Chronic hepatitis C is a common associated with hepatic granulomas.
OBJECTIVE
To determine the most frequent etiologies of hepatic epithelioid granulomas, and whether there was an association with chronic hepatitis C virus (HCV).


METHODS
Both a retrospective review of the pathology database of liver biopsies at our institution from 1996 through 2006 as well as data from a prospective study of hepatic fibrosis markers and liver biopsies from 2003 to 2006 were reviewed to identify cases of hepatic epithelioid granulomas. Appropriate charts, liver biopsy slides, and laboratory data were reviewed to determine all possible associations. The diagnosis of HCV was based on a positive HCV RNA.


RESULTS
There were 4578 liver biopsies and 36 (0.79%) had at least one epithelioid granuloma. HCV was the most common association. Fourteen patients had HCV, and in nine, there were no concurrent conditions known to be associated with hepatic granulomas. Prior interferon therapy and crystalloid substances from illicit intravenous injections did not account for the finding. There were hepatic epithelioid granulomas in 3 of 241 patients (1.24%) with known chronic HCV enrolled in the prospective study of hepatic fibrosis markers.


CONCLUSIONS
Although uncommon, hepatic granulomas may be part of the histological spectrum of chronic HCV. When epithelioid granulomas are found on the liver biopsy of someone with HCV, other clinically appropriate studies should be done, but if nothing else is found, the clinician can be comfortable with an HCV association.
Snyder
Ned
N
Department of Internal Medicine, University of Texas Medical Branch, Division of Gastroenterology, Galveston, Texas 77555-0764, United States. nesnyder@utmb.edu
Martinez
Juan G
JG
Xiao
Shu-Yuan
SY
D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006099:Granuloma / Q000473:pathology / Q000821:virology*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors
D012367:RNA, Viral