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Omata K, Okada N, Miyahara G, Hirata Y, Sanada Y, Onishi Y, Fukuda S, Kumagai H, Lefor AK, Sakuma Y, Sata N. Peliosis Hepatis in a Child with X-Linked Myotubular Myopathy Treated with Living-Donor Liver Transplant: A Case Report. Transplant Proc 2021; 53:1317-1321. [PMID: 33468339 DOI: 10.1016/j.transproceed.2020.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myotubular myopathy is a rare disease sometimes accompanied by peliosis hepatis, a leading cause of fatal liver hemorrhage. CASE REPORT We present a case of a 2-year-old boy with myotubular myopathy who developed liver hemorrhage because of peliosis hepatis and was successfully treated with living-donor liver transplant. The patient initially presented with fever, anemia, and liver dysfunction. A computed tomographic scan revealed hemorrhages in the liver, and the patient underwent hepatic artery embolization twice. After the second embolization, multiple peliosis hepatis cavities appeared in the left lobe of the liver that had increased in size. Therefore, the patient underwent ABO-incompatible living-donor liver transplant using a lateral segment graft from his father. The patient developed severe septic shock with an unknown focus on postoperative day 18, which resolved with antibiotic therapy. On postoperative day 62, he was discharged. Fourteen months after undergoing living-donor liver transplant, the patient showed no recurrence of peliosis hepatis. CONCLUSIONS Although the long-term prognosis of peliosis hepatis due to myotubular myopathy after living-donor liver transplant remains unclear, liver transplant may be a curative treatment for patients with myotubular myopathy who have uncontrollable peliosis hepatis.
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Affiliation(s)
- Kanako Omata
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Noriki Okada
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Go Miyahara
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yuta Hirata
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yukihiro Sanada
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yasuharu Onishi
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Shinya Fukuda
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Alan Kawarai Lefor
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yasunaru Sakuma
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan.
| | - Naohiro Sata
- Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Tochigi-ken, Japan
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Abstract
RATIONALE Peliosis hepatis (PH), which is characterized by blood-filled cavities in the liver, is a rare disease. Its diagnosis depends on postoperative pathological examinations and immunohistochemistry. PATIENT CONCERNS A 44-year-old female complained of right-middle upper abdominal pain and distension for 1 month, with occasional vomiting and fever. DIAGNOSIS Because of the similar imaging features, the patient was initially misdiagnosed as cystic echinococcosis (CE). The immunoassay of echinococcosis was negative. Irregular hepatectomy was performed. Eventually, the patient was diagnosed with PH based on postoperative histopathology and immunohistochemistry. INTERVENTIONS The patient underwent hepatectomy. Then, the cystic lesion was collected for intraoperative pathological examination. Thus, the blood liquid was extracted from the cystic lesion. Pringle maneuver was administered to prevent bleeding, and then the whole cystic lesion was removed. OUTCOMES She recovered smoothly and there was no relapse occurred during 6 months' follow-up. LESSONS It is difficult to differentiate PH from CE and other hepatic diseases due to the lack of special imaging features. Pathological examinations and immunohistochemistry can provide a confirmed diagnosis of PH.
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Affiliation(s)
- JinHeng Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu
- Department of Hepatobiliary-Pancreatic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - YanTin Wang
- Department of Hepatobiliary-Pancreatic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - SiNeng Yin
- Department of Hepatobiliary-Pancreatic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - NengWen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu
| | - XuBao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu
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Crocetti D, Palmieri A, Pedullà G, Pasta V, D’Orazi V, Grazi GL. Peliosis hepatis: Personal experience and literature review. World J Gastroenterol 2015; 21:13188-13194. [PMID: 26675327 PMCID: PMC4674738 DOI: 10.3748/wjg.v21.i46.13188] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 05/22/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Peliosis hepatis (PH) is a disease characterized by multiple and small, blood-filled cysts within the parenchymatous organs. PH is a very rare disease, more common in adults, and when it affects the liver, it comes to the surgeon’s attention only in an extremely urgent situation after the lesion’s rupture with the resulting hemoperitoneum. This report describes the case of a 29-year-old woman affected by recurring abdominal pain. Computed tomography scans showed a hepatic lesion formed by multiple hypodense areas, which showed an early acquisition of the contrast during the arterial phase. Furthermore, it remained isodense with the remaining parenchyma during the late venous phase. We decided on performing a liver resection of segment VII while avoiding a biopsy for safety reasons. The histopathologic examination confirmed the diagnosis of focal PH. PH should always be considered in the differential diagnosis of hepatic lesions. Clinicians should discuss the possible causes and issues related to the differential diagnosis in addition to the appropriate therapeutic approach. The fortuitous finding of a lesion, potentially compatible with PH, requires elective surgery with diagnostic and therapeutic intents. The main aim is to prevent the risk of a sudden bleeding that, in absence of properly equipped structures, may have a fatal outcome.
