Multiple Blood-filled Cavities Research Articles

S2536 A Very Rare Tumor Like Liver Lesions: Peliosis Hepatis

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).

Isolated splenic peliosis

Peliosis a rare condition characterized by multiple blood-filled cavities within the parenchyma of solid organs mainly organs of mononuclear phagocytic system. Peliosis is associated with tuberculosis, human immunodeficiency virus, disseminated cancer, previous thorium dioxide contrast injection, chronic hematological disorders, and many other conditions. Peliosis is usually asymptomatic and diagnosed as an incidental finding. Imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging are useful for diagnosis. On CT, hypoattenuating nodules with fluid-fluid levels are a unique feature for diagnosing peliosis. Although rare and asymptomatic most of the time, peliosis is an important condition to be aware of because rupture of the blood-filled cysts can lead to hemoperitoneum and ultimately be fatal. We reported a case of a 35-year-old male with isolated splenic peliosis with its rupture and resultant hemoperitoneum.

Peliosis hepatis: A mimicker of hepatic tumors

Peliosis hepatis (PH) is a rare benign liver lesion, characterized by the presence of multiple blood-filled cavities and marked dilation of the hepatic sinusoids throughout the hepatic parenchyma. It is often confirmed after the liver resection or liver biopsy. In the present study, we report a case of a 41-year-old woman who presented with a asymptomatic right hepatic mass. The imaging findings of the mass, including computed tomography and magnetic resonance imaging, showed centrifugal progression of enhancement during the portal and delayed phases. Because of the possibility of hepatic malignancy, partial resection of the liver was performed. The final pathological diagnosis was PH. By referring to the relevant literature, we conclude that, as a result of insignificant clinical manifestation and imaging features, PH should be kept in mind for patients with hepatic mass.

A Case of Peliosis Hepatis Mimicking Metastatic Lesions of Increasing Size

Peliosis hepatis, an uncommon vascular condition, is characterized by multiple blood-filled cavities distributed throughout the liver. Computed tomography and magnetic resonance imaging findings of peliosis hepatis are nonspecific. A 40-year-old woman presented with multiple hepatic cystic masses. Two years later, the number and sizes of the masses had increased. We suspected metastatic hepatic disease and performed a liver biopsy. Histological examination revealed dilatation of hepatic sinusoids and multiple blood-filled cavities throughout the liver parenchyma. Thus, a diagnosis of peliosis hepatis was confirmed.

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

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.

"Peliosis Hepatis" Como Complicación del Uso de Anticonceptivos Orales en una Paciente con Mielodisplasia

ABSTRACT “Peliosis Hepatis” as a Complication of the Ise of Oral Contraceptives in a Patient withMyelodysplasia Introduction: Peliosis hepatis (PH) is an uncommon condition in pediatrics; however, it is one of the mostserious complications associated with the long-term use of use of steroids. It is characterized by multipleblood-filled cavities, mostly involving the liver. Myelodysplastic Syndrome (MDS) is also a complex andinfrequent hematological condition; it may transform into acute leukemia and its treatment requiresmedications that may lead to PH. Case Report: 13 year-old girl with MDS, refractory cytopenia type. Afamily donor for SCT was not available, therefore immunosuppressive treatment, steroids and transfusionswere initiated. Due to metrorrhage, estrogen was used at high doses. She developed acute abdominal pain;abdominal ultrasound and CT scan showed PH and peritoneal bleeding. Oral contraceptives were decreasedresulting in reduction of PH, but a new episode of uterine bleeding causing hypovolemic shock forced ahysterectomy in order to suspend estrogen treatment. Due to lack of response to treatment to SMD, shecontinued been treated with transfusions as needed, and died 32 months post diagnosis.

Peliosis Hepatis following treatment with androgen-steroids in patients with bone marrow failure syndromes

Androgens widely used in the treatment of bone marrow failure syndromes can in rare cases cause hepatic peliosis, a pathological entity characterized by multiple blood-filled cavities in the liver parenchyma. Bone marrow failure syndromes per se are associated with a low coagulation status, which is further magnified by bone marrow transplantation for aplastic anaemia due to deep thrombocytopenia. Both these conditions can cause bleeding; their combination is especially dangerous. We describe two cases of aplastic anaemia due to paroxysmal nocturnal hemoglobinuria and Fanconi syndrome, in which patients developed peliosis hepatis after prolonged treatment with androgens. One patient developed severe subcapsular bleeding, successfully treated with catheterization of the right hepatic artery and embolization of the bleeding site. The second patient bridged over deep post-transplant aplasia with high frequency platelet transfusions, and demonstrated an uncomplicated post-BMT course. We suggest avoiding or interrupting treatment with androgens in patients preparing for BMT.

Splenic Peliosis in a Patient with Aplastic Anemia during Danazol Therapy

We experienced a case of danazol-induced splenic peliosis. A 42-year-old woman had taken danazol for refractory aplastic anemia for 2 years. Her anemia gradually became aggravated, and the patient complained of intermittent left upper-abdominal pain. Because computed tomography scanning showed multiple blood-filled cavities in the enlarged spleen without intraperitoneal hemorrhage, a splenectomy was emergently performed. This report is the first of a case of splenic peliosis developing during danazol therapy for aplastic anemia. The possible association between the administration of anabolic steroids or danazol and the development of peliosis is discussed.

Splenic peliosis and rupture in patients with dyskeratosis congenita on androgens and granulocyte colony‐stimulating factor

Splenic peliosis and rupture in patients with dyskeratosis congenita on androgens and granulocyte colony‐stimulating factor