Fibrin Ring Granuloma in Chronic Hepatitis C: Virus-Related Vasculitis and/or Immune Complex Disease?

ABSTRACT

Fibrin ring granulomas are rare lesions whose pathophysiology has remained somewhat elusive. It has been suggested that these peculiar lesions are related to focal vasculitis with endothelial injury and deposition of immune complexes. Fibrin ring granulomas have been described in Q fever; in viral infections such as cytomegalovirus, Epstein-Barr virus, and hepatitis A virus; and in other conditions. We submit the first reported case of fibrin ring granuloma in a patient with chronic hepatitis C infection, in whom other potential etiologies have been excluded, and offer a brief review of available literature on the pathogenesis of both conditions.

KEYWORDS

Fibrin ring granuloma - hepatitis C - endotheliitis - immune complexes

REFERENCES

• 1 Voigt J J, Delsol G, Fabre J. Liver and bone marrow granulomas in Q fever.  Gastroenterology. 1983;  84 887-888
• 2 Lobdell D H. “Ring” granulomas in cytomegalovirus hepatitis.  Arch Pathol Lab Med. 1987;  111 881-882
• 3 Moreno A, Marazuel M, Yebra M et al.. Hepatic fibrin-ring granulomas in visceral leishmaniasis.  Gastroenterology. 1988;  95 1123-1124
• 4 Ponz E, Garcia-Pagan J C, Bruguera M et al.. Hepatic fibrin-ring granulomas in patients with hepatitis A.  Gastroenterology. 1991;  100 268-270
• 5 Vanderstigel M, Zafrani S, Lejonc J L et al.. Allopurinol hypersensitivity syndrome as a cause of hepatic fibrin-ring granulomas.  Gastroenterology. 1986;  90 188-190
• 6 Goodman Z D, Ishak K G. Histopathology of hepatitis C infection.  Semin Liver Dis. 1995;  15 70-81
• 7 Bernstein M, Edmonson H A, Barbour B H. The liver lesion in Q fever.  Arch Intern Med. 1965;  116 491-498
• 8 Batts K P. Acute and chronic hepatic allograft rejection: pathology and classification.  Liver Transpl Surg. 1999;  5 S21-S29
• 9 Jones K D, Farrell L D. Interpretation of biopsy findings in the transplanted liver.  Semin Diagn Pathol. 1998;  15 306-317
• 10 Nonomura A, Mizukami Y, Matsubara F. Clinicopathological study of lymphocyte attachment to endothelial cells (endotheliitis) in various liver diseases.  Liver. 1991;  11 78-88
• 11 Yeh M M, Larson A M, Tung B Y et al.. Endotheliitis in chronic viral hepatitis.  Am J Surg Pathol. 2006;  30 727-733
• 12 Shields P L, Morland C M, Salmon M et al.. Chemokine and chemokine receptor interactions provide a mechanism for selective T cell recruitment to specific liver compartments within hepatitis C-infected liver.  J Immunol. 1999;  163 6236-6243
• 13 Saadoun D, Asselah T, Resche-Rigon M et al.. Cryoglobulinemia is associated with steatosis and fibrosis in chronic hepatitis C.  Hepatology. 2006;  43 1337-1345
• 14 Sansonno D, Dammacco F. Hepatitis C virus, cryoglobulinaemia, and vasculitis: immune complex reactions.  Lancet Infect Dis. 2005;  5 227-236
• 15 Sansonno D, Lauletta G, De Re V. Intrahepatic B cell clonal expansion and extrahepatic manifestations of chronic HCV infection.  Eur J Immunol. 2004;  34 126-136
• 16 Curry M P, Golden-Mason L, Doherty D G. Expansion of innate CD5pos B cells expressing high levels of CD81 in hepatitis C infected liver.  J Hepatol. 2003;  38 642-650
• 17 Musset L, Diemert M C, Taibi F. Characterization of cryoglobulins by immunoblotting.  Clin Chem. 1992;  38 798-802
• 18 Feiner H D. Relationship of tissue deposits of cryoglobulin to clinical features of mixed cryoglobulinemia.  Hum Pathol. 1983;  14 710-715
• 19 Yamamoto S, Iguchi Y, Ohomoto K et al.. Epithelioid granuloma formation in type C chronic hepatitis: report of two cases.  Hepatogastroenterology. 1995;  42 291-293
• 20 Vakiani E, Hunt K K, Mazziotta R M et al.. Hepatitis C-associated granulomas after liver transplantation: morphologic spectrum and clinical implications.  Am J Clin Pathol. 2007;  127 128-134