who developed sepsis, acute respiratory failure and acute hepatic failure with encephalopathy whose liver biopsy confirmed the presence of atypical, granulomatous-like lesions. Recovery was observed only after empirical therapy for Mycobacterium bovis with isoniazid, rifampicin, ethambutol and steroids was introduced. This case highlights the importance of a thorough patient assessment in order to exclude other more common causes of hepatic granulomas and to confirm diagnosis. Histological findings may be non-specific when the liver is involved in BCGinduced disseminated infection.

show abstract

Section: Discussionmentioning

confidence: 99%

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Kaklamanos

Hardavella²,

Trigidou³

et al. 2011

WJH

View full text Add to dashboard Cite

show abstract

“…The infectious etiologies of hepatic granulomatous disease include mycobacterial, viral, fungal, and parasitic infections (schistosomiasis in known endemic areas) [18•,19]. Patients with AIDS are especially prone to granulomatous disease associated with Mycobacterium avium complex (MAC), viral infections (cytomegalovirus), and fungal infections (histoplasmosis, cryptococcosis, and coccidioidomycosis) although fungal infections are also noted in immunocompetent persons in endemic areas [5,20,21]. Patients who require treatment with immunosuppressive medications such as tumor necrosis factor antagonists are at increased risk of infectious granulomatous complications [21].…”

Section: Infectious Causesmentioning

confidence: 99%

“…Granulomas rarely incite a hepatocellular reaction, more often serving as a morphologic manifestation of an underlying systemic process [20]. Granulomas themselves are typically asymptomatic and do not cause laboratory evidence of hepatic dysfunction.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Testing for mycobacteria, Coxiella or Brucella organisms, fungi, and parasites is warranted [20]. An erythrocyte sedimentation rate, leukocyte differential (specifi cally looking for eosinophils), Mantoux skin test, and chest radiograph have also been reported to be useful in evaluating those with granulomas on liver biopsy [20].…”

Section: Laboratory Fi Ndings and Diagnostic Studiesmentioning

confidence: 99%

“…A liver biopsy showing granulomatous infl ammation may not be suffi cient to determine the etiology of a systemic granulomatous disease. If infectious etiologies have been assessed, and studies for angiotensin-converting enzyme and antimitochondrial antibody are normal, then repeat liver biopsy with culture or biopsy of other organs (eg, lymph nodes, lung, bone marrow, or rectum) may yield the diagnosis [20]. Strict criteria must be followed to establish the diagnosis of drug-induced liver disease: the medication should have the potential to cause granulomatous infl ammation, and there must be a compatible chronology, improvement upon withdrawal of the drug, and exclusion of alternative causes of liver damage [44].…”

Section: Prognosis and Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Granulomatous liver disease

Bhardwaj¹,

Saxena²,

Kwo

2009

Curr Gastroenterol Rep

View full text Add to dashboard Cite

Hepatic granulomas are often encountered on liver biopsy and may represent a primary hepatic process, a manifestation of a systemic illness, or an innocent finding of no clinical relevance. Hepatic granulomas are a unique inflammatory response that may be idiopathic or may be a response to a bacterial, fungal, viral, or parasitic infection; a manifestation of drug-induced liver injury; or a manifestation of underlying malignancy. When granulomas are found on liver biopsy, clinicians must correlate the histologic findings with historical and clinical data to help provide an accurate diagnosis and guide management. Therapy may be warranted, either directly for the granulomatous inflammation of the liver or for a systemic process. For some patients, observation may be the most appropriate form of management.

show abstract

Uncommon hepatic macrophagic foamy‐cell nodules in Iberian barbel (Luciobarbus bocagei Steindachner, 1864) from the Vizela River (Portugal)

Carrola

Fontaínhas‐Fernandes

Rocha

2019

Microscopy Res & Technique

View full text Add to dashboard Cite

The main intent of this work (after the by chance finding, in archived histological slides) is to characterize one previously non-described liver lesion of the Iberian barbel from the Vizela River (Portugal). This ran through a textile and dyeing industrial region. The lesion type was made of groups of foamy cells (presumptive macrophages), which appear either as a "smaller non-nodular form," without a connective tissue capsule and displaying an irregular profile, or as a "bigger nodular form," presenting a thin capsule and a circular profile. The nodular forms could appear multi-layered, resembling "cross-sectioned onions". The lesions number, dimension, and structural complexity were greater in bigger fish, appearing only after a history of poor water quality.In extreme cases, the lesions slightly protruded the liver surface. Special histological staining proved the connective tissue nature of the capsule (and its eventual septa), the presence of proteins, glycoproteins, lipofuscin, melanin, iron (putative hemosiderin), and copper, in a variable number of foamy cells within the lesions. At times, degenerating hepatocytes appeared at the border of the lesions. It is proposed that this lesion type incorporates both macrophages and degenerating hepatocytes, looking as one (unpublished) form of a macrophage aggregate. The term "foamy-cell nodules" was advanced for this abnormality. The lesion could have been induced by pollution, because: no parasites were ever associated with the lesion; there was coexistence of the lesion with a water quality status scored as "bad"; such lesion neither existed in fish sampled after mitigation and remediation measures nor in reference fish.

show abstract

Diagnosis of Hepatic Granulomas: A Review¹

Cited by 15 publications

References 17 publications

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Granulomatous liver disease

Uncommon hepatic macrophagic foamy‐cell nodules in Iberian barbel (Luciobarbus bocagei Steindachner, 1864) from the Vizela River (Portugal)

Contact Info

Product

Resources

About

Diagnosis of Hepatic Granulomas: A Review1

Cited by 15 publications

References 17 publications

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Multi-organ failure with atypical liver granulomas following intravesical Bacillus Calmette-Guerin instillation

Granulomatous liver disease

Uncommon hepatic macrophagic foamy‐cell nodules in Iberian barbel (Luciobarbus bocagei Steindachner, 1864) from the Vizela River (Portugal)

Contact Info

Product

Resources

About

Diagnosis of Hepatic Granulomas: A Review¹