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Abstract
Atypical hepatocellular neoplasm (AHN) is an adenoma-like hepatic tumor that even occurs in noncirrhotic liver of males (any age) or females ≥ 50 years old, or associates focal atypical features. In this article, 2 unusual cases diagnosed in elderly cirrhotic patients, unrelated to steroids, are presented. The first case was incidentally diagnosed in an 83-year-old female. During laparoscopic surgery for cholecystectomy, hemoperitoneum was installed and laparotomy was necessary to remove a 70-mm nodular encapsulated hepatic tumor that was microscopically composed by hepatocyte-like cells with clear cytoplasm, arranged in 1- to 2-cell-thick plates and intermingled with areas of peliosis, negative for alpha fetoprotein (αFP), p53, and keratin 7, with low Ki67 index and intact reticulin framework. The second case was incidentally diagnosed at ultrasound examination in a 66-year-old male. The surgical specimen was a 50-mm solid multinodular tumor that microscopically consisted of 3-cell-thick plates of hepatocyte-like cells with acinar, pseudoglandular, and trabecular architecture, intermingled with peliotic areas, without nuclear atypia and disintegrated reticulin framework. Both of the cases occurred in cirrhotic liver. The tumor cells were marked by AE1/AE3 keratin, displayed a Ki67 index < 5% and were negative for αFP, p53, and keratin 7. No recurrences or any other disorder occurred 6 months after surgery. In cirrhotic liver, adenomas with peliosis that do not satisfy all the diagnosis criteria synthesized in the article should be considered AHNs and differential diagnosis includes hepatocellular carcinoma but also focal nodular hyperplasia, regenerative nodules, and dysplastic nodules. This histological entity is not yet included in the WHO Classification list.
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Affiliation(s)
- Simona Gurzu
- From Department of Pathology, University of Medicine and Pharmacy, Tirgu-Mures, Romania (SG, IJ, AOC, MT); and Department of Surgery, University of Medicine and Pharmacy, Tirgu-Mures, Romania (AT)
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5
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Yu CY, Chang LC, Chen LW, Lee TS, Chien RN, Hsieh MF, Chiang KC. Peliosis hepatis complicated by portal hypertension following renal transplantation. World J Gastroenterol 2014; 20:2420-2425. [PMID: 24605041 PMCID: PMC3942847 DOI: 10.3748/wjg.v20.i9.2420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/25/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023] Open
Abstract
Peliosis hepatis (PH) is a vascular lesion of the liver that mimics a hepatic tumor. PH is often associated with underlying conditions, such as chronic infection and tumor malignancies, or with the use of anabolic steroids, immunosuppressive drugs, and oral contraceptives. Most patients with PH are asymptomatic, but some present with abdominal distension and pain. In some cases, PH may induce intraperitoneal hemorrhage and portal hypertension. This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation. The patient experienced progressive abdominal distention and pain in the six months prior to this study. Initially, imaging studies revealed multiple liver tumor-like abnormalities, which were determined to be PH by pathological analysis. Because the hepatic lesions were progressively enlarged, the patient suffered from complications related to portal hypertension, such as intense ascites and esophageal varices bleeding. Although the patient was scheduled to undergo liver transplantation, he suffered hepatic failure and died prior to availability of a donor organ.
