Hepatic granuloma at King Hussein Medical Center : a ten-year review

Abstract EN

Objectives : To determine the incidence and possible causes of hepatic granuloma in Jordan during the ten-year period 1987- 1996.

Methods : A retrospective review of all patients at King Hussein Medical Center in whom liver biopsy contained epithelioid cell granulomas was undertaken.

The study covered the ten-year period from January 1987-December 1996.

Patients were identified by reviewing the histology reports of all liver biopsies submitted to Histopathology section at King Hussein Medical Center over the ten-year study period.

Results : During the ten-year period of the study 1078 liver biopsies were performed.

These consisted largely of needle biopsies although small numbers of wedge resections were included.

Sixty-six patients with hepatic granuloma were identified, accounting for (6.1 %) of all liver biopsies undertaken during the period of the study.

In forty-two of these cases (63.6 %) a definite clinical diagnosis was established.

The most common clinical diagnoses were: tuberculosis 19 cases (28.8 %) sarcoidosis 8 cases (12.2 %) and primary biliary cirrhosis 7 cases (10.6 %).

Other less common conditions associated with hepatic granulomas included brucellosis (3 cases) and schistosomiasis (2 cases).

Miscellaneous conditions accounting for single examples of granulomatous hepatitis were Hodgkin's disease, extrahepatic biliary atresia and drug hypersensitivity.

Twenty-four cases (36.4 %) remained idiopathic with no definite diagnosis.

Conclusions : We identified granulomatous hepatitis in 6.1 % of liver biopsies in the study.

The clinical profile responsible for the presence of granulomas is wide and extensive investigations are often required to establish a definitive diagnosis.

Tuberculosis and sarcoidosis accounted for the majority of cases.

Even after investigation, there remained a group of cases (36.4 %) in which no definite cause could be identified.