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Background and Objectives Hepatic sarcoidosis is an uncommon and heterogeneous manifestation of sarcoidosis that may occur in isolation or as part of a multisystem disease, frequently mimicking malignant, infectious, or cholestatic liver disorders. We systematically reviewed reported cases to define its clinical, radiologic, histologic, therapeutic, and outcome profiles.Materials and Methods A PRISMA-compliant systematic review of English-language case reports and case series published up to 2025 was performed ( figure 1). Demographic, clinical, laboratory, imaging, histopathologic, diagnostic, treatment, and outcome data were extracted and descriptively analyzed.Results Eighty-three publications (76 case reports, 7 case series) describing over 102 patients were included. Patients were predominantly female (~60%), with a mean age in the fifth decade. Most cases originated from Asia (36.4%), followed by Europe (32.3%), North America (22.2%), and Africa (9.1%). Clinical presentation ranged from asymptomatic disease (30–35%) to cholestatic symptoms (40–50%), with portal hypertension (15–20%), Budd-Chiari syndrome (<10%), and decompensated cirrhosis (<10%) occurring less frequently. Laboratory abnormalities most commonly showed a cholestatic or mixed pattern (>70%), with elevated alkaline phosphatase and γ-glutamyl transferase; serum ACE levels were elevated in 40–50%. Liver biopsy typically demonstrated non-caseating epithelioid granulomas, predominantly portal or periportal. Corticosteroids were the mainstay of therapy and led to biochemical and radiologic improvement in most treated patients, while immunosuppressants or biologics were used for refractory disease. Liver transplantation was required in a minority (>8.0%); post-transplant granuloma recurrence was usually mild.Conclusions Hepatic sarcoidosis is an underrecognized cause of cholestatic liver disease and tumor-like hepatic lesions. Although prognosis is generally favorable, delayed diagnosis may result in significant morbidity. Recognition of characteristic imaging patterns and histology within a multidisciplinary framework is essential to avoid misdiagnosis and unnecessary surgical intervention.Abstract P84 Figure 1PRISMA flowchart outlining the study search