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Pan W, Hong HJ, Chen YL, Han SH, Zheng CY. Surgical treatment of a patient with peliosis hepatis: A case report. World J Gastroenterol 2013; 19:2578-2582. [PMID: 23674863 PMCID: PMC3646152 DOI: 10.3748/wjg.v19.i16.2578] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 02/04/2013] [Accepted: 03/07/2013] [Indexed: 02/06/2023] Open
Abstract
This report describes a case of a space-occupying lesion in the right liver in a 38-year-old man who was found to have peliosis hepatis. Clinical data of this patient were presented, including medical history, laboratory test and imaging results, and postoperative pathological findings (hematoxylin and eosin staining). Review of his medical history showed that the patient had been bitten by a dog three years earlier. B-mode ultrasonography revealed an uneven echo mass in the right hemiliver, and magnetic resonance imaging scans also showed a mass in the anterior segment of the right liver. Upon surgical removal, the mass was found to be 4.0 cm × 3.8 cm × 3.8 cm in size and located in segment VI. The mass had a dark and soft appearance, with an irregular edge on intraoperative ultrasonography. Postoperative pathological findings revealed many small capsules filled with blood cells. The patient was diagnosed with peliosis hepatis based on his medical history of having been bitten by a dog, presence of mild anemia, and lack of characteristic symptoms, including fever of unknown origin, abdominal pain, and hepatosplenomegaly, combined with intraoperative and postoperative pathologic findings. The operation was successful, and after being treated with anti-infection agents, the patient had a good recovery.
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7
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Naeshiro N, Waki K, Aikata H, Chayama K. [Q & A. Intra-hepatic multiple nodules developing following treatment of hepatic calculi]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:2056-2061. [PMID: 23038851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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8
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Miranda R, Stambuk J, Vial MT, Miranda A. [Peliosis hepatis: report of one case]. Rev Med Chil 2010; 138:1135-1139. [PMID: 21249282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Peliosis hepatis is a rare vascular condition of the liver characterized by the presence of cystic blood-fi lled cavities distributed randomly throughout the liver parenchyma. We report a 46 year old female, with dyspepsia. An abdominal Doppler ultrasound showed a hyper vascularized solid liver nodule of 5 cm diameter. Magnetic resonance imaging and CT scan showed the same hyper vascularized nodule. With the possible diagnoses of primary hepatocellular carcinoma or focal nodular hyperplasia, the patient was subjected to an excision of hepatic segment VI, where the nodule was located. The pathological diagnosis of the surgical piece was a peliosis hepatis.
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Affiliation(s)
- Roberto Miranda
- Servicio de Radiología, Hospital Clínico de la Fuerza Aérea de Chile, Chile.
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9
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Abstract
Peliosis is a rare benign disorder that is characterized by the presence of diffuse blood-filled cystic spaces and can occur in the liver, spleen, bone-marrow, and lungs. We present a 10-year-old boy with Fanconi anemia who presented with peliosis hepatis due to androgen treatment. Magnetic resonance (MR) imaging revealed multiple non-enhancing masses. Some of the lesions revealed fluid-fluid levels and extrahepatic extension on MR images. Diffusion-weighted (DW) imaging showed restricted diffusion. Fluid-fluid levels and extrahepatic extensions are unusual findings for hepatic peliotic lesions. In addition, DW imaging findings of peliosis hepatis have not been reported previously.
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Affiliation(s)
- Bilal Battal
- Sarikamis Military Hospital, Department of Radiology, Sarikamis, Kars, Turkey.
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10
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Nougaret S, Aufort S, Ramos J, Pierredon MA, Delhom E, Colleau J, Ragu N, Gallix B, Bruel JM. [Hepatic peliosis: an entity to remember]. J Radiol 2009; 90:1745-1749. [PMID: 19953064 DOI: 10.1016/s0221-0363(09)73275-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- S Nougaret
- Service d'Imagerie Médicale, Hôpital St Eloi, CHU de Montpellier, Montpellier Cedex 5, France.
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11
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Abstract
Recognition of pseudolesions of the liver at imaging is important because of their close resemblance to primary liver cancer or metastases. There are several types of pseudolesions: pseudolesions, with mostly straight borders, corresponding to perfusion abnormalities, fatty liver, confluent fibrosis and radiation hepatitis; morphologic changes of the liver; true pseudotumors. The use of multidetector CT and MR imaging increases the likelihood of detecting such lesions in routine practice. Radiologists must recognize these lesions and understand the underlying etiology.
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Affiliation(s)
- V Vilgrain
- Service de Radiologie, Hôpital Beaujon, 100, boulevard du Général Leclerc, 92118 Clichy Cedex.
