Although identified in a small percentage of all liver biopsies, hepatic granulomas may pose a significant diagnostic challenge due to their broad morphologic features, differential diagnoses, and extensive workup. This chapter provides a detailed review of both infectious and noninfectious causes, focusing on key histopathological differences. Granuloma morphology, localization, associated inflammatory responses, histochemical staining patterns, and relevant clinical findings are described. If relevant, the role of advanced diagnostic tools, including special stains, and available molecular techniques, is included in the text. The main categories include infections, immune-mediated disorders such as primary biliary cholangitis and sarcoidosis, medications, and others. Infectious causes encompass bacterial, viral, fungal, and parasitic pathogens. Noninfectious etiologies such as primary biliary cholangitis and systemic sarcoidosis are described in detail. Drug-induced hepatic granulomas, often associated with hypersensitivity reactions, represent another critical diagnostic consideration. By integrating clinical, histopathological, and laboratory findings, this chapter aims to refine the diagnostic approach to hepatic granulomas. It can serve as a valuable resource for pathologists, providing a structured framework for distinguishing different etiologies and guiding appropriate treatment strategies.