A histological analysis of granulomatous hepatitis

A study has been made of 33 cases of granulomatous hepatitis. Of these, 12 were eventually established as cases of sarcoidosis, nine as cases of tuberculosis, and four as examples of primary biliary cirrhosis. No clinical diagnosis was ever reached in six cases. Analysis of the histological features of these cases shows that the presence of caseation or of tubercle bacilli will only allow for the diagnosis of approximately 50% of cases of tuberculosis. Histological features which are suggestive of tuberculosis are a paucity of granulomata, a scantiness of giant cells, a relatively mild surrounding chronic inflammatory cell infiltrate, and an absence of reticulin. The granulomata are more likely to be due to sarcoidosis if they are numerous, contain many giant cells, are confined to the portal areas, and show a well marked surrounding non-specific chronic inflammatory cell infiltrate. Histological features of cases in which no clinical diagnosis was reached suggest that they are more likely to be due to sarcoidosis than to tuberculosis.