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The page below is a sample from the LabCE course Liver Biopsies: Anatomy and Histological Considerations. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Granulomatous Hepatitis

Granulomas can be found in the liver due to a variety of causes. The most common among these are:
  • Medication reactions
  • Infections with fungal or acid fast organisms
  • Sarcoidosis
Distinction of these is not always possible, although in ALL cases, the following stains should be performed to rule out infection:

For fungal organisms: Grocott-Gomori methenamine-silver stain (GMS) OR digested periodic acid-Schiff (PAS)


For acid-fast organisms: Ziehl-Nielsen OR Fite stain
    Unfortunately, these stains have a relatively high false-negative rate, so negative stains should be correlated with clinical and culture findings before excluding an infection.