1
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Su R, Liu HN, Wang YB, Bai Y. Cirrhosis after pancreaticoduodenectomy for pancreatic cancer. Hepatobiliary Pancreat Dis Int 2024:S1499-3872(24)00107-3. [PMID: 39129077 DOI: 10.1016/j.hbpd.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/29/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Rui Su
- Graduate Academy, Hebei Medical University, Shijiazhuang 050017, China; Department of Geriatric Gastroenterology, Hebei General Hospital, Shijiazhuang 050000, China
| | - Hong-Na Liu
- Department of Geriatric Gastroenterology, Hebei General Hospital, Shijiazhuang 050000, China
| | - Yu-Bo Wang
- Department of Geriatric Gastroenterology, Hebei General Hospital, Shijiazhuang 050000, China; Graduate Academy, North China University of Science and Technology, Tangshan 063000, China
| | - Yun Bai
- Department of Geriatric Gastroenterology, Hebei General Hospital, Shijiazhuang 050000, China.
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2
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Iordache A, Fuursted K, Rift CV, Rasmussen A, Willemoe GL, Hasselby JP. Hepatic granulomas following liver transplantation: A retrospective survey, and analysis of possible microbiological etiology. Pathol Res Pract 2024; 255:155201. [PMID: 38367601 DOI: 10.1016/j.prp.2024.155201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Liver granulomas have always been a diagnostic challenge for pathologists. They have been described in up to 15% of liver biopsies and can also be seen in liver allograft biopsy specimens, but there is a paucity of information regarding the prevalence and associated etiologic factors of granulomas in liver transplanted patients. The aim of this study is to shed light on the etiology of liver granulomas. METHODS Liver biopsies from liver transplanted patients, in the period from 01.01.2011 - 01.05.2017, were examined. We registered the histo-morphological characteristics and clinicopathological data of all biopsies and performed next-generation sequencing (NGS) to detect possible pathogens (bacteria, fungi, and parasites) in the biopsies containing granulomas. RESULTS We reviewed a total of 400 liver biopsies from 217 liver transplant patients. Of these, 131 liver biopsies (32.8%) from 98 patients (45.2%) revealed granulomas. Most were epithelioid granulomas located parenchymal and were detected in 115 (87.7%) biopsies. We also identified 10 cases (7.6%) with both lobular and portal granulomas and six biopsies (4.5%) with portal granulomas alone. In 54 biopsies (41.2%), granulomas were found in biopsies with acute cellular rejection (ACR). Fifty (51%) patients with granulomas underwent liver transplantation for autoimmune-related end-stage liver disease (AILD). The granulomas were found most frequently in the first six months after transplantation, where patients also more often were biopsied. NGS analysis did not reveal any potential infectious agent, and no significant differences were observed in the microbiological diversity (microbiome) between clinical- and granuloma characteristics concerning bacteria, fungi, and parasites. CONCLUSION Our study confirmed that granulomas are frequently seen in liver allograft biopsy specimens, and most often localized in the parenchyma, occurring in the first post-transplant period in patients with AILD, and often seen simultaneously with episodes of ACR. Neither a specific microbiological etiological agent nor a consistent microbiome was detected in any case.
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Affiliation(s)
- Anisoara Iordache
- Department of Pathology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Kurt Fuursted
- Department of Microbiology and Infection Control, Reference Laboratory, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | | | - Allan Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Gro Linno Willemoe
- Department of Pathology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
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3
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Navarro Moreno E, Hallouch Toutouh S, Pinotchet S, Casado Martín M, Vega Sáenz JL. Hepatic focal lesions and constitutional syndrome, is it always cancer? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38305672 DOI: 10.17235/reed.2024.10195/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Hepatic focal lesions are a heterogeneous group of lesions that can be either benign or malignant in nature. They are typically diagnosed through ultrasound in all cases needing to rule out a metastatic nature. We present the case of a 51-year-old male from Morocco diagnosed with hepatic SOLs in the context of abdominal pain and constitutional syndrome.
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4
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Khalil A, Taha A. Hepatic Sarcoid-Like Reaction Mimicking Liver Metastases in a 36-Year-Old Female With Rheumatoid Arthritis. Cureus 2023; 15:e43974. [PMID: 37746507 PMCID: PMC10515738 DOI: 10.7759/cureus.43974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Hepatic and splenic sarcoidosis are still challenging issues for medical imaging, and in many cases, medical images can't exclude the most common mimic of sarcoidosis which is liver metastases; therefore, a liver biopsy is required. A young female patient who had rheumatoid arthritis presented to our hospital with abdominal pain, anorexia, and weight loss for the past three weeks. She was admitted to the acute medical ward and treated with intravenous fluid hydration for hypercalcemia. Her liver function tests were deranged (anicteric cholestasis picture), and her etanercept medication was stopped after being reviewed by the rheumatologist and gastroenterologist. She had a CT and MRI scan of the abdomen, an ultrasound (US) of the abdomen with enhanced contrast, and a positron emission tomography (PET) scan. The radiological findings could not exclude liver metastases, but an ultrasound-guided liver biopsy confirmed the finding of hepatic granulomatous changes of sarcoidosis. Her symptoms and hypercalcemia resolved, and her liver functions gradually normalized.
