25. Peliosis of the spleen presenting as spontaneous splenic rupture – report of two cases

Abstract

Background Peliosis is a rare acquired condition characterised by the presence of multiple blood-filled cavities most commonly in the liver and less frequently in the spleen and other organs. The clinical presentation of splenic peliosis is varied. Some patients remain asymptomatic and peliosis is an incidental finding at autopsy. Others present with abdominal pain or a left upper quadrant mass. The most serious manifestation is splenic rupture which may be fatal. Splenic peliosis is associated with tuberculosis, solid organ and haematological malignancies, chronic renal failure, and medications including androgenic steroids, oral contraceptives and erythropoietin. There are no reported associations with amyloidosis. Aim To highlight diagnostic features of splenic peliosis. Methods We present two cases of isolated splenic peliosis leading to spontaneous splenic rupture and outline clinical and pathological features of the condition. Case 1 – A 59-year-old man presented with spontaneous splenic rupture on a background of excessive alcohol intake, a bleeding diathesis, plasma cell dyscrasia and a lung lesion metastatic to liver and small bowel. Case 2 – A 33-year-old man presented with spontaneous splenic rupture on a background of excessive alcohol intake, depression and schizophrenia. Neither patient reported use of steroid medications. Results Macroscopically both spleens contained numerous blood filled cystic spaces that histologically lacked an endothelial lining. In Case 1 amyloid deposition was confirmed in the spleen and this is the first reported case of splenic peliosis in association with amyloidosis. Conclusion Peliosis should be considered in the pathological differential diagnosis of a spontaneously ruptured spleen.