Liver lesions detected in a hepatitis B core total antibody-positive patient masquerading as hepatocellular carcinoma: a rare case of peliosis hepatis and a review of the literature

Abstract

Peliosis Hepatis (PH) is a rare vascular disorder of the liver, characterized by the presence of cystic blood-filled cavities distributed throughout the hepatic parenchyma. The pathogenesis of PH remains controversial. The preoperative diagnosis of PH is difficult, due to the non-specific imaging characteristics of PH and almost all cases are diagnosed on histology post resection. This study presents a case of PH masquerading as hepatocellular carcinoma (HCC). The patient is a 45-year old Chinese lady, who presented with transaminitis. She was found to be hepatitis B virus core total antibody-positive with an alpha-fetoprotein (AFP) of 29.4 ng/ml. Triphasic liver computed tomography showed several arterial hypervascular lesions and hypoenhancing lesions on the venous phase, particularly in the segments 6/7. Subsequently, a magnetic resonance imaging scan showed multiple lesions in the right hemiliver with an indeterminate enhancement patterns. Subsequently, she decided to undergo a resection procedure. Histopathology revealed findings consistent with PH with some unusual features. This case demonstrates a clinical conundrum, in which PH presented with a raised AFP, in a patient with risk factors for the development of HCC. The clinical suspicion of PH should be high in patients, who present with multiple hepatic lesions with variable enhancement patterns.

Keywords: Hepatis; Hepatocellular carcinoma; Hepatoma; Peliosis.

Fig. 1. Computed tomography showing arterial phase with an arterial enhancing focus in segment 6 (A) and portal venous phase with hypodense lesion in the segment 6/7.

Fig. 2. Magnetic resonance imaging showing T2-weighted coronal section with multiple hyperintense lesions (A) and T2-weighted transverse cuts with multiple hyperintense lesions (B) and (C) in the right lobe.

Fig. 3. Gross cut specimen showing one of the hemorrhagic lesions in the right lobe of the liver.

Fig. 4. Microphotographs showing (A) blood-filled cavity in the hepatic parenchyma with no discernible endothelial lining or surrounding fibrosis and mild sinusoidal dilation at the periphery (Hematoxylin and Eosin stain, ×100) and (B) dense reticulin meshwork within the area of hemorrhage (reticulin stain, ×100).