Primary biliary cirrhosis with multinucleated giant cells and intralobular granuloma formation -Report of two cases-

Abstract

Two cases of primary biliary cirrhosis (PBC) with giant cell granuloma and intralobular granuloma formation were reported. Case 1 was a 35 year-old woman, who presented with bleeding from esophageal varices and splenomegaly. Anti-mitochondrial antibody (AMA) was strongly positive and elevated IgM (1599mg/dl) was noted. Histological examination of surgical biopsy revealed typical chronic non-suppurative desctructive cholangitis (CNSDC) and non-caseating granulomas with giant cells were noted in the portal zones. Case 2 was a 56 year-old woman, who was admitted to our hospital because of cholecystolithiasis. High level of alkaline phosphatase (344 IU/l) and positive AMA suggested the presence of PBC.
Surgical biopsy showed typical CNSDC and well-defined epitheloid cell granulomas were noted adjacent to central vein as well as in the portal tracts. Of the twelve cases of PBC experienced in our laboratory two showed granulomas both in the portal area and in the intralobular parenchyma. A large specimen by surgical wedge biopsy and examination by serial section was thought to be useful in detecting granulomas in PBC.