Hepatic granulomas: a 17-year single tertiary centre experience

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Gaspar, R (Author) Other; Andrade, P (Author) Other; sousa, m (Author) ICBAS; Peixoto, A (Author) Other; Lopes, J (Author) Other; Carneiro F (Author) FMUP; Liberal, R (Author) Other; Macedo G (Author) FMUP

Journal

Title: Histopathology

Vol. 73

Pages: 240-246

ISSN: 0309-0167

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 3 Citations

Scopus - 6 Citations

Other information

Authenticus ID: P-00P-03W

DOI: 10.1111/his.13521

Abstract (EN): Aims Hepatic granulomas have an estimated prevalence of 5% in liver biopsies, with a wide range of aetiologies globally. Our aim was to assess the clinical relevance, presenting features and underlying aetiology in a non-transplant, tertiary referral centre from a western country. Methods and resultsThis was a retrospective, single-centre review of clinical, laboratory and histological data including all adult patients for whom a liver biopsy was performed from January 1998 to December 2014. A total of 297 cases with hepatic granulomas were found in 9374 biopsies, but 57 were excluded from analysis either because they were lipogranulomas or the biopsy/aetiological work-up had not been performed at our institution. Overall, the most common aetiology was tuberculosis (35.8%), followed by primary biliary cholangitis (PBC) - 15.0%. In 30 patients (12.5%) granulomas were classified as idiopathic. From 1998 to June 2006 there were 147 granulomas in 5304 biopsies (2.8%), a frequency that did not change significantly compared to the period from July 2006 to December 2014 (93 granulomas in 4070 biopsies, 2.3%, P > 0.05). However, for the majority of cases (61.9%) there was a shift in granuloma aetiology during the former time-period that infectious diseases were responsible, whereas in the latter, autoimmune liver diseases (43%) were the main aetiology. In addition, while three cases of drug-induced granulomas were found from 1998 to June 2006, we report two cases in the second time-period. ConclusionsHepatic granulomas can result from various infectious and non-infectious diseases. During recent years, an epidemiological shift regarding granuloma aetiology was observed, from systemic infectious diseases to non-infectious, mainly immune-mediated primary liver disorders. With an appropriate work-up the aetiology can be identified in the vast majority of cases (similar to 90%), rendering its histological identification and characterisation essential, as disease-specific therapies are becoming available.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7