Clinicopathological Significance of Granulomas

Abstract

Primary biliary cirrhosis (PBC) is histologically characterized by chronic non-suppurative destructive cholangitis (CNSDC), and is also a granulomatous disease. The characteristics of granulomas and the correlation between granulomas and bile duct changes were morphologically investigated in 31 patients with granulomas, compared with in those without granulomas.Results were as follows : 1) Most of the granulomas (93%) were poorly-defined, and well-organized granulomas with distinct fibrosis were rare (7 %).2) Granulomas with multinucleated giant cells (MGCs) were not always well-organized and were found both in portal area and near central veins. MGCs sometimes had inclusions with negative H-E stain.3) Seventy-two per cent of granulomas were found in portal area, some of them were in contact with damaged bile ducts, others surrounded them.4) The patients with granulomas were rather early in the histologic stages. Twenty-three of 31 patients with granulomas were asymptomatic.5) Ratio of disappearance of interlobular bile ducts was significantly lower in PBC patients with granulomas than in those without granulomas.From these results, it was suggested that granulomas in PBC were closely related to interlobular bile duct lesions and that something derived from interlobular bile ducts seemed to play an important role for granuloma formation.