HEPATIC GRANULOMAS IN CHILDREN - A CLINICOPATHOLOGICAL ANALYSIS OF 23CASES INCLUDING POLYMERASE CHAIN-REACTION FOR HISTOPLASMA

In a 15-year period at the Riley Hospital for Children, granulomas wer e found in 23 (4%) of a total of 521 liver biopsies. An etiology was i dentified in 87%: Histoplasma was diagnosed in 15 cases (65%) by polym erase chain reaction (PCR) on paraffin-embedded tissue, serology, and special stains; sarcoidosis was diagnosed in four cases; and schistoso miasis was diagnosed in one case. Serial liver biopsies were available from five patients; granulomas occurred in only one biopsy of the ser ies from each patient. Extrahepatic tissue from six patients contained granulomas, and an etiology for the liver granulomas was identified i n all six patients (four histoplasmosis, two sarcoidosis). The extrahe patic tissue from two patients with Histoplasma was diagnostic. We mad e the following conclusions: that PCR is applicable to archival materi al and greatly increases the yield of specific infectious diagnoses of liver granulomas compared with conventional diagnostic methods (65 ve rsus 22%); that the infections causing liver granulomas are those that are endemic in a community (e.g., Histoplasma in Indiana); that Histo plasma can coexist with a wide variety of systemic and primary liver d iseases; that the likelihood of identifying a cause of liver granuloma s is increased if there are extrahepatic granulomas; and that hepatic granulomas may have a limited life span. Treatment of liver granulomas should be determined by the clinical setting and directed at the unde rlying cause.