Abstract
We examined 1100 liver biopsy cases clinicopathologically and pathomorphologically to determine histological figures and pathogenesis of granulomatous lesions in hepatic tissue. The granulomatous lesions were histologically classified into 2 types, based on the presence of fatty droplets, such as lipogranuloma (LG) and non-lipogranuloma (NLG) . Each type was divided into 2 subtypes according to its elements, such as histiocytic subtype (HLG, HNLG) and epithelioid subtype (ELG, ENLG) . There were 69 cases of (6.3 %) granulomatous lesions : 51 cases of LG (36 of HLG, 15 of ELG), and 18 cases of ENLG. LG appeared frequently in alcoholic liver injury and hypernutritional fatty liver. NLG appeared frequently in PBC. LG was prominent in hepatic lobules such as pericentral vein areas, whereas ENLG was evident in portal areas. Relations between the degree of hepatocytic fatty degeneration and the cases of LG were parallel. From these findings, LG appeared to be the basis of hepatocytic fatty degeneration, and was considered to be an inflammatory reaction to ruptured fatty droplets. The ELG was larger than the HLG, and more histocytes were evident in the ELG than in the HLG. The serum transaminase level in ELG cases was higher than that in HLG cases. ELG was thus considered to react more actively than HLG. However, HNLG was thought to be the reactive change to necrotic lesions ; and ENLG was considered to be both direct reaction to necrotic lesions, and more complicated reaction, including immunoreaction.