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Affiliation(s)
- Abdalla Khalil
- Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, GBR
- Acute Medicine, Princess Royal University Hospital, King's College NHS Foundation Trust, London, GBR
| | - Ahmed Taha
- Medical Imaging, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR
- Radiology, University of Manitoba, Winnipeg, CAN
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5
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Omachi K, Imai K, Nakao Y, Nakamura H, Kaida T, Shiraishi Y, Itoyama R, Nitta H, Hayashi H, Asato T, Mikami Y, Baba H. A surgical resection of hepatic granuloma mimicking intrahepatic cholangiocarcinoma: a case report. Int Cancer Conf J 2023; 12:195-199. [PMID: 37251010 PMCID: PMC10212907 DOI: 10.1007/s13691-023-00607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Hepatic granuloma is relatively rare, and benign tumor of the liver. Herein, we report an unusual case of hepatic granuloma mimicking intrahepatic cholangiocarcinoma (ICC). An 82-year-old woman with a history of viral hepatitis B was admitted for investigation of liver mass in the left lobe. Dynamic computed tomography revealed a mostly hypo-enhancing main tumor with a peripheral ring enhancement, and positron emission tomography demonstrated localized an abnormal accumulation of fludeoxyglucose. Considering the possibility of malignant disease, extended left hepatectomy was performed. The resected tumor was macroscopically a periductal infiltrating nodular type, 4.5 × 3.6 cm in diameter. The pathological findings showed that granuloma and coagulative necrosis were present, and diagnosis of hepatic granuloma was confirmed. Pathological studies demonstrated that periodic acid-Schiff stain, Grocott-Gomori stain and Ziehl-Neelsen stain were all negative in the lesion.
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Affiliation(s)
- Kazuki Omachi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Hiro Nakamura
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Takayoshi Kaida
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Yuta Shiraishi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Rumi Itoyama
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
| | - Tsuguharu Asato
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556 Japan
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6
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Horst LJ, Weidemann S, Lohse AW, Sebode M. [Hepatic granuloma-A diagnostic challenge]. Z Rheumatol 2022; 81:567-576. [PMID: 35763059 DOI: 10.1007/s00393-022-01235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Hepatic granulomas can have various causes and their detection requires a systematic diagnostic evaluation. First, identification of risk factors for granulomatous diseases and the exclusion of extrahepatic organ manifestation are necessary. Laboratory investigations and serological screening for the most common underlying diseases of liver granulomas in Germany, such as primary biliary cholangitis (PBC), sarcoidosis and infectious causes (primarily tuberculosis and hepatitis C infections), are recommended. A liver biopsy is essential for confirming the diagnosis, whereby a minilaparoscopically guided tissue sampling offers many advantages, such as the macroscopic detection of granulomas on the liver surface, on the peritoneum or on the spleen. Whether the detection of hepatic granulomas results in a therapeutic consequence, depends decisively on the underlying primary disease. If hepatic granulomas are present without concomitant liver parenchymal damage or other manifestations that would make treatment necessary, a watch and wait approach under close clinical and laboratory monitoring is sufficient. If liver values increase or in cases of hepatic parenchymal damage, urgent treatment of the underlying disease is indicated.
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Affiliation(s)
- Ludwig J Horst
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Europäisches Referenznetzwerk für seltene Lebererkrankungen (ERN RARE-LIVER), Hamburg, Deutschland
| | - Sören Weidemann
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ansgar W Lohse
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Europäisches Referenznetzwerk für seltene Lebererkrankungen (ERN RARE-LIVER), Hamburg, Deutschland
| | - Marcial Sebode
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Europäisches Referenznetzwerk für seltene Lebererkrankungen (ERN RARE-LIVER), Hamburg, Deutschland.
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7
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Over the Threshold: an Exercise in Clinical Reasoning. J Gen Intern Med 2022; 37:1290-1294. [PMID: 35075534 PMCID: PMC8971242 DOI: 10.1007/s11606-021-07206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
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8
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Agnello F, Rabiolo L, Midiri F, Lo Re G, Grassedonio E, La Grutta L, Buscemi S, Agrusa A, Galia M. Focal hepatic intrinsically hyperattenuating lesions at unenhanced CT: Not always calcifications. Clin Imaging 2021; 80:304-314. [PMID: 34482241 DOI: 10.1016/j.clinimag.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
Due to the growing use of CT, there has been an increase in the frequency of detecting focal liver lesions. Intrinsically hyperattenuating hepatic lesions or pseudolesions are not uncommon at unenhanced CT. Hyperattenuating hepatic lesions can be divided into non-calcified and calcified. Causes of intrinsic hyperattenuation include hemorrhage, thrombosis, and calcifications. Focal liver lesions can show hyperattenuation on unenhanced CT in case of severe liver steatosis. Recognition of etiologies associated with hyperattenuation on unenhanced CT can help the radiologist in characterizing focal liver lesions and pseudolesions. In this paper, we describe the spectrum of intrinsically hyperattenuating focal liver lesions and pseudolesions at unenhanced CT.
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Affiliation(s)
- Francesco Agnello
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Lidia Rabiolo
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Federico Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giuseppe Lo Re
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Emanuele Grassedonio
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy.
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9
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Hochegger A, Moret S, Geurts L, Gude T, Leitner E, Mertens B, O'Hagan S, Poças F, Simat TJ, Purcaro G. Mineral oil risk assessment: Knowledge gaps and roadmap. Outcome of a multi-stakeholders workshop. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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10
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Granuloma With an Underlying Lymphoma: A Diagnostic Challenge and a Wider Histologic Spectrum Including Adult T-Cell Leukemia/Lymphoma. Appl Immunohistochem Mol Morphol 2021; 28:316-324. [PMID: 30653030 DOI: 10.1097/pai.0000000000000731] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Granulomatous reaction is not uncommon in histopathology, with various etiologies in different organs and geographic regions. Lymphoma is one of the underlying causes of granuloma; and sometimes the neoplastic cells may be masked by the granulomatous reaction. In this report, we present our experience with 7 lymphoma cases of various histologic types with coexisting granuloma to show the diagnostic challenges. In all cases, a granulomatous reaction was simultaneously present with the neoplastic cells. The 7 cases included 3 cases of adult T-cell leukemia/lymphoma in the lymph node or skin including one coexisting with mycobacterial infection, 2 cases of classical Hodgkin lymphoma involving the liver, and 1 case each of systemic Epstein-Barr virus-positive peripheral T-cell lymphoma and a hepatic inflammatory pseudotumor-like follicular dendritic cell sarcoma. Three cases were initially misdiagnosed as reactive change or mycobacterial infection instead of lymphoma, and a wrong histologic lymphoma type was diagnosed in 1 case. In this report, we showed that granulomatous reaction might mask lymphomas of various histologic types; and a diagnosis of mycobacterial infection or sarcoidosis could not exclude the possibility of an underlying lymphoma. We emphasized the importance of detailed histologic examination with the aid of ancillary studies to reach a correct diagnosis and to avoid inappropriate management of the patients. Our study also broadened the spectrum of lymphoma types coexisting with granuloma.
