Hepatic Granulomas: A Clinician’s Perspective

Abstract

Hepatic granulomas are focal aggregates of transformed epithelioid histiocytes with or without multinucleated giant cells that are
cuffed by lymphocytes and plasma cells. They represent delayed-type specialized cell-mediated immunity to a wide-spectrum
of antigenic stimuli. Hepatic granulomas are found in up to 10% of liver biopsies and the causes are usually multifactorial.
Different antigens like infectious agent, medication, foreign body and malignancy can initiate granuloma formation. Hepatic
granulomas per se seldom cause architectural changes and often provide a clue to a systemic disease. Most often, to a practicing
clinician, it is a combination of clinical presentation, laboratory parameters with information on the typical localization and
characterization of the granuloma within the liver by the pathologist that often provides a clue to a definitive diagnosis.