S2536 A Very Rare Tumor Like Liver Lesions: Peliosis Hepatis

Abstract

INTRODUCTION: Peliosis hepatis (PH) is a rare tumor-like vascular condition characterized by a proliferation of the sinusoidal hepatic capillaries and randomly distributed multiple blood-filled cavities in liver parenchyma. PH mimics liver abscess, cavernous hemangioma, or hepatocellular carcinoma. Most clinicians and radiologists are not familiar with this rare disease. CASE DESCRIPTION/METHODS: A 28-year-old woman was referred to our gastroenterology and hepatology clinic for right upper abdominal pain and multiple liver lesions. She was complaining of dull type right upper quadrant abdominal pain which was associated with decreased appetite and unintentional weight loss. The patient denied diet-related abdominal pain, recent bowel habit change, or melena. She was taking oral contraceptive pills but denied the use of steroids or chemotherapies. No history of liver diseases, human immunodeficiency virus (HIV) infection, or malignancies. On examination, the patient was stable; vital signs were normal. She had pink conjunctiva and non-icteric sclera. No lymphadenopathy. The chest was clear with normal heart sounds. She had mild right upper quadrant abdominal tenderness, but no shifting dullness or fluid thrill. Laboratory tests revealed a white blood cell count 10.4K, hemoglobin of 13.5 gm/dl, platelet 321K, alanine transferase 56units/L, aspartate transaminases 41 units/L, alkaline phosphatase 145 units/L and total bilirubin of 0.4 mg/dl. Magnetic resonance imaging of the abdomen revealed multiple masses and cysts in the right and left lobes of the liver (the largest measures 9.5 cm × 6.9 cm × 9.2 cm size) (see Figures 1 and 2). Biopsy was performed and histopathology revealed peliosis hepatis (see Figure 3). Upper GI endoscope (EGD) and colonoscopy showed acute gastritis and normal colon respectively. DISCUSSION: Peliosis hepatis is a rare tumor-like liver lesion, and it can be confused with liver abscess, hemangiomas, or hepatocellular carcinoma. Etiology is unclear but it is associated with malignancies, bacterial infections, use of steroids, or oral contraceptive pills. PH is usually benign but it can be complicated due to acute hemorrhage, portal hypertension, or liver failure. Imaging alone may not be sufficient for diagnosis, histopathology helps to confirm the diagnosis and to rule out malignancy. EGD and colonoscopy are indicated to rule out underlying malignancy. The management of PH depends on underlying etiology including counseling patients to avoid contact sports.Figure 1.: MRI with and without contrast showed multiple right hepatic lesions with heterogeneity on the T2 signal. Arterial enhancement without significant washout. The lesion within the inferior right hepatic lobe showed arterial enhancement with a questionable wash in.Figure 2.: MRI with and without contrast showing right hepatic lesions with heterogeneity on the T2 signal. Arterial enhancement without significant washout.Figure 3.: Large, intraparenchymal, blood-filled spaces surrounded by hepatocytes (H&E ×50).