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12
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Atila K, Coker A, Uçar D, Karademir S, Sağol O, Astarcioğlu H, Astarcioğlu I. A rare clinical entity misdiagnosed as a tumor: peliosis hepatis. ULUS TRAVMA ACIL CER 2007; 13:149-53. [PMID: 17682959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is thought to be unavoidable. In this case report, ominous results of clinically misdiagnosed PH have been presented. PH should be kept on mind in all patients with hepatic mass, especially presented by sudden onset distention of the abdomen. Every effort should be done for the differential diagnosis with other cystic conditions like hydatid cyst in endemic areas.
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Affiliation(s)
- Koray Atila
- Department of General Surgery, Dokuz Eylül University Medical Faculty, Izmir, Turkey
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13
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Abstract
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.
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Affiliation(s)
- Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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14
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Sapierzyński R. Peliosis hepatis-like lesion in a pekingese dog. A case report. Pol J Vet Sci 2007; 10:43-6. [PMID: 17388024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Peliosis hepatis (PH) is a rare condition characterized by dilatation of hepatic sinusoids and the presence of blood-filled spaces within the liver. The disease occurs mainly in subjects exposed to toxic substances or estrogens, and is often asymptomatic. A 9 year-old pekingese female dog was sent to Division of Pathology for autopsy because of sudden death of unclear cause. Autopsy revealed severe hydroperitoneum (1500 ml of transsudate), dilatation of heart ventricles, passive hyperemia of lungs, spleen and kidneys. The liver was enlarged, with slightly wrinkled surface, with many red spots, of different size and shape. Microscopic examination of the liver revealed the presence of areas with severe dilatation of hepatic sinusoids, and multiple cystic spaces filled with blood. Some of these spaces were lined with endothelium and other were not. Spaces were different in shape and size and were localized in the areas between dilated sinusoids. Based on the macroscopic and microscopic examination, the liver lesions were identified as severe hepatic sinusoidal dilatation with formation of peliosis hepatis-like structures.
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Affiliation(s)
- R Sapierzyński
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Warsaw Agricultural University (SGGW), Nowoursynowska 159c, 02-766 Warsaw, Poland.
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15
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Kahraman A, Miller M, Baba H, Gerken G, Hilgard P. [Angiosarcoma of the liver as a rare cause of rapidly progressive liver failure]. ACTA ACUST UNITED AC 2006; 101:746-50. [PMID: 16977400 DOI: 10.1007/s00063-006-1102-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Revised: 07/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Angiosarcoma of the liver is a rare, highly malignant and sometimes diffusely infiltrating vessel tumor with rapid progression and poor prognosis. CASE REPORT A 46-year-old male patient with rapidly progressive liver failure, initially regarded as decompensation of known alcoholic liver cirrhosis, is reported. The patient was referred to the authors' center for evaluation of liver transplantation, but a massive weight loss despite long absence of any alcohol intake raised the suspicion of a malignant disease. The abdominal ultrasound examination showed a massive hepatomegaly with an extremely inhomogeneous echo structure as well as moderate ascites. A following MRI demonstrated diffuse focal contrast enhancement in the entire liver parenchyma, confirming diffuse infiltration of the organ by a malignant tumor. In addition, MRI was suspicious of bone metastases. The usual tumor markers were normal. Sonographically guided percutaneous liver biopsy established the diagnosis of a malignant vascular tumor with diffuse infiltration of the liver parenchyma. 3 days later the patient died of uncontrollable bleeding from esophageal varices. Macroscopic examination of the liver during autopsy showed multiple lacunae filled with blood. Therefore, the differential diagnosis of a peliosis hepatis was raised. However, histology confirmed the diagnosis of a malignant angiosarcoma with diffuse osseous metastases. CONCLUSION A diffuse infiltration of the liver by an angiosarcoma in the absence of any definite lesions may lead to a substantial delay of the diagnosis. The only relevant differential diagnosis in this case is the equally rare peliosis hepatis.