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11
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Abstract
Gastrointestinal (GI) tuberculosis (TB) remains a significant problem worldwide, and may involve the luminal GI tract from oral cavity to perianal area in addition to associated viscera and peritoneum. Although GI TB more commonly affects immunocompromised hosts, it can also occur in immunocompetent people. Diagnosis is difficult because it usually mimics a malignancy or inflammatory bowel disease. A high index of clinical suspicion and appropriate use of combined investigative methods help in early diagnosis, and reduce morbidity and mortality. Anti-TB therapy is the same as for pulmonary disease, and invasive and specialized interventions are reserved for selected complications.
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Affiliation(s)
- Haluk Eraksoy
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, TR-34093 Istanbul, Turkey.
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12
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Sève P, Pacheco Y, Durupt F, Jamilloux Y, Gerfaud-Valentin M, Isaac S, Boussel L, Calender A, Androdias G, Valeyre D, El Jammal T. Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis. Cells 2021; 10:cells10040766. [PMID: 33807303 PMCID: PMC8066110 DOI: 10.3390/cells10040766] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022] Open
Abstract
Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25-50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren's syndrome, lupus pernio, Heerfordt's syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, 69007 Lyon, France
- Correspondence:
| | - Yves Pacheco
- Faculty of Medicine, University Claude Bernard Lyon 1, F-69007 Lyon, France;
| | - François Durupt
- Department of Dermatology, Lyon University Hospital, 69004 Lyon, France;
| | - Yvan Jamilloux
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
| | - Sylvie Isaac
- Department of Pathology, Lyon University Hospital, 69310 Pierre Bénite, France;
| | - Loïc Boussel
- Department of Radiology, Lyon University Hospital, 69004 Lyon, France
| | - Alain Calender
- Department of Genetics, Lyon University Hospital, 69500 Bron, France;
| | - Géraldine Androdias
- Department of Neurology, Service Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon University Hospital, F-69677 Bron, France;
| | - Dominique Valeyre
- Department of Pneumology, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne et Université Paris 13, Sorbonne Paris Cité, 93008 Bobigny, France;
| | - Thomas El Jammal
- Department of Internal Medicine, Lyon University Hospital, 69007 Lyon, France; (Y.J.); (M.G.-V.); (T.E.J.)
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13
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Wee J, Sobhi S, De Boer B, Xu D. Liver rheumatoid nodules imitating liver malignancy: a rare occurrence. BMJ Case Rep 2020; 13:13/12/e234366. [PMID: 33328208 DOI: 10.1136/bcr-2020-234366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 61-year-old man with a background of rheumatoid arthritis who presented to the emergency department with a single-reported episode of haemoptysis on the background of an upper respiratory tract infection. A CT scan revealed an incidental 40 mm mass in upper right lobe of the liver abutting the diaphragmatic surface. A subsequent positron emission tomography scan confirmed the mass and raised the possibility of another lesion in the liver raising the suspicion of malignancy. The case was complicated by the inability to perform a fine needle aspiration biopsy due to the mass' proximity to the diaphragm. After discussion with the patient, it was decided to resect the affected liver segment. Histological analysis of the mass revealed localised necrotising granulomatous inflammation suggestive of a rheumatoid nodule, which is seldom reported in the literature.
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Affiliation(s)
- Jason Wee
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Salar Sobhi
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Bastiaan De Boer
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.,Anatomical Pathology, PathWest Laboratory Medical WA, Murdoch, Western Australia, Australia
| | - Dan Xu
- School of Public Health, Curtin University Bentley Campus, Perth, Western Australia, Australia .,Medical Education, Sun Yan-sen University of Medical Sciences, Guangzhou, China
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14
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Bekki T, Yamamoto Y, Saeki Y, Arihiro K, Tanabe K, Ohdan H. Iatrogenic hepatic granuloma (suspected liver metastatic lesion on imaging) caused by liver retraction during laparoscopic gastrectomy: A case report. Clin Case Rep 2020; 8:2353-2357. [PMID: 33363739 PMCID: PMC7752566 DOI: 10.1002/ccr3.3100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
There are no previous reports of hepatic granuloma secondary to intraoperative liver retraction. Using softer hepatic retraction instruments and keeping hepatic retraction time to a minimum are vital in preventing postoperative liver damage.
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Affiliation(s)
- Tomoaki Bekki
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yuji Yamamoto
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Yoshihiro Saeki
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Koji Arihiro
- Department of PathologyHiroshima UniversityHiroshimaJapan
| | - Kazuaki Tanabe
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant SurgeryApplied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
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15
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Rais R, Chatterjee D, McHenry S, Byrnes K. Poorly formed hepatic granulomas: a rare manifestation of acute T cell-mediated rejection. Histopathology 2020; 77:847-848. [PMID: 32649778 DOI: 10.1111/his.14207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rehan Rais
- Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Deyali Chatterjee
- Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Scott McHenry
- Department of Internal Medicine, Division of Gastroenterology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Kathleen Byrnes
- Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO, USA
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16
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Rossi G, Ziol M, Roulot D, Valeyre D, Mahévas M. Hepatic Sarcoidosis: Current Concepts and Treatments. Semin Respir Crit Care Med 2020; 41:652-658. [PMID: 32777850 DOI: 10.1055/s-0040-1713799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatic sarcoidosis is a relatively common manifestation of extrapulmonary sarcoidosis. It occurs in 20 to 30% of cases and is rarely severe. However, a cluster of patients may develop severe complications such as cirrhosis and portal hypertension. In this review, we describe the current knowledge of clinical, biological, pathological, and radiological features of liver involvement in sarcoidosis and discuss essential clues for management and treatment.
