Peliosis hepatis: 2 case reports of a rare liver disorder and its differential diagnosis

Abstract

Rationale: Peliosis hepatis (PH) is a rare tumor-like liver lesion composed of multiple blood-filled cavities within the liver parenchyma. It is hard to differentiate PH from other liver lesions by imaging, such as carcinoma, metastases, or abscess.

Patient concerns: Here, we reported 2 cases that presented with liver lesions under ultrasound and computed tomography (CT) scanning, without any history of liver diseases or drug usage traced back.

Diagnoses: Liver biopsy and laparoscopy were processed, and the lesions were eventually diagnosed as PH by histopathology, which microscopically presented with multiple sinusoidal dilatations with blood-filled cystic spaces.

Interventions: After the liver biopsy or laparoscopy, the patients were discharged and followed up in the clinic.

Outcomes: Both patients were followed up for at least 1 year with good recovery.

Lessons: PH should always be recognized in the differentiation of liver lesions, particularly indistinctive lesion(s) without any history of liver-related diseases.

Figure 1

(A) Arterial phase of contrast-enhanced computed tomography (CT) in Case 1; (B) Portal phase of contrast-enhanced CT showed the lesion (arrows) with heterogeneous enhancement, but the lesions were somewhat poorly defined; (C) Magnetic resonance cholangiopancreatography (MRCP) in case 1 showed hepatosplenomegaly on T2 weight.

Figure 2

Histology of the liver lesion in case1 indicated a typical feature of peliosis hepatis presenting with multiple sinusoidal dilatations together with blood-filled cystic spaces (arrow). (H&E, x100).

Figure 3

Liver ultrasound in Case 2 demonstrated a clear heterogeneous echo (38 mm × 35 mm) in the right lobe of liver.

Figure 4

Liver histology in case 2. Peliosis hepatis is morphologically recognized as the formation of “blood lake” due to vascular dilation mixed with focal bleeding (arrow). (H&E, x100).