Gaya, D.R.; Thorburn, D.; Oien, K.A.; Morris, A.J.; Stanley, A.J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA104
Academic Journal
Introduction: Epitheliod granulomas have been reported in 2-15% of unselected liver biopsies with numerous underlying aetiologies described. However, most series were reported prior to the identification of hepatitis C and the improvement in laboratory markers of other causes of liver dysfunction. This study was performed to evaluate the current aetiologies of hepatic granulomas and in particular to assess the prognosis for the "idiopathic" group in whom no underlying cause was identified. Methods: A retrospective study of the pathology department records at Glasgow Royal Infirmary was undertaken over the 10 year period 1991-2001. All patients who had a liver biopsy revealing epitheliod granulomas had their case notes reviewed and a standard proforma completed. Results: Over the 10 year period, of 1662 liver biopsies performed, 63 were identified with hepatic granulomas (4.2% of biopsies). Of those identified, 47 (75%) were female with a mean age of 42 years (range 17 - 81). Underlying aetiologies were as follows: PBC (23.8%), sarcoidosis (11.1%), idiopathic (11.1%), drug induced (9.5%), HCV (9.5%), PBC/AIH overlap (6.3%), Hodgkin's disease (6.3%), AIH (4.8%), TB (4.8%), resolving biliary obstruction (3.2%), and other single miscellaneous causes (9.5%). With respect to the 7 patients with idiopathic hepatic granulomas, one was lost to follow up, one died of a stroke, and the remaining 5 were all well with no liver related morbidity at a mean follow up of 6.2 years. Conclusions: The aetiologies of granulomas on liver biopsy are confirmed to be broad ranging with HCV a significant cause in our population. Despite extensive investigations, there remain a significant minority who have "idiopathic" hepatic granulomas. The prognosis in this latter group appears to be excellent.


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