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Affiliation(s)
- Geoffrey Rossi
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Marianne Ziol
- Service d'anatomopathologie, Centre Hospitalier Jean-Verdier, Bondy, France
| | - Dominique Roulot
- Service d'Hépatologie, Centre Hospitalier Universitaire Avicenne, Bobigny, France.,Service de Pneumologie, Centre Hospitalier Universitaire Avicenne, Université Sorbonne Paris Nord, APHP, Bobigny, France
| | - Dominique Valeyre
- Service de Pneumologie, Centre Hospitalier Universitaire Avicenne, Université Sorbonne Paris Nord, APHP, Bobigny, France
| | - Matthieu Mahévas
- Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
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17
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Bevan R, Harrison PTC, Jeffery B, Mitchell D. Evaluating the risk to humans from mineral oils in foods: Current state of the evidence. Food Chem Toxicol 2019; 136:110966. [PMID: 31751646 DOI: 10.1016/j.fct.2019.110966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
Key issues around the evaluation of risks to humans from mineral oils in food and feedstuffs are discussed. MOHs (MOAH and MOSH) occur in food due to intentional use, contamination from environmental sources and during transport/processing, or through migration from food contact materials. Problems in setting and enforcing human health guidelines for MOH include uncertainty around MOH toxicity and the specialist expertise needed for analysis of complex food matrices. Currently, the method of choice for measuring mineral oils is LC-GC-FID, however some complex food matrices also require additional analytical techniques to differentiate between some naturally occurring hydrocarbons and those from other sources, including of petrogenic origin. This requires the skills of an experienced analyst. Significant toxicological gaps for MOHs prevent robust human health risk assessment and the derivation of guidance values. As food-grade mineral oils are virtually MOAH-free, the key issue explored here is the relevance to humans of liver (micro)granulomas observed in F344 rats following oral intake. Available data suggest that despite the ubiquitous nature of MOH in the human diet, the prevalence of liver lipogranulomas in the population is low. These are not associated with inflammation and based on current evidence are not considered of human health significance.
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Affiliation(s)
- R Bevan
- IEH Consulting Ltd, Nottingham, UK.
| | | | - B Jeffery
- Mars Global Food Safety Center, Beijing, PR China
| | - D Mitchell
- Mars Global Food Safety Center, Beijing, PR China
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18
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Hepatic Silicone Granulomas Secondary to Ruptured Breast Implants: A Report of Two Cases. Case Reports Hepatol 2019; 2019:7348168. [PMID: 31781428 PMCID: PMC6875346 DOI: 10.1155/2019/7348168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/24/2019] [Indexed: 11/18/2022] Open
Abstract
The differential diagnosis of hepatic granulomas is vast and includes infections, drugs, immunologic diseases, foreign material exposure, and neoplasia. Silicone, whether directly injected into tissues or used as a filler in breast implants, is known to cause localized granulomatous reactions. It can also migrate to other anatomic locations resulting in granulomatous inflammation at a distance. We report two cases of unsuspected hepatic silicone granulomas in patients undergoing liver biopsy for isolated elevated alkaline phosphatase levels, both with a history of ruptured breast implants. These cases highlight the need for awareness of hepatic silicone granulomas as an etiology of elevated liver enzymes in patients with a history of surgical interventions utilizing silica, such as cosmetic surgery.
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19
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Aldyab M, Ells PF, Bui R, Chapman TD, Lee H. Kratom-Induced Cholestatic Liver Injury Mimicking Anti-Mitochondrial Antibody-Negative Primary Biliary Cholangitis: A Case Report and Review of Literature. Gastroenterology Res 2019; 12:211-215. [PMID: 31523332 PMCID: PMC6731044 DOI: 10.14740/gr1204] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
Kratom is an herbal supplement used to relieve chronic pain or opioid withdrawal symptoms. Recent news articles covering adverse effects associated with kratom use have brought attention to its organ toxicities. Reports of kratom-induced hepatic toxicity are limited and only three case reports of kratom-induced liver injury with histopathologic examination of the liver biopsies are available. A 40-year-old female presented with symptoms of mixed cholestatic and hepatocellular liver injury without clear etiology. The laboratory and imaging workup suggested possibilities of autoimmune hepatitis, autoimmune hepatitis-primary biliary cholangitis (PBC) overlap syndrome, or drug-induced liver injury. Autoantibodies including anti-mitochondrial antibody (AMA) were negative. Liver biopsy showed granulomatous hepatitis with prominent duct injury, suggestive of AMA-negative PBC. She subsequently was referred to a hepatologist and a history of recent kratom use was finally revealed. Kratom was discontinued and the symptoms improved. Kratom-induced hepatic toxicity may manifest with variable biochemical and clinical abnormalities. Histologically, it may mimic AMA-negative PBC. Our case highlights the importance of thorough history taking, interdisciplinary approach and communication for optimal patient care.
