Hepatic granuloma in Turkish adults: A report of 13 cases

Onal, Ibrahim Koral; Ersoy, Osman; Aydınlı, Musa; Yonem, Ozlem; Harmancı, Ozgur; Sokmensuer, Cenk; Bayraktar, Yusuf

doi:10.1016/j.ejim.2008.01.012

« Previous Next »European Journal of Internal Medicine
Volume 19, Issue 7 , Pages 527-530, November 2008

Hepatic granuloma in Turkish adults: A report of 13 cases

Ibrahim Koral Onal
- Department of Internal Medicine, Hacettepe University Medical School, Turkey
- Corresponding author. Hacettepe Üniversitesi Tıp Fakültesi, İç Hastalıkları/Gastroenteroloji Bölümü, Sıhhiye/Ankara, 06100, Turkey. Tel.: +903123051713, fax: +903123052302.
Osman Ersoy
- Department of Internal Medicine-Gastroenterology Division, Hacettepe University Medical School, Turkey
Musa Aydınlı
- Department of Internal Medicine-Gastroenterology Division, Hacettepe University Medical School, Turkey
Ozlem Yonem
- Department of Internal Medicine-Gastroenterology Division, Hacettepe University Medical School, Turkey
Ozgur Harmancı
- Department of Internal Medicine-Gastroenterology Division, Hacettepe University Medical School, Turkey
Cenk Sokmensuer
- Department of Pathology, Hacettepe University Medical School, Turkey
Yusuf Bayraktar
- Department of Internal Medicine-Gastroenterology Division, Hacettepe University Medical School, Turkey

Received 30 October 2007; accepted 20 January 2008. published online 12 March 2008.

Abstract

Backgroud

Hepatic granuloma (HG) is a well defined histopathological finding with an heterogenous clinical presentation. Diagnosis of a specific clinical entity is not possible every time. Descriptive studies may shed light on the various etiologies also common and distinctive findings among these patients.

Methods

We reviewed the results of the liver biopsies of 592 patients. Characteristics of the patients with HG were extracted from the hospital charts. Laboratory studies included biochemical tests, hepatitis C virus (HCV) antibody, Brucella agglutination tests, tuberculin skin test. According to the diagnostic clues further tests (thoracic computed tomography (CT), ultrasonography, organ biopsy in addition to liver, antimitochondrial antibody, hepatitis B surface (HBs) antigen, venereal disease research laboratory (VDRL)) were performed.

Results

HG was found in 13 of the 592 patients (2.2%). Primary biliary cirrhosis (three cases) was the most frequent cause followed by sarcoidosis, miliary tuberculosis and BCGitis (Bacillus Calmette Guerin) (two cases each). Two patients with HG could not be diagnosed. Only three patients had remarkable physical examination findings. Alkaline phosphatase and gamma-glutamyl transpeptidase were the most frequently elevated enzymes. Abdominal ultrasonography provided no specific diagnostic clue in any patient. Localization of the HGs was portal in 6 patients, parenchymal in 5 patients and both portal and parenchymal in 2 patients. Three exitus were due to BCGitis, miliary tuberculosis and fungal infection.

Conclusions

Tuberculosis is still among the most common etiologic factors. BCGitis has a fulminant rather than an indolent course. Abdominal ultrasonography could be used to rule out obstructive jaundice rather than to reach a specific diagnosis. Involvement of portal area by HG in most of the cases might cause obstruction of the biliary canaliculi and elevation of the cholestatic enzymes. Follow up of the difficult cases may be the best approach since the presence of HG was not proved as a bad prognostic factor for any disease.

Keywords: Hepatic granuloma, Tuberculosis, BCGitis, Hepatitis B