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Affiliation(s)
- Alisan Kahraman
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen
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16
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Han JK, Kim SH. [Focal peliosis hepatis mimicking hepatocellular carcinoma]. Korean J Hepatol 2006; 12:460-3. [PMID: 16998300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Joon Koo Han
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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17
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Iannaccone R, Federle MP, Brancatelli G, Matsui O, Fishman EK, Narra VR, Grazioli L, McCarthy SM, Piacentini F, Maruzzelli L, Passariello R, Vilgrain V. Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol 2006; 187:W43-52. [PMID: 16794138 DOI: 10.2214/ajr.05.0167] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE It is important to recognize the imaging characteristics of peliosis hepatis because peliotic lesions may mimic several different types of focal hepatic lesions CONCLUSION We illustrate the spectrum of imaging findings of peliosis hepatis, including sonography, CT, MR, and angiography.
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Affiliation(s)
- Riccardo Iannaccone
- Department of Radiological Sciences, University of Rome, La Sapienza, 324 Viale Regina Elena, Rome, Italy 00161.
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19
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Abstract
Peliosis hepatis is a rare benign condition characterized by oval or irregular, multiple blood-filled spaces within the liver parenchyma. It is most commonly seen in adults and may be idiopathic, but has various associations including malignancy, infection and drugs. The imaging findings are often non-specific and the condition may be mistaken for multiple abscesses, metastases or vascular malformations. Peliosis hepatis is an especially rare condition in children and to our knowledge only six cases have been described in the literature. Our case describes and illustrates peliosis in a 3-year-old girl and is the first described in any age group to cause complete IVC obstruction. The patient subsequently made a full recovery.
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Affiliation(s)
- Melanie P Hiorns
- Department of Radiology, Great Ormond Street Children's NHS Trust, London, WC1N 3JH, UK.
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20
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Liu X, Zhang ZN, Gong J. [Hepatic peliosis: a case report]. Zhonghua Gan Zang Bing Za Zhi 2004; 12:676. [PMID: 15690584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Xin Liu
- Department of Gastroenterology, Second Hospital of Xi'an Jiaotong University, China
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21
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Samyn M, Hadzic N, Davenport M, Verma A, Karani J, Portmann B, Mieli-Vergani G. Peliosis hepatis in childhood: case report and review of the literature. J Pediatr Gastroenterol Nutr 2004; 39:431-4. [PMID: 15448437 DOI: 10.1097/00005176-200410000-00024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M Samyn
- Department of Child Health, King's College Hospital, Denmark Hill, London, United Kingdom.
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22
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Yekeler E, Dursun M, Tunaci A, Cevikbas U, Rozanes I. Diagnosing of peliosis hepatis by magnetic resonance imaging. J Hepatol 2004; 41:351. [PMID: 15288487 DOI: 10.1016/j.jhep.2004.01.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2003] [Revised: 01/09/2004] [Accepted: 01/09/2004] [Indexed: 12/14/2022]
Affiliation(s)
- Ensar Yekeler
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, 34390, Capa, Istanbul, Turkey
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23
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Omori H, Asahi H, Irinoda T, Takahashi M, Kato K, Saito K. Peliosis hepatis during postpartum period: successful embolization of hepatic artery. J Gastroenterol 2004; 39:168-71. [PMID: 15069624 DOI: 10.1007/s00535-003-1268-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2003] [Accepted: 06/13/2003] [Indexed: 02/04/2023]
Abstract
Peliosis hepatis is a rare disorder characterized by the presence of blood-filled spaces in the liver, and it usually has a chronic presentation pattern. It has been reported mainly in adult patients in association with various pharmacological agents and infections. The present report concerns a postpartum patient in whom peliosis hepatis initially presented as active intraperitoneal hemorrhage from peliotic liver lesions, with no obvious etiology. We report here a 31-year-old woman who developed symptomatic peliosis hepatis and underwent superselective hepatic artery embolization, with control of the bleeding. We also present the sonographic, computed tomographic, and magnetic resonance images and laparoscopic findings. The patient recovered well and was discharged without any complaints. The pathogenesis in this patient remains unclear, but it is suggested that in her case estrogens and progesterone could not have been responsible for the development of peliosis hepatis.