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Affiliation(s)
- Mahmoud Aldyab
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY 12208, USA
| | - Peter F Ells
- Gastroenterology, Albany Medical College, Albany, NY 12208, USA
| | - Rosa Bui
- Gastroenterology, Albany Medical College, Albany, NY 12208, USA
| | | | - Hwajeong Lee
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY 12208, USA
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20
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Altınay L, Coşkun E, Tekin A, Tütün U. Epicardial anthracosis in a patient undergoing coronary artery bypass graft surgery. Am J Ind Med 2018; 61:1005-1007. [PMID: 30367815 DOI: 10.1002/ajim.22915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 11/06/2022]
Abstract
Anthracosis is an occupational disease which is caused by long-term inhalation of coal and rock dust. We present a case of epicardial anthracosis in a patient who underwent coronary artery bypass graft surgery for coronary artery disease. This is the first case of anthracosis related to the heart in the literature to the best of our knowledge. This case report emphasizes the systemic dissemination of inorganic particles such as carbon in the human body.
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Affiliation(s)
- Levent Altınay
- Faculty of Medicine, Department of Cardiovascular Surgery; Bülent Ecevit University; Zonguldak Turkey
| | - Elif Coşkun
- Faculty of Medicine, Department of Cardiovascular Surgery; Bülent Ecevit University; Zonguldak Turkey
| | - Anıl Tekin
- Faculty of Medicine, Department of Cardiovascular Surgery; Bülent Ecevit University; Zonguldak Turkey
| | - Ufuk Tütün
- Faculty of Medicine, Department of Cardiovascular Surgery; Bülent Ecevit University; Zonguldak Turkey
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21
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Abstract
Hepatic granulomas are encountered in approximately 2% to 10% of liver biopsies. There are many potential infectious and noninfectious causes; granulomas can be generally classified by their morphology, which may be helpful in refining the differential diagnosis. This article provides a review of hepatic granulomas with an emphasis on infectious causes.
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Affiliation(s)
- Eun-Young Karen Choi
- Department of Pathology, University of Michigan, University of Michigan, 5231B Medical Science I, 1301 Catherine Street, SPC 5602, Ann Arbor, MI 48109, USA.
| | - Laura W Lamps
- Department of Pathology, University of Michigan, University of Michigan, 5231B Medical Science I, 1301 Catherine Street, SPC 5602, Ann Arbor, MI 48109, USA
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22
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Gaspar R, Andrade P, Silva M, Peixoto A, Lopes J, Carneiro F, Liberal R, Macedo G. Hepatic granulomas: a 17-year single tertiary centre experience. Histopathology 2018; 73:240-246. [PMID: 29603759 DOI: 10.1111/his.13521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/22/2018] [Indexed: 01/08/2023]
Abstract
AIMS 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. METHODS AND RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Rui Gaspar
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Patricia Andrade
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joanne Lopes
- Pathology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fatima Carneiro
- Pathology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto (Ipatimup, and i3S-Instituto de Investigação e Inovação em Saúde), Universidade do Porto, Porto, Portugal
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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23
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Yan YQ, Su ZB, Zheng ZY. Disseminated granulomatous hepatitis: A case. Shijie Huaren Xiaohua Zazhi 2017; 25:2825-2828. [DOI: 10.11569/wcjd.v25.i31.2825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Disseminated granulomatous hepatitis is a form of multifocal, disseminated epithelioid granulomatous hepatitis. Granulomatous hepatitis is mostly caused by infection and rarely observed in non-infectious diseases. At present, there have been very few reports of disseminated granulomatous hepatitis in China. Here we report a case of disseminated granuloma hepatitis and analyze its clinical and pathological characteristics and etiology, with an aim to enhance the awareness of this condition.
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Affiliation(s)
- Yong-Qin Yan
- Department of Pathology, Fuzhou General Hospital of Chinese PLA, Fuzhou 350025, Fujian Province, China
| | - Zhe-Bin Su
- Department of Pathology, Fuzhou General Hospital of Chinese PLA, Fuzhou 350025, Fujian Province, China
| | - Zhi-Yong Zheng
- Department of Pathology, Fuzhou General Hospital of Chinese PLA, Fuzhou 350025, Fujian Province, China
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24
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Adenuga D, Goyak K, Lewis RJ. Evaluating the MoA/human relevance framework for F-344 rat liver epithelioid granulomas with mineral oil hydrocarbons. Crit Rev Toxicol 2017; 47:750-766. [DOI: 10.1080/10408444.2017.1319336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- David Adenuga
- ExxonMobil Biomedical Sciences, Inc., Annandale, NJ, USA
| | - Katy Goyak
- ExxonMobil Biomedical Sciences, Inc., Annandale, NJ, USA
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25
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Affiliation(s)
- Rabih Geha
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
| | - Marion Peters
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
| | - Ryan M Gill
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
| | - Gurpreet Dhaliwal
- From the Division of Gastroenterology (M.P.), Department of Medicine (R.G., M.P., G.D.), and the Department of Pathology (R.M.G.), University of California, San Francisco, and Medical Service, San Francisco Veterans Affairs Medical Center (G.D.) - both in San Francisco
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26
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Paone G, Perriard-Noetzold U, Giovanella L. A rare case of idiopathic granulomatous hepatitis presenting as tumoral lesion detected by 18F-FDG-PET/CT. Ann Hepatol 2016; 15:121-2. [PMID: 26626647 DOI: 10.5604/16652681.1184286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Gaetano Paone
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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27
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Culver EL, Watkins J, Westbrook RH. Granulomas of the liver. Clin Liver Dis (Hoboken) 2016; 7:92-96. [PMID: 31041038 PMCID: PMC6490265 DOI: 10.1002/cld.544] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/10/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
- Emma L. Culver
- Sheila Sherlock Liver CentreRoyal Free HospitalLondonUnited Kingdom
| | - Jennifer Watkins
- Department of HistopathologyRoyal Free HospitalLondonUnited Kingdom
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28
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Abstract
CONTEXT Many diseases that cause granulomas or granulomatous inflammation involve the liver. Some of these disease processes are intrinsic hepatic diseases, whereas others are disseminated systemic diseases that involve the liver as well as other organs. OBJECTIVE To review the evaluation of granulomas in the liver with an emphasis on infectious causes, as well as the use of special stains, serologic studies, and molecular diagnostic techniques. Pertinent noninfectious causes of hepatic granulomas that are in the differential diagnosis are also discussed. DATA SOURCES Literature review and cases acquired during years of practice. CONCLUSIONS A wide variety of infectious and noninfectious entities cause hepatic granulomas.
