Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Subject: Re: Sarcoidosis or something else?
Forum: The Gastroenterology and Liver Diseases Forum
Topic Area: Digestive
Posted by HFHSM.D.-D.M. on December 23, 1998 at 18:09:13:
In Reply to: Sarcoidosis or something else? posted by Jeanne on November 21, 1998 at 15:47:43:


In early October I had my gall bladder removed. The surgeon did not like the "look" of my liver so he did a biopsy. The result was: a) marked fatty change and b) Noncaseating granulomatous inflammation. The comment on the pathology report was: "The histology suggests sarcoidosis, however, similar granulomas could be seen in patients with ulcerative colitis. Primary biliary cirrhosis is a less likely possibility." I have seen a pulmonologist and he has done blood work and another chest x-ray which have come back normal. He has now ordered a gallium scan. He says if that test shows nothing, he will refer me to a gastro-enterologist.

The text from the Microscopic examination of the liver tissue is as follows:
"Sections examined at multiple levels show a segment of liver parenchyma exhibiting marked fatty change. Scattered throughout the parenchyma are multiple noncaseating granulomas. Although a few of these are associated with bile ducts, most are within the parenshyma and subcapsular. They show epithelioid histiocytes surrounded at their periphery with lymphocytes. Rare asteroid bodies are present within the histiocytes. No evidence of malignancy is present. Special stains are negative for acid fast bacilli and fungi."

I am wondering if at this point the gallium scan is necessary? Could this be something other than sarcoidosis? Should I go directly to a gastroenterologist and save the time and money?

______
Dear Jeanne:

Well, I have to admit you certainly have an interesting liver biopsy. I appreciate the opportunity to hear about your case and to comment on it.

First of all, I am very appreciative of youre typing in the actual report of the biopsy. I did not get a feel, however, if there was significant damage to the liver or early cirrhosis. It is one thing to have a granulomatous process in the liver. But it is also important to know if the process is damaging the liver.

A long list of things can cause granulomas in the liver, but the major ones are tuberculosis, sarcoid, drugs and primary biliary cirrhosis. It will be critical for you to get off any medications that can be discontinued safely. Secondly, it will be important for you to have a test called an anti-mitochondrial antibody (AMA) which is a good test for a disease called primary biliary cirrhosis. Finally, some effort should be made to make sure you do not have tuberculosis or some evidence of sarcoid. While the negative gallium scan has some meaning, no specific test rules out sarcoidosis.

All of this is going to require that you have an excellent physician and, at some point, I feel you are going to want to see a liver specialist. The most important thing, however, is that you identify an individual with some experience with granulomatous hepatitis and someone who is concerned with you care.

Good luck with youre situation. I hope this information is helpful to you. If you have additional questions or more information, feel free to post the material back to MEDHELP or you are always welcome to contact us directly at Henry Ford at (313) 916-8865. If you are in the Detroit area, we would always welcome to come see us. We have a very active group of liver specialists.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

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