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 August 13th, 2022.
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