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Affiliation(s)
- Laura W Lamps
- From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
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29
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30
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Stelzer T, Kohler S, Marques Maggio E, Heuss LT. An unusual cause of febrile hepatitis. BMJ Case Rep 2015; 2015:bcr-2014-205857. [PMID: 26113581 DOI: 10.1136/bcr-2014-205857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We describe the case of a 51-year-old man with recently diagnosed ulcerative colitis who developed fever and elevated liver enzymes as well as cholestasis a few weeks after starting treatment with mesalazine. As no obvious cause was found and fever persisted, liver biopsy was performed and revealed granulomatous hepatitis. The patient recovered completely after cessation of mesalazine, so that a drug-induced granulomatous hepatitis after exclusion of other differential diagnoses in an extensive work up was assumed. The present case demonstrates that even though drug-induced liver injury due to mesalazine is rare, it should be considered in unclear cases and lead to prompt discontinuation of mesalazine.
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Affiliation(s)
- Teresa Stelzer
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Sibylle Kohler
- Department of Endocrinology, University Hospital Zurich, Zurich, Switzerland
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31
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A case of typhoid Fever with hepatic granulomas and enteritis. Case Rep Pathol 2015; 2015:745461. [PMID: 25699196 PMCID: PMC4324953 DOI: 10.1155/2015/745461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 01/12/2015] [Indexed: 11/17/2022] Open
Abstract
The common histopathologic hepatic manifestations in patients infected with Salmonella include cloudy swelling and balloon degeneration with vacuolation of the hepatocytes and steatosis. Hepatic granulomas are a very rare finding, so far reported in very few cases. We report a 64-year-old patient with Salmonella enteritis who was found to have multiple 1.4 to 1.6 cm hypoechoic liver masses on ultrasound of the abdomen which on biopsy revealed hepatic granulomas. This case highlights the importance of keeping the differential diagnosis of Salmonella typhi (S. typhi) in mind in a patient with hepatic granulomas.
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32
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Paul S, Sepehr GJ, Weinstein B, Roper J. Co-occurrence of idiopathic granulomatous hepatitis and primary biliary cirrhosis. Dig Dis Sci 2014; 59:2831-5. [PMID: 25108519 DOI: 10.1007/s10620-014-3216-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 05/12/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND PBC is an autoimmune disease affecting the bile ducts. Granulomas can be found in portal triads in 45 % of patients with PBC. Idiopathic granulomatous hepatitis is a rare disease of unknown cause which is characterized by recurrent fevers, sweats, elevated levels of liver enzyme tests, particularly the serum alkaline phosphatase, and granulomas in the portal and lobular regions of the liver. Previous literature suggests that a diagnosis of idiopathic granulomatous hepatitis can be made only if PBC has been excluded. STUDY We reviewed instances in which PBC and idiopathic granulomatous hepatitis occurred in the same patient. RESULTS We report three patients in whom both diseases occurred: 1) A patient with PBC who was diagnosed 15 years later with idiopathic granulomatous hepatitis; 2) A patient with idiopathic granulomatous hepatitis who developed PBC 12 years later; and 3) A patient who had features of both idiopathic granulomatous hepatitis and PBC at the time of initial diagnosis. CONCLUSIONS Our experience with these patients suggests that idiopathic granulomatous hepatitis and PBC can occur in the same individual. Knowing this association is important, as clinical deterioration in a patient with either disease could suggest the presence of the other and should be treated accordingly.
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Affiliation(s)
- Sonali Paul
- Division of Gastroenterology and Hepatology, Tufts Medical Center, 800 Washington Street, Box #233, Boston, MA, 02111, USA,
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33
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Barp L, Kornauth C, Wuerger T, Rudas M, Biedermann M, Reiner A, Concin N, Grob K. Mineral oil in human tissues, Part I: Concentrations and molecular mass distributions. Food Chem Toxicol 2014; 72:312-21. [DOI: 10.1016/j.fct.2014.04.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/10/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
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34
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Baptista MA, Lo DS, Hein N, Hirose M, Yoshioka CRM, Ragazzi SLB, Gilio AE, Ferronato AE. Cat-scratch disease presenting as multiple hepatic lesions: case report and literature review. Autops Case Rep 2014; 4:43-48. [PMID: 28580326 PMCID: PMC5448301 DOI: 10.4322/acr.2014.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/10/2014] [Indexed: 11/23/2022]
Abstract
Although infectious diseases are the most prevalent cause of fevers of unknown origin (FUO), this diagnosis remains challenging in some pediatric patients. Imaging exams, such as computed tomography (CT) are frequently required during the diagnostic processes. The presence of multiple hypoattenuating scattered images throughout the liver associated with the history of cohabitation with cats should raise the suspicion of the diagnosis of cat-scratch disease (CSD), although the main etiologic agent of liver abscesses in childhood is Staphylococcus aureus. Differential diagnosis by clinical and epidemiological data with Bartonella henselae is often advisable. The authors report the case of a boy aged 2 years and 9 months with 16-day history of daily fever accompanied by intermittent abdominal pain. Physical examination was unremarkable. Abdominal ultrasound performed in the initial work up was unrevealing, but an abdominal CT that was performed afterwards disclosed multiple hypoattenuating hepatic images compatible with the diagnosis of micro abscesses. Initial antibiotic regimen included cefotaxime, metronidazole, and oxacillin. Due to the epidemiology of close contact with kittens, diagnosis of CSD was considered and confirmed by serologic tests. Therefore, the initial antibiotics were replaced by clarithromycin orally for 14 days followed by fever defervescence and clinical improvement. The authors call attention to this uncommon diagnosis in a child presenting with FUO and multiple hepatic images suggestive of micro abscesses.
