Granulomas of the liver

Abstract

SummaryThe authors personally studied 138 patients with liver granulomas: seventy-five (54%°) had sarcoidosis, twenty-six (19Y.) had primary biliary cirrhosis, twenty-three (17%) had miscellaneous recognizable disorders and fourteen (10%) were undiagnosed. The modes of presentation, the clinical, biochemical and radiological features are compared, and the course of each disease is followed. The undiagnosed group were frequently middle-aged men presenting with abdominal pain, fever and hepato-splenomegaly. The unsatisfactory term granulomatous hepatitis, if used, should be reserved for this undiagnosed residue until follow-up reveals a more definite aetiology.

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

“…Hughes, Wagoner, Klatskin and Cunningham, who analysed hepatic granulomas in western countries, described sarcoidosis and TBC as the most common aetiologies (21)(22)(23)(24). While PBC was underestimated until the early 1980s (4,(21)(22)(23)(24)(25)(26)(27), it is now the leading cause of hepatic granulomas in western countries (2,3,7,20). After the discovery of hepatitis C virus, a small percentage of granulomas were interpreted as an epiphenomenon of chronic hepatitis C (2,(28)(29)(30).…”

Conventional renal cell carcinoma with granulomatous reaction: a report of three cases

“…NCG associated with carcinomas were documented in case reports from breast, liver, colon, stomach carcinoma and they are quite commonly seen in germ cell tumours especially seminomas [2,3,5,8,9,11,12]. A single case report dealing with granulomatous reaction within renal cell carcinoma was published by Campbell [1].…”

Hepatic granulomas: a 10 year single centre experience

“…''The only published series from the UK largely included patients diagnosed before the discovery of the hepatitis C virus, now recognised as a common cause of hepatic epithelioid granulomas'' Epithelioid granulomas have been reported in 2-15% of unselected liver biopsies [1][2][3][4][5][6][7][8] with a large number of underlying aetiologies. Unfortunately, only rarely do granulomas possess distinct histological features-for example, caseous necrosis containing acid fast bacilli (tuberculosis; TB) or ova of Schistosoma mansoni (schistosomiasis), which enable such clinical conditions to be diagnosed.…”

“…9 10 Thus, a specific aetiological agent often cannot be identified despite serological, immunological, microbiological, and radiological investigations, leading to a diagnosis of ''idiopathic'' hepatic granulomas; there is a consistent cohort of such patients, accounting for approximately 15% of hepatic granuloma series. [1][2][3][4][5][6][7][8] The only published series from the UK, including one from this centre, largely included patients diagnosed before the discovery of the hepatitis C virus (HCV), now recognised as a common cause of hepatic epithelioid granulomas. 4 7 8 10 We undertook a further analysis of all liver biopsies revealing hepatic granulomas over a 10 year period, after the introduction of HCV antibody testing, to establish whether, with advances in immunological and virological testing, there has been an alteration in the distribution of diagnoses in patients identified with hepatic granulomas.…”