Peliosis and gummatous syphilis of the liver: a case report

Abstract

Peliosis hepatis is a rare benign vascular disorder of the liver that may be associated with malignancy, infection and drugs. The imaging manifestation of this disorder is often variable and nonspecific making its diagnosis difficult. We describe a rare case of peliosis hepatis and gummatous syphilis of the liver with emphasis on CT findings. Image characteristics of our patient included pseudotumoral appearance of peliosis hepatis, isodensity to the adjacent liver parenchyma on unenhanced and dual-phase scanning. To our knowledge, peliosis hepatis associated with syphilis and unique enhancement pattern has not been reported. Considering the imaging features of peliosis hepatis, it should be considered in the differential diagnosis of atypical focal hepatic lesion.

Figure 1

Doppler sonographic image showing a slightly heterogeneous hyperechoic lesion in the right lobe of liver without mass effect on the right hepatic vein.

Figure 2

Transverse unenhanced CT image showing the protrudent visceral surface which hints a local iso-attenuated lesion (arrowheads) with punctate calcification (arrow) (A), identical density of the lesion to the adjacent liver parenchyma at arterial phase (B) and portal phase (C). The right hepatic vein with a normal shape and location crosses the lesion (arrow).

Figure 3

Portal phase image showing a hypo-attenuated lesion (10 mm in diameter) within segment VIII (arrow). Histopathology proved it to be a gumma.

Figure 4

Histology of specimens (HE, × 50). Microscopy reveals multiple blood-filled cystic spaces and ectatic sinusoids.

Figure 5

Gumma on segment VIII characterized by multifocal coagulation necrosis and significant infiltration of plasma cells mixed with lymph cells (HE, × 100).