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Affiliation(s)
- Mariana Andrade Baptista
- Department of Pediatrics - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Denise Swei Lo
- Department of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Noely Hein
- Department of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Maki Hirose
- Department of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Selma Lopes Betta Ragazzi
- Department of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Alfredo Elias Gilio
- Department of Pediatrics - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil.,Department of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Angela Esposito Ferronato
- Department of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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35
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Tadros M, Forouhar F, Wu GY. Hepatic Sarcoidosis. J Clin Transl Hepatol 2013; 1:87-93. [PMID: 26357609 PMCID: PMC4521279 DOI: 10.14218/jcth.2013.00016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 12/20/2022] Open
Abstract
Sarcoidosis is a multisystem disease characterized by the presence of non-caseating granulomas in affected organs. Pulmonary involvement is the most common site of disease activity. However, hepatic involvement is also common in sarcoidosis, occurring in up to 70% of patients. Most patients with liver involvement are asymptomatic. Therefore, the majority of cases are discovered incidentally, frequently by the finding of elevated liver enzymes. Pain in the right upper quadrant of the abdomen, fatigue, pruritus, and jaundice may be associated with liver involvement. Portal hypertension and cirrhosis are complications linked to long-standing hepatic sarcoidosis. Liver biopsy is usually required to confirm the diagnosis. It is important to differentiate hepatic sarcoidosis from other autoimmune and granulomatous liver diseases. Not all cases of hepatic sarcoidosis require treatment. For symptomatic patients, the first line treatment includes corticosteroids or ursodeoxycholic acid. Various immunosuppressant agents can be used as second line agents. Rarely, severe cases require liver transplantation.
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Affiliation(s)
- Micheal Tadros
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Faripour Forouhar
- Department of Anatomic Pathology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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36
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de Melo Braga G, Hessel G, Pereira RM, Escanhoela CAF. Hepatic involvement in paediatric patients with paracoccidioidomycosis: a histological study. Histopathology 2013; 64:256-62. [PMID: 24117867 DOI: 10.1111/his.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/29/2013] [Indexed: 12/01/2022]
Abstract
AIM Paracoccidioidomycosis is a systemic mycosis that is endemic to certain countries in Latin America. This study aimed to describe the histological features of liver involvement in patients with paracoccidioidomycosis aged <16 years of age who were treated between 1980 and 2010, with a diagnosis that was confirmed by detection of the fungus by pathological examination. METHODS AND RESULTS Liver tissue was obtained from one necropsy and 12 biopsies. Throughout 2007, biopsies were taken from patients with persistent jaundice or portal hypertension, after which biopsies became indicated due to elevated aminotransferase and low albumin levels. Using haematoxylin and eosin (H&E), Masson's trichrome and immunohistochemical (CK7 and CK19) staining, we noted degenerative alterations in bile duct cells and inflammatory injury to the bile ducts in 10 biopsies. Using immunohistochemistry for CK7 and CK19, we observed ductal proliferation in all 12 samples. CONCLUSIONS Bile duct injuries by inflammatory cells might explain the predominant increase in canalicular enzymes; immunohistochemistry is more sensitive in demonstrating ductular reactions and might show changes that are not apparent on H&E staining.
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Affiliation(s)
- Giselle de Melo Braga
- Center for Investigation in Pediatrics, UNICAMP School of Medicine, Campinas, Brazil
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37
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Kanhere HA, Trochsler MI, Pierides J, Maddern GJ. Atypical mycobacterial infection mimicking metastatic cholangiocarcinoma. J Surg Case Rep 2013; 2013:rjt038. [PMID: 24964448 PMCID: PMC3813460 DOI: 10.1093/jscr/rjt038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mycobacterial infections are rare in developed countries. Isolated involvement of the liver and biliary tree by mycobacterial infection is extremely rare. We report a case of a 45-year-old Caucasian female presenting with obstructive jaundice with a common bile duct stricture and multiple hypodense liver lesions raising suspicion of a metastatic cholangiocarcinoma. Percutaneous core biopsies of the liver lesions however suggested granulomatous process and histology at surgical excision confirmed this finding. Atypical mycobacteria (M. abcessus) sensitive to Amikacin were cultured from the surgical specimen proving the diagnosis. With the resurgence of tubercular and atypical mycobacterial infections in the developed world, it is important not to overlook these in differential diagnosis of various malignancies.
