HEPATOBILIARY SARCOIDOSIS: TYPICAL APPEARANCE IN LAPAROSCOPY

We present a case of systemic sarcoidosis. A 72-year-old Japanese woman, who was diagnosed with asymptomatic enlarged abdominal para-aortic lymph nodes in April 2000, was admitted to our hospital in December 2003 because of multiple mass lesions of the liver and spleen. She had hepatosplenomegaly and asymptomatic pulmonary fibrosis. Blood examination revealed cholestasis and progressing liver synthetic dysfunction. In laparoscopic photographs, various sizes of whitish flat lesions were scattered on the surface of the liver. Liver biopsy showed non-caseating epithelioid cell granulomas. These lesions of the spleen disappeared on contrast-enhanced computed tomography imaging, and serum liver dysfunction was improved rapidly after steroid therapy. Laparoscopy may be useful for the diagnosis of granulomatous liver disease, such as hepatobiliary sarcoidosis.