Original ArticlesEosinophilic Granuloma of the Liver A Characteristic Lesion With Relationship to Visceral Larva MigransKaplan, Keith J. M.D.; Goodman, Zachary D. M.D., Ph.D.; Ishak, Kamal G. M.D., Ph.D. Author Information From the Department of Pathology, Walter Reed Army Medical Center (K.J.K.) and the Department of Hepatic and Gastrointestinal Pathology (Z.D.G., K.G.I.), and the Veterans Administration Special Reference Laboratory for Pathology (Z.D.G.), Washington, DC, U.S.A. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Department of the Army or Department of Defense. Address correspondence and reprint requests to Keith J. Kaplan, MD, Walter Reed Army Medical Center, Department of Pathology, 6900 Georgia Ave. NW, Washington, DC 20307-5001, U.S.A.; e-mail: [email protected] The American Journal of Surgical Pathology: October 2001 - Volume 25 - Issue 10 - p 1316-1321 Buy Abstract Children with the clinical syndrome of visceral larva migrans as a result of Toxocara species have typical lesions in the liver and other viscera, consisting of palisading granulomas that contain numerous eosinophils and often Charcot–Leyden crystals; recognizable parasites are uncommon. Similar eosinophilic granulomas that are found incidentally in adults often cause diagnostic problems. To define better the clinical, laboratory, and pathologic features of these lesions, we reviewed 43 cases of hepatic eosinophilic granuloma (excluding cases of Langerhans' cell histiocytosis) collected in the files of the AFIP over a period of 31 years. The eosinophilic granulomas were found in patients of all ages (range 12 months to 77 years); 30% were younger than 20 years. There were 26 male and 17 female patients. Most patients (26 of 43; 60%) were asymptomatic, and the lesions were discovered incidentally. Others had fever (20%) or abdominal pain (20%). The granulomas were typically multiple (61%), with central necrosis surrounded by a mixed inflammatory infiltrate with numerous eosinophils and variable numbers of neutrophils, lymphocytes, and a palisade of epithelioid histiocytes and/or giant cells. Charcot–Leyden crystals were present in 19 cases (44%). Remnants of parasites (eight Toxocara sp., two Capillaria sp.) were identified in the tissue in 10 patients. There was a positive serologic test for Toxocara sp. in five additional cases. Immunohistochemical staining using polyclonal antiserum against Toxocara canis larvae demonstrated positivity in macrophages in eight of 13 cases tested. We conclude that identification of an eosinophilic granuloma in the liver should suggest the diagnosis of visceral larva migrans and prompt a search for the causative organism with serial sectioning of the block and serologic tests for Toxocara and other causative parasites. © 2001 Lippincott Williams & Wilkins, Inc.