Diagnosis: Sarcoidosis with Hepatic Granulomas
• When granulomas are seen in a liver biopsy specimen, the major differential diagnosis includes five conditions: sarcoidosis, tuberculosis, primary biliary cirrhosis (PBC), drug hepatotoxicity, and schistosomiasis.
The numerous etiologies of hepatic granulomas include infectious disorders, systemic diseases, and drug hepatotoxicity. Hepatitis C virus infection has also been associated with hepatic granulomas (including granuloma development after liver transplantation).
• The granulomas seen in sarcoidosis may have specific histopathologic features depending on the type of associated damage they produce in the liver parenchyma. Devaney et al. described categories of sarcoid-related liver disease, including hepatitic (associated with variable chronic portal and periportal inflammation that may mimic chronic hepatitis), biliary (wherein portal tracts show changes of bile duct obstruction or of bile duct loss resembling PBC), and vascular (wherein the granulomas impact on portal tract vascular structures).
• Sarcoidosis may lead to destruction of interlobular bile ducts and a clinical syndrome resembling PBC; sarcoidosis also may rarely result in cirrhosis and extensive confluent regions of fibrosis in the liver.
