Spectrum Of Granulomatous Liver Disease in a Tertiary Care Hospital from North India

Abstract

Background: Granulomas in liver are known to occur due to various conditions in around 2–8% of liver specimens. Their detection in the liver may provide the first clue to an ongoing systemic disease. Aim: We conducted the present study to categorize the granulomas based on the pathological features and try to ascertain the etiology. Methods: Forty three cases diagnosed with the presence of granulomas on liver biopsy during a period of 4 years from July 2009 to November 2013 in our department were included in the study. Age ranged from 4 months to 65 years. The cases comprised of 31 males and 12 females. Relevant clinical and imaging findings were reviewed. Stains for reticulin and acid fast bacilli Ziehl Neelson were done in all the cases. Fungal stains were performed in 8 cases where clinical suspicion of fungal infection was high. Results: Most common etiology noted was tuberculosis, in 15 cases (34.8%). Sarcoidosis was the diagnosis in 2 cases. Idiopathic chronic granulomatous hepatitis was considered in 9 cases after ruling out other diseases. Other rarer causes included granulomas associated with chronic hepatitis B 5, Hodgkin’s lymphoma 1, chronic hepatitis C1, other chronic hepatitis 2, drug induced 2, hepatocellular carcinoma 1 and hydatid cyst 1. In 4 cases, no definite etiology was found. Conclusion: Identification of granulomas in trucut biopsies of liver is important because its rare association with other diseases may mislead histopathological interpretation leading to increased morbidity. Characterization by using special stains as Zeihl Neelsen stain and auramine rhodamine stain along with appearance and localization of granulomas may help one to reach to an etiological clue, fetching appropriate management.