Liver & intrahepatic bile ducts
Noninfectious hepatitis
Granulomatous hepatitis-noninfectious
Author: Anthony W.H. Chan, F.R.C.P.A.
Topic Completed: 1 May 2015
Minor changes: 17 March 2021
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PubMed Search: Granulomatous hepatitis[TI] liver full text[sb]
Table of Contents
Definition / general | Etiology | Case reports | Microscopic (histologic) description | Microscopic (histologic) imagesCite this page: Chan A. Granulomatous hepatitis-noninfectious. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livergrannoninfect.html. Accessed April 16th, 2021.
Definition / general
- Hepatic granulomas are present in 2 - 15% of all liver biopsy and excision specimens (Pathol Res Pract 2011;207:359)
Etiology
- Found in a wide range of infectious and noninfectious conditions (Nat Rev Gastroenterol Hepatol 2011;8:455)
- Immune mediated: primary biliary cirrhosis, autoimmune hepatitis
- Fatty liver disease with lipogranuloma: see alcoholic and nonalcoholic fatty liver disease
- Drug induced liver injury
- Foreign material: periportal talc or other material from intravenous drug abusers, beryllium, mineral oil, thorotrast
- Neoplastic disorder: lymphoma (Hodgkin and non-Hodgkin), hepatocellular carcinoma, cholangiocarcinoma
- Systemic disease, e.g. chronic granulomatous disease, Crohn's disease, sarcoidosis, systemic lupus erythematosus, IgG4 disease and other connective tissue disorders
- Idiopathic: 10 - 15% of all hepatic granulomas; a diagnosis of exclusion; excellent prognosis (J Clin Pathol 2003;56:850)
Case reports
- Infant girl with granulomatous liver involvement and systemic lupus erythematosus (Lupus 2013;22:1388)
- 57 year old man with pancreatic mass with multiple hepatic lesions (Clin Gastroenterol Hepatol 2015;13:e3)
- 79 year old man with non-Hodgkin lymphoma causing paraneoplastic cholestasis (BMJ Case Rep 2013 May 22;2013)
Microscopic (histologic) description
- Morphology (epithelioid, suppurative, fibrin ring or lipogranuloma) may suggest underlying etiology
- Epithelioid granuloma: infectious and noninfectious (e.g. primary biliary cirrhosis, drug induced liver injury, foreign body reaction, sarcoidosis, Crohn's disease, chronic granulomatous disease, lymphoma)
- Caseating epithelioid granuloma: typically associated with infections, most notably tuberculosis
- Suppurative granuloma (granulomatous inflammation with stellate abscess formation or suppurative inflammation): bartonellosis, yersinosis, tularemia, listerosis, melioidosis, actinomycosis and fungal infection
- Fibrin ring granuloma (also known as doughnut granuloma; central fat globule surrounded by a circumferential rim of fibrin and histiocytes): originally pathognomonic for Q fever (Coxiella burnetii); now considered as nonspecific and could be associated with mycobacterial infection, staphylococcal bacteremia, leishmaniasis, toxoplasmosis, cytomegalovirus, Epstein-Barr virus, acute hepatitis A, systemic lupus erythematosus, allopurinol toxicity and lymphoma
- Lipogranuloma (central fat globule surrounded by histiocytes without fibrin ring): alcoholic and nonalcoholic fatty liver disease, mineral oil
Microscopic (histologic) images
Contributed by Anthony W.H. Chan, F.R.C.P.A.
Fibrin ring granuloma
Classical Hodgkin lymphoma
Trifluoperazine induced liver injury
Primary biliary cirrhosis
In sarcoidosis
Lipogranuloma in nonalcoholic fatty liver disease
