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

Abstract

Background/Aims: Granulomas are focal aggregates of modified macrophages that are surrounded by a rim of lymphocytes and fibroblasts. The present study aimed to evaluate the prevalence and etiology of hepatic granulomas (HGs) in the Department of Gastroenterology with a wider population. Materials and Methods: We performed a retrospective study on 2662 liver biopsy specimens analyzed between 2005 and 2011 at Gazi University Department of Gastroenterology to determine the presence of HGs. Results: There were 16 cases with primary biliary cirrhosis, of whom 14 without any other causative etiology. There were 6 cases of sarcoidosis, 2 cases of Fasciola hepatica infection, 2 cases of hepatitis C, and 2 cases of hepatitis B. One case had both tuberculosis and rheumatoid arthritis and one case had both tuberculosis and brucellosis. There was also one case each of leishmaniasis and Hodgkin's lymphoma. The diagnosis of autoimmune hepatitis was found in two cases. One case had immune cholangiopathy. Conclusion: The leading causative etiology of HGs was primary biliary cirrhosis, followed by sarcoidosis. As a study performed in a center that accepts patient profiles throughout Turkey, tuberculosis took a minor part in HG etiology. A drug-affected or toxic case of HG was not observed.

Hepatic granulomas: a 17‐year single tertiary centre experience

“…The reported prevalence of hepatic granulomas varies between 2 and 15%, although this is likely to be influenced by geographic variations and indications for biopsy. In agreement with those reports, this study shows an overall prevalence of 2.6%, a frequency that has remained unchanged over the years …”

“…In agreement with those reports, this study shows an overall prevalence of 2.6%, a frequency that has remained unchanged over the years. 3,5,20 Comparing the two time-periods, we observed a reduction of 1254 biopsies in the latter (5304 liver biopsies from January 1998 to June 2006 and 4070 biopsies from July 2006 to December 2014). Nowadays, in an era of non-invasive techniques, the diagnosis and staging of liver disease relies mainly upon blood and imaging tests, although liver biopsy is still the cornerstone in the diagnosis and management of liver diseases.…”

“…In all these cases, patients presented with typical features of AIH, namely elevated transaminases, high immunoglobulin (Ig)G levels, positivity for autoantibodies and other typical histological features. Although granulomata are not a feature seen commonly in AIH, other series have described its presence in AIH . Whether the presence of granuloma in AIH has any clinical significance should be addressed in future studies.…”

“…For example, in the two UK series published to date, no cases of granuloma were reported among patients infected with HBV . However, other more recent series emanating from Greece and Turkey, countries with a higher overall HBV endemicity, reported a few cases of hepatic granulomas attributable to HBV infection …”

“…5,23 However, other more recent series emanating from Greece and Turkey, countries with a higher overall HBV endemicity, reported a few cases of hepatic granulomas attributable to HBV infection. 20,21 Overall, autoimmune liver disease was the underlying aetiology in 28.8%. PBC was the most common among these, accounting for almost 15.8% of patients, and therefore placing it as the second most common cause of hepatic granulomas.…”