Granulomatous Liver Disease: Pathology

  • Jay H. Lefkowitch


Granulomas are found in up to 10% of liver biopsies1, 2 and thereby represent a significant diagnostic challenge for the histopathologist. These focal collections of mature apposed macrophages participate in an immunologic reaction to foreign material or other antigenic stimuli. Participating macrophages may attain epithelium-like features (epithelioid macrophages) or may fuse (giant cells). Interleukins 1 and 2 (IL-1 and IL-2), T-helper (T4) and T-suppressor (T8) lymphocytes, and variable numbers of eosinophils and plasma cells contribute to the formation of these localized lesions.3 The pathologic features of hepatic granulomas have been comprehensively reviewed by Ishak1 and others.3–9


Primary Biliary Cirrhosis Acquire Immune Deficiency Syndrome Chronic Granulomatous Disease Portal Tract Immune Deficiency Syndrome 
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  1. 1.
    Ishak KG: Granulomas of the liver, in Ioachim HL (ed): Pathology of Granulomas. Raven, New York, 1983, pp. 307–369.Google Scholar
  2. 2.
    Petersdorf RG, Beeson PB: Fever of unexplained origin—Report on 100 cases. Medicine (Baltimore) 40:1–30, 1961.CrossRefGoogle Scholar
  3. 3.
    James DG: Hepatic granulomas, in Brunner H, Thaler H (eds): Hepatology. A Festschrift for Hans Popper. Raven, New York, 1985, pp. 269–280.Google Scholar
  4. 4.
    Fauci AS, Wolff SM: Granulomatous hepatitis, in Popper H, Schaffner F (eds): Progress in Liver Diseases, Vol. V. Grune & Stratton, Orlando, Florida, 1976, pp. 609–621.Google Scholar
  5. 5.
    Cunningham D, Mills PR, Quigley EMM, et al: Hepatic granulomas—Experience over a 10-year period in the West of Scotland. Q J Med 51:162–170, 1982.Google Scholar
  6. 6.
    Klatskin G: Hepatic granulomata: Problems in interpretation. Mt Sinai J Med 44:798–812, 1977.PubMedGoogle Scholar
  7. 7.
    Neville E, Piyasena KHG, James DG: Granulomas of the liver. Postgrad Med J 51:361–365, 1975.PubMedCrossRefGoogle Scholar
  8. 8.
    Guckian JC, Perry JE: Granulomatous hepatitis: An analysis of 63 cases and review of the literature. Ann Intern Med 65:1081–1100, 1966.PubMedGoogle Scholar
  9. 9.
    Christoffersen P, Poulsen S: Granulomatous inflammatory diseases, in Peters RL, Craig JR (eds): Liver Pathology. Churchill Livingstone, New York, 1986, pp. 147–160.Google Scholar
  10. 10.
    Lee RG, Epstein O, Jauregui H, et al: Granulomas in primary biliary cirrhosis: A prognostic feature. Gastroenterology 81:983–986, 1981.PubMedGoogle Scholar
  11. 11.
    Rudzki C, Ishak KG, Zimmerman HJ: Chronic intrahepatic cholestasis of sarcoidosis. Am J Med 59:373–387, 1975.PubMedCrossRefGoogle Scholar
  12. 12.
    Warren KS: The kinetics of hepatosplenic schistosomiasis. Semin Liver Dis 4:293–300, 1984.PubMedCrossRefGoogle Scholar
  13. 13.
    Maddrey WC, Johns CJ, Boitnott JK, et al: Sarcoidosis and chronic hepatic disease: A clinical and pathological study of 20 patients. Medicine (Baltimore) 49:375–395, 1970.Google Scholar
  14. 14.
    McMaster KR, Hennigar GR: Drug-induced granulomatous hepatitis. Lab Invest 44:61–73, 1981.PubMedGoogle Scholar
  15. 15.
    Simon HB, Wolff SM: Granulomatous hepatitis and prolonged fever of unknown origin: A study of 13 patients. Medicine (Baltimore) 52:1–21, 1973.Google Scholar
  16. 16.
    Nakanuma Y, Ohta G: Quantitation of hepatic granulomas and epithelioid cells in primary biliary cirrhosis. Hepatology 3:423–427, 1983.PubMedCrossRefGoogle Scholar
  17. 17.
    Beswick DR, Klatskin G, Boyer JL: Asymptomatic primary primary biliary cirrhosis. A progress report on long-term follow-up and natural history. Gastroenterology 89:267–271, 1985.PubMedGoogle Scholar
  18. 18.
    Portmann B, Popper H, Neuberger J, Williams R: Sequential and diagnostic features in primary biliary cirrhosis based on serial histologic study in 29 patients. Gastroenterology 88:1777–1790, 1985.PubMedGoogle Scholar
  19. 19.
    Kaplan MM: Primary biliary cirrhosis. S Engl J Med 316:521–528, 1987.CrossRefGoogle Scholar
  20. 20.
    Klatskin G: Hepatitis associated with systemic infections, in Schiff L (ed): Diseases of the Liver, 4th ed. JB Lippincott, Philadelphia, 1975, pp. 711–754.Google Scholar
  21. 21.
    Lebovics E, Thung SN, Schaffner F, Radensky PW: The liver in acquired immune deficiency syndrome. Hepatology 5:293–298, 1985.PubMedCrossRefGoogle Scholar
  22. 22.
    Orenstein MS, Tavitian A, Yonk B, et al: Granulomatous involvement of the liver in patients with AIDS. Gut 26:1220–1225, 1985.PubMedCrossRefGoogle Scholar
  23. 23.
    Nakanuma Y, Liew CT, Peters RL, Govindarajan S: Pathologic features of the liver in acquired immune deficiency syndrome. Liver 6:158–166, 1986.PubMedGoogle Scholar
  24. 24.
    Dworkin BM, Stahl RE, Giardina MA, et al: The liver in acquired immune deficiency syndrome: Emphasis on patients with intravenous drug abuse. Am J Gastroenterol 82:231–236, 1987.PubMedGoogle Scholar
  25. 25.
    Pellegrin M, Delsol G, Auvergnat JC, et al: Granulomatous hepatitis in Q fever. Hum Pathol 11:51–57, 1980.PubMedCrossRefGoogle Scholar
  26. 26.
    Wanless IR, Geddie WR: Mineral oil lipogranulomata in liver and spleen. Arch Pathol Lab Med 109:283–286, 1985.PubMedGoogle Scholar
  27. 27.
    Edland JF: Liver disease in heroin addicts. Hum Pathol 3:75–84, 1972.PubMedCrossRefGoogle Scholar
  28. 28.
    Leong A S-Y, Disney APS, Gore DW: Spallation and migration of silicone from blood-pump tubing in patients in hemodialysis. S Engl J Med 306:135–140, 1982.CrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Jay H. Lefkowitch
    • 1
  1. 1.Department of Pathology, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

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