Hepatic granuloma: Histologic pattern and possible causes

Granuloma histologic pattern	Possible causes	Other features
Noncaseating: Nonnecrotic	Sarcoidosis Primary biliary cholangitis Drug-induced injury	In the US, sarcoidosis and primary biliary cholangitis are common causes of noncaseating granuloma
Caseating: Areas of central necrosis	Tuberculosis Brucellosis Viral infections	In the US, tuberculosis is a common cause of caseating granuloma
Fibrin-ring: Epithelioid cells surround a vacuole that has an encircling fibrin-ring	Noninfectious: Hodgkin lymphoma, drug-induced injury Infectious: Q fever, Epstein-Barr virus, cytomegalovirus, toxoplasmosis, leishmaniasis
Lipogranuloma: Contains a central lipid vacuole	Mineral oil ingestion Hepatic steatosis	Typically not associated with symptoms

US: United States.

Adapted from: Choi EYK, Lamps LW. Granulomas in the liver, with a focus on infectious causes. Surg Pathol Clin 2018; 11:231.

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