SARCOIDOSIS OF THE LIVER AND BILE-DUCTS

In sarcoidosis, granulomas are frequently present in multiple organs, including the liver. Typically, epithelioid granulomas (noncaseating) are scattered throughout the liver, but confluent granulomas can be pr esent in cases with severe hepatic involvement. The characteristic inc lusions in giant cells (for example, Schaumann bodies and asteroid bod ies) are not seen in all cases and are not pathognomonic, The granulom as of sarcoidosis may heal without a trace, but confluent granulomas c an result in extensive, irregular scarring. Occlusion of intrahepatic portal vein branches by the granulomatous inflammation probably accoun ts for the development of portal hypertension in some cases. A granulo matous cholangitis leading to ductopenia seems to be the underlying pa thogenetic mechanism of the chronic cholestatic syndrome of sarcoidosi s. Recognition of this syndrome is important in the differential diagn osis of other chronic cholestatic diseases, such as primary biliary ci rrhosis or primary sclerosing cholangitis. Other rare complications of sarcoidosis are the Budd-Chiari syndrome and obstructive jaundice att ributable to hepatic hilar lymphadenopathy or strictures of the bile d ucts.