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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 7, 2008; 14(41): 6366-6369
Published online Nov 7, 2008. doi: 10.3748/wjg.14.6366
Chronic hepatitis C is a common associated with hepatic granulomas
Ned Snyder, Juan G Martinez, Shu-Yuan Xiao
Ned Snyder, Juan G Martinez, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0764, United States
Shu-Yuan Xiao, Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0588, United States
Author contributions: Snyder N designed study, compiled and interpreted data, and wrote the paper; Martinez JG compiled and interpreted data and constructed tables; Xiao SY read the liver biopsies and contributed to the manuscript.
Supported by The grant from the National Center for Research Resources, NIH, USPHS, No. M01 RR 00073
Correspondence to: Ned Snyder, MD, 301 University, Department of Internal Medicine, Division of Gastroenterology, Galveston, Texas 77555-0764, United States. nesnyder@utmb.edu
Telephone: +1-409-7721501 Fax: +1-409-7724789
Received: July 25, 2008
Revised: September 16, 2008
Accepted: September 23, 2008
Published online: November 7, 2008
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Hepatitis C; Liver; Granulomas; Liver biopsy