GRANULOMATOUS CHOLANGITIS IN CHRONIC HEPATITIS-C - A NEW DIAGNOSTIC PROBLEM IN LIVER PATHOLOGY

A case of chronic hepatitis C at the pre-cirrhotic stage complicated w ith hepatocellular carcinoma is reported, The patient, a 64 year old f emale, showed elevated levels of serum alkaline phosphatase and immuno globulin M. Antimitochondrial antibodies were negative by indirect imm unofluorescence. Western blotting using beef heart mitochondria and re combinant polypeptides coding for mitochondrial antigens revealed that the patient's serum was positive only for the E2-subunit of the branc hed chain ketoacid dehydrogenase complex, In the non-neoplastic liver, chronic nonsuppurative cholangitis surrounded by epithelioid granulom a, resembling the granulomatous destructive cholangitis of primary bil iary cirrhosis, was found, The damaged bile ducts were immunohistochem ically minimally positive or ambiguous for HLA-DR, and their expressio n of the E2-subunit of the pyruvate dehydrogenase complex E2 (PDC-E2) was diffuse or granular, and not typical of primary biliary cirrhosis, There was no bile duct loss, and orcein-positive copper binding granu les reflecting chronic cholestasis were negative in periportal hepatoc ytes, The overall features in this case were consistent with primary b iliary cirrhosis presenting an infrequent profile of antimitochondrial antibodies and atypical expression of HLA-DR and PDC-E2 on biliary ep ithelial cells, with late superimposition on chronic hepatitis C, Howe ver, it is also possible that this is a case of chronic hepatitis C wi th hepatitis-associated bile duct damage accompanied by granulomatous reaction, Either way, this case raises new diagnostic issues in the di fferential diagnosis of chronic liver diseases presented with granulom atous cholangitis.