The number of granulomas and loosely arranged epithelioid cell foci in wedge liver biopsy specimens of 39 patients with primary biliary cirrhosis were counted and correlated with other hepatic lesions. Granulomas and cell foci were present in 76.9 and 87.2% of the patients, respectively; their numbers varied greatly from case to case (mean f S.D.: 2.4 k 3.4 per cm2 and 4.7 2 5.5 per cm2 of liver section; range: 0 to 18.5 per cm2 and 0 to 23.3 per cm2, respectively) and decreased as bile duct loss progressed. There was positive correlation between the number of cell foci with the extent of florid duct lesions, and negative correlation with hepatic fibrosis and deposition of copper granules.
Hepatic granulomas are associated with many types of liver disorders (1, 2) and are diagnostically useful in primary biliary cirrhosis (PBC) because of frequent occurrence around affected bile ducts (3) with or without a florid lesion. Typical granulomas occur in the liver of asymptomat,ic patients (4). Recently, PBC patients with hepatic granulomas were reported to have a better survival (5).
To evaluate the significance of the number of granulomas in PBC, a correlation study between the number of granulomas and other hepatic lesions, especially the degree of bile duct disappearance, was performed.
Methods
Wedge biopsies from 39 patients with histologic and clinical diagnosis of PBC (Table 1) were obtained from several institutions in Japan. The patients ranged from 28 to 70 years old; 37 were females. No patient had been treated with D-penicillamine or azathioprine before laparotomy for diagnostic surgical liver biopsy. Pruritus and/or jaundice were present in 20 cases. Antimitochondrial antibodies (AMAs) were found in 31 of 37 patients (83.8%). Eight patients, in whom AMAs were not detected, were diagnosed as PBC on the basis of clinical, laboratory, and morphologic findings: All livers showed chronic nonsuppurative destructive cholangitis and/or marked reduction in interlobular bile ducts (6-9).