Lipiodol accumulation in focal peliosis hepatis with sinusoidal dilatation

Clinicopathological study of hepatocellular carcinoma with peliotic change

Peliosis hepatis-like blood-filled cavities are frequently observed in the tumors of hepatocellular carcinoma (HCC). This finding is generally referred to as 'peliotic change' in HCC. However, the clinicopathological features of HCC with peliotic change (PHCC) are not fully understood. These issues are addressed in the present study. Among 294 consecutively surgically resected HCCs, the clinicopathological features of PHCC were compared with those of a common type of HCC (control). PHCC was observed in 116 (39.5%) of 294 HCCs. The mean tumor diameter of 3.4±0.9 cm of the PHCC group was significantly larger than that of the 2.5±0.9 cm of the control, and the incidence of PHCC was related to increased tumor diameter. In the 116 PHCCs, the tumors were completely or incompletely encapsulated. On ultrasonography, PHCCs showed hyperechoic and/or mosaic patterns. The mean diameter of 3.5±0.8 cm of PHCCs with a hyperechoic and/or mosaic pattern was significantly larger than that of 2.3±0.9 cm in the control. In conclusion, it is necessary for clinicians and pathologists to discern the characteristics of peliotic change as a morphological feature that modifies ultrasound findings.

Focal peliosis hepatis as a mimicker of hepatic tumors: radiological-pathological correlation

OBJECTIVE

To retrospectively evaluate the radiological findings in patients with focal peliosis hepatis and to correlate them with pathological findings.

METHODS

Eight patients with pathologically proven peliosis hepatis underwent ultrasonography (n = 6), computed tomography (CT; n =8), and/or magnetic resonance imaging (MRI; n = 3). Two radiologists analyzed the images for the size, margin, echogenicity, presence of posterior acoustic enhancement, and enhancement pattern of the lesion. The enhancement patterns on CT or MRI were correlated with the pathological findings.

RESULTS

The average lesion size was 1.9 cm. On ultrasonography, 4 lesions were ill defined and low echoic compared with the hepatic parenchyma. Two lesions showed posterior acoustic enhancement. In 4 lesions, centripetal enhancement was observed on dynamic CT images. Two lesions showed homogeneously high and 2 showed persistently low enhancement patterns. On dynamic MR phases, 2 lesions showed strong and persistent enhancement. In 1 lesion, MR showed slow centripetal enhancement. In the 3 patients who showed a homogeneously high enhancement pattern on dynamic CT or MRI, microscopic examination demonstrated that the dilated sinusoids were filled with fresh blood cells. On the contrary, in 5 patients who showed a centripetal or persistently low enhancement pattern, their dilated sinusoids were filled with old stagnated blood.

CONCLUSIONS

Focal peliosis hepatis showed various enhancement patterns on contrast-enhanced CT and MRI, depending on the histopathologic findings.