Hepatic eosinophilic granuloma without peripheral eosinophilia diagnosed by laparoscopic liver resection: a case report

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Abstract
Introduction and importance: Eosinophilic granuloma is a histopathological condition characterized by eosinophil-rich granulomatous inflammation and is considered a manifestation of allergic reactions. Hepatic eosinophilic granuloma (HEG) is an extremely rare entity and is most commonly associated with parasitic infections. We report a case of HEG without peripheral eosinophilia or a confirmed parasitic infection, with a difficult preoperative diagnosis, treated by laparoscopic liver resection. Case presentation: A 67-year-old woman was referred for further evaluation of a liver tumor in segment 3 detected by computed tomography performed for unexplained abdominal pain. Tumor markers were not elevated, and although further imaging studies did not exclude hepatic malignancy, an inflammatory pseudotumor or intrahepatic cholangiocarcinoma was suspected. Laparoscopic sub-segmentectomy of segment 3, and lymph node dissection around the common hepatic artery, were performed for diagnostic and therapeutic purposes, respectively. Histopathological examination revealed a granuloma with marked eosinophilic infiltration and central coagulative necrosis. Tests for mycobacterial infection were negative, and neither parasitic organisms nor serological evidence of parasitic infection was identified. Clinical discussion: Preoperative diagnosis of HEG remains challenging because its radiological findings often resemble those of hepatic malignancies, particularly in the absence of peripheral eosinophilia or evidence of parasitic infection. Conclusion: HEG is most frequently associated with parasitic infections. However, precise preoperative diagnosis of nonparasitic HEG remains challenging. Laparoscopic resection enabled a definitive diagnosis. Therefore, HEG should be considered in the differential diagnosis of primary hepatic tumors, even in the absence of confirmed parasitic infections or peripheral eosinophilia. Minimally invasive surgery is a reasonable option from both therapeutic and diagnostic perspectives.

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