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Affiliation(s)
- Harsh A Kanhere
- Division of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Markus I Trochsler
- Division of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - John Pierides
- Department of Surgical Pathology, Institute of Medical and Veterinary Sciences, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Guy J Maddern
- Division of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
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38
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Guarner J. Detection of microorganisms in granulomas that have been formalin-fixed: review of the literature regarding use of molecular methods. SCIENTIFICA 2012; 2012:494571. [PMID: 24278704 PMCID: PMC3820445 DOI: 10.6064/2012/494571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 06/02/2023]
Abstract
Granuloma is an organized aggregate of immune cells that under the microscope appear as epithelioid macrophages. A granuloma can only be diagnosed when a pathologist observes this type of inflammation under the microscope. If a foreign body or a parasite is not observed inside the granuloma, stains for acid-fast bacilli and fungi are ordered since mycobacteria and fungi are frequently the cause of this type of inflammation. It is calculated that 12 to 36% of granulomas do not have a specific etiology and many have wondered if with new molecular methods we could reduce this number. This paper will summarize the frequently known causes of granulomas and will present the recent literature regarding the use of molecular techniques on tissue specimens and how these have helped in defining causative agents. We will also briefly describe new research regarding formation and function of granulomas and how this impacts our ability to find an etiologic agent.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA
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Bieze M, Bioulac-Sage P, Verheij J, Balabaud C, Laurent C, van Gulik TM. Hepatocellular adenomas associated with hepatic granulomas: experience in five cases. Case Rep Gastroenterol 2012. [PMID: 23185149 PMCID: PMC3506110 DOI: 10.1159/000343434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We present five cases in whom two rare entities were simultaneously found within the liver, i.e. hepatocellular adenomas (HCAs) and granulomas. Coexistence of both entities confuses diagnosis. Our aim is to disclose the association between HCA and hepatic granulomas. Five patients presented with HCA for which they underwent resection. During laparotomy or at pathological examination, granulomas were found in tumorous and non-tumorous tissue. No specific cause for the granulomas was found. Immunohistochemistry showed overexpression of C-reactive protein and serum amyloid A in 4/5 patients, classifying these lesions as inflammatory HCA. HCA and especially the inflammatory subtype may cause formation of granulomas in (peri-)tumorous tissue as a local response to persistent inflammation and/or the presence of a tumor. Both HCA and hepatic granulomas have also been associated with oral contraceptive use. In conclusion, HCAs associated with hepatic granulomas derive from a local response to (inflammatory) HCA or neoplasm, chronic use of oral contraceptives, or a combination of these factors.
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Affiliation(s)
- Matthanja Bieze
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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40
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You Z, Wang Q, Bian Z, Liu Y, Han X, Peng Y, Shen L, Chen X, Qiu D, Selmi CF, Gershwin ME, Ma X. The immunopathology of liver granulomas in primary biliary cirrhosis. J Autoimmun 2012; 39:216-21. [PMID: 22727562 PMCID: PMC3558985 DOI: 10.1016/j.jaut.2012.05.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 05/24/2012] [Accepted: 05/24/2012] [Indexed: 02/07/2023]
Abstract
Liver granulomas and elevated serum IgM are commonly observed in patients with primary biliary cirrhosis (PBC) but their pathogenetic significance remains largely unknown. To address this issue we performed an extensive immunostaining and colocalization study of markers associated with dendritic cells and IgM in a large cohort of tissue samples from PBC and control livers as well as from non-hepatic granulomatous diseases. First, the classical dendritic cell CD11c marker is highly expressed and more sensitive than classical hematoxylin-eosin staining in detecting granulomas associated with PBC and other conditions. Second, PBC cases with CD11c-positive granulomas have significantly higher serum IgM levels and earlier disease stages. Third, granulomas from PBC and other diseases demonstrate markers of dendritic cell immaturity, i.e. CD11b, reduced MHC II, IL-23, CCR7 and CD83 expression, and elevated C1q expression. Lastly, B cells and IgM-positive plasma cells are largely represented around PBC granulomas along with macrophages. In conclusion, our comprehensive immunohistochemical study suggests that dendritic cells are key to the pathogenesis of granulomas, regardless of their origin. More specifically, PBC liver granulomas may result from the interaction between immature dendritic cells and IgM.
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Affiliation(s)
- Zhengrui You
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Qixia Wang
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Zhaolian Bian
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yuan Liu
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiaofeng Han
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yanshen Peng
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Lei Shen
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiaoyu Chen
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Dekai Qiu
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Carlo F. Selmi
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M. Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Xiong Ma
- Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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41
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Mannion M, Zolak M, Kelly DR, Beukelman T, Cron RQ. Sarcoidosis in a young child with Alagille syndrome: a case report. Pediatr Rheumatol Online J 2012; 10:32. [PMID: 22937766 PMCID: PMC3599400 DOI: 10.1186/1546-0096-10-32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/20/2012] [Indexed: 12/14/2022] Open
Abstract
We report a now 6-year-old African-American male with both Alagille syndrome and pediatric sarcoidosis. With a prior JAG1 mutation positive diagnosis of Alagille syndrome, he presented to the hospital with a subacute, predominantly respiratory febrile condition, eventually diagnosed as sarcoidosis. A liver biopsy revealed paucity of bile ducts and scattered epithelioid granulomas, while a skin biopsy showed granulomatous angiitis, a manifestation of sarcoidosis not yet reported in a pediatric patient. He has subsequently been treated with corticosteroids, mycophenolate mofetil, and infliximab with clinical response. Alagille syndrome and sarcoidosis have not yet been reported in the medical literature in the same patient to the best of our knowledge. We briefly review these two seemingly unrelated conditions and propose a possible common pathogenic mechanism.
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Affiliation(s)
- Melissa Mannion
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Mem Zolak
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David R Kelly
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy Beukelman
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Randy Q Cron
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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43
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Disseminated sarcoidosis presenting as granulomatous gastritis: a clinical review of the gastrointestinal and hepatic manifestations of sarcoidosis. J Clin Gastroenterol 2012; 46:367-74. [PMID: 22334224 DOI: 10.1097/mcg.0b013e318247106b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Commonly considered a pulmonary disease, sarcoidosis is actually a multisystemic granulomatous disorder of unclear etiology. There is a wide range of organ system involvement, with gastrointestinal being among the rarest. We describe the diagnostic challenge of a patient presenting with gastritis without pulmonary complaints who was later found to have extrathoracic disseminated sarcoidosis. This case highlighted both the variability in the presentation of the disease and difficulties in its diagnosis. We performed a literature review to identify studies published on gastrointestinal and hepatic sarcoidosis to better understand the characteristics of this disease and help in the differentiation between other commonly encountered disorders that may be mimicked in presentation. We have also created a diagnostic approach that can be applied when endoscopic or hepatic biopsies reveal granulomas. We anticipate that this review may be useful for clinicians who face these diagnostic dilemmas and management decisions for this complex and variable condition.
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