Granulomas of the liver are circumscribed focal lesions
(size from 50 to 300 mm) composed of epithelioid cells,
varied numbers of mononuclear cells, multinucleated giant
cells and other inflammatory cells. They represent a specialized,
cell-mediated immune response to a wide variety
of etiological antigenic stimulation, infectious and non-infectious
or sequestration of a foreign indigestible, inorganic
particle within macrophages. The causes of hepatic granulomas
are numerous, and their identification can be difficult.
The wide variety of etiologic factors includes primary
biliary cirrhosis, sarcoidosis, drugs, hepatitis viruses,
Hodgkin and non-Hodgkin lymphomas, tuberculosis, and
other miscellaneous causes. Sarcoidosis is the main cause.
Idiopathic cryptogenic granulomatous hepatitis is a poorly
defined term characterized by a febrile illness with systemic
signs and symptoms such as fatigue, sweating, shivering,
hepatomegaly and/or splenomegaly, and abnormalities
in serum liver tests (aminotransferase, alkaline phosphatase).
In granulomatous hepatitis, granulomas are
found exclusively in the liver and should not be used as an
equivalent term for hepatic granulomas. Hepatic granulomas
are typically asymptomatic. Constitutional symptoms
such as fever, weight loss, anorexia and night sweats are
often manifestations of the underlying disease. The recommended
evaluation to establish the underlying cause of hepatic
granulomas depends on the patientÂ’s clinical status,
co-existing diseases and exposure history. Liver biopsy provides
diagnosis in approximately 15-30% of cases. In almost
one third of cases it is impossible to reach aetiological
diagnosis on histological criteria alone.
Key words: granuloma, granulomatous hepatitis, sarcoidosis,
drug induced hepatitis, tuberculosis