Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal.
Pathology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal.
Histopathology. 2018 Aug;73(2):240-246. doi: 10.1111/his.13521. Epub 2018 May 30.
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.
This 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.
Hepatic 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 (~90%), rendering its histological identification and characterisation essential, as disease-specific therapies are becoming available.
肝脏肉芽肿在肝活检中的患病率估计为 5%，其病因在全球范围内广泛存在。我们的目的是评估在一个来自西方国家的非移植三级转诊中心，其临床相关性、表现特征和潜在病因。
这是一项回顾性的、单中心的临床、实验室和组织学数据研究，包括 1998 年 1 月至 2014 年 12 月期间所有接受肝活检的成年患者。在 9374 例肝活检中发现了 297 例肝脏肉芽肿，但由于其中 57 例为脂肪肉芽肿或活检/病因学检查并非在我们机构进行，因此将其排除在分析之外。总的来说，最常见的病因是结核病（35.8%），其次是原发性胆汁性胆管炎（PBC）（15.0%）。在 30 例患者（12.5%）中，肉芽肿被归类为特发性。1998 年至 2006 年 6 月期间，5304 例肝活检中有 147 例肉芽肿（2.8%），这一频率与 2006 年 7 月至 2014 年 12 月期间（4070 例肝活检中有 93 例肉芽肿，2.3%）相比无显著变化（P > 0.05）。然而，对于大多数病例（61.9%），在前者时期，肉芽肿的病因从传染病转变为自身免疫性肝病（43%）。此外，虽然 1998 年至 2006 年 6 月期间发现了 3 例药物诱导性肉芽肿，但我们在第二个时期报告了 2 例。
肝脏肉芽肿可由各种感染性和非感染性疾病引起。近年来，关于肉芽肿病因的流行病学发生了转变，从全身性感染性疾病转变为非感染性疾病，主要是免疫介导的原发性肝脏疾病。通过适当的检查，大多数病例（约 90%）的病因可以确定，这使得其组织学识别和特征变得至关重要，因为针对特定疾病的治疗方法正在不断涌现。
