Eosinophilic granuloma of the liver - A characteristic lesion with relationship to visceral larva migrans

Children with the clinical syndrome of visceral larva migrans as a result o f Toxocara species have typical lesions in the liver and other viscera, con sisting of palisading granulomas that contain numerous eosinophils and ofte n Charcot-Leyden crystals; recognizable parasites are uncommon. Similar eos inophilic granulomas that are found incidentally in adults often cause diag nostic problems. To define better the clinical, laboratory, and pathologic features of these lesions, we reviewed 43 cases of hepatic eosinophilic gra nuloma (excluding cases of Langerhans' cell histiocytosis) collected in the files of the AFIP over a period of 31 years. The eosinophilic granulomas w ere found in patients of all ages (range 12 months to 77 years); 30% were y ounger than 20 years. There were 26 male and 17 female patients. Most patie nts (26 of 43; 60%) were asymptomatic, and the lesions were discovered inci dentally. Others had fever (20%) or abdominal pain (20%). The granulomas we re typically multiple (61%), with central necrosis surrounded by a mixed in flammatory infiltrate with numerous eosinophils and variable numbers of neu trophils, lymphocytes, and a palisade of epithelioid histiocytes and/or gia nt cells. Charcot-Leyden crystals were present in 19 cases (44%). Remnants of parasites (eight Toxocara sp., two Capillaria sp.) were identified in th e tissue in 10 patients. There was a positive serologic test for Toxocara s p. in five additional cases. Immunohistochemical staining using polyclonal antiserum against Toxocara canis larvae demonstrated positivity in macropha ges in eight of 13 cases tested. We conclude that identification of an eosi nophilic granuloma in the liver should suggest the diagnosis of visceral la rva migrans and prompt a search for the causative organism with serial sect ioning of the block and serologic tests for Toxocara and other causative pa rasites.