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Affiliation(s)
- Hiroaki Omori
- First Department of Surgery, Iwate Medical University, 19-1 Uchimaru, 020-8505, Morioka, Japan
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24
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Eulderink F. A man with pancytopenia and liver complications. Neth J Med 2004; 62:22, 27. [PMID: 15061229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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25
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Steinke K, Terraciano L, Wiesner W. Unusual cross-sectional imaging findings in hepatic peliosis. Eur Radiol 2003; 13:1916-9. [PMID: 12942295 DOI: 10.1007/s00330-002-1675-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2002] [Revised: 07/15/2002] [Accepted: 08/06/2002] [Indexed: 12/28/2022]
Abstract
Hepatic peliosis is a rare entity that represents focal, multifocal, segmental, or diffuse dilatation of liver sinusoids. Hepatic peliosis is often associated with chronic wasting diseases but also has been reported in association with anabolic, contraceptive, or other hormonal treatment, and even in context with HIV-related bacterial infections. Hepatic peliosis is usually clinically unapparent and mostly found only during autopsy, but occasionally it may lead to diagnostic problems if detected radiologically since the imaging findings in hepatic peliosis are quite variable according to the variety of its possible histologic features as well as the possibility of additional hemorrhage. We present a case of hepatic peliosis associated with bronchial carcinoma that showed moderate centripetal enhancement during the portal-venous phase on CT, pronounced venous pooling on contrast enhanced T1-weighted images acquired during the hepatic-venous phase, and bright signal on T2-weighted images, thus mimicking in some way a capillary hemangioma. We also discuss some not yet described CT and MR features of this rare entity which should be included into the differential diagnosis of atypical liver lesions in patients with the above-mentioned conditions.
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Affiliation(s)
- K Steinke
- Department of Diagnostic Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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26
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Verswijvel G, Janssens F, Colla P, Mampaey S, Verhelst H, Van Eycken P, Erven W. Peliosis hepatis presenting as a multifocal hepatic pseudotumor: MR findings in two cases. Eur Radiol 2003; 13 Suppl 4:L40-4. [PMID: 15018164 DOI: 10.1007/s00330-003-1852-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Two cases of pseudotumoral peliosis hepatis are presented with emphasis on MRI findings. One patient had four individual lesions, the other had two. Image characteristics in both were: heterogeneic signal intensity on T1-weighted images (T1WI) with areas of high-, intermediate, and low signal intensity; heterogeneic signal intensity on T2WI with presence of numerous intralesional "cystic" hyperintense areas with a hypointense border. Signal intensities on T1WI were iso- to hypointense in one case and mild central hyperintensities were demonstrated in the other case, probably due to intra-lesional hemorrhage or diffuse accumulation of fresh clotting within the sinusoids. One case demonstrated early enhancement of the peripheral borders in the arterial phase, and both demonstrated enhancement in the portovenous and late phases. One case was studied with Gd-BOPTA and iron oxides and demonstrated enhancement with both products, suggestive for the presence of hepatocytes and Kupffer cells. This is the first report of the use of hepato-specific contrast agents in this entity. Spontaneous regression of the lesions was demonstrated on a follow-up MR examination in one case.
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Affiliation(s)
- G Verswijvel
- Department of Radiology, Ziekenhuis Oost Limburg, Campus St. Jan, Schiepse Bos 6, 3600 Genk, Belgium.
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27
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Drevelengas A, Chourmouzi D, Boulogianni G. Peliosis of the liver in a patient with prostate carcinoma. JBR-BTR 2003; 86:158-9. [PMID: 12880163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- A Drevelengas
- Asklipios-Aristotelio Diagnostic Center, Thessaloniki, Greece
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28
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Abstract
This article reviews the primary circulatory liver diseases, which include Budd-Chiari syndrome, obstruction of the hepatic portion of the inferior vena cava, portal vein thrombosis, sinusoidal obstruction syndrome (veno-occlusive disease), nodular regenerative hyperplasia, and peliosis hepatis. In addition, two systemic cardiovascular diseases that impair hepatic circulation, ischemic hepatitis and congestive hepatopathy, are briefly discussed. A characteristic of the primary circulatory liver diseases is that portal hypertension usually precedes liver dysfunction; however, this is not the case with the primary parenchymal liver diseases, in which liver dysfunction always progresses before portal hypertension is manifested. Significant overlap exists among the diseases and risk factors that predispose patients to the primary circulatory liver diseases, though the pathogenesis of individual diseases varies.
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Affiliation(s)
- Laurie D DeLeve
- Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, 2011 Zonal Avenue-HMR 603, Los Angeles, CA 90033, USA.
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29
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Abstract
These liver diseases are diseases of the hepatic circulation. Myeloproliferative disorders are among the most common prothrombotic disorders that lead to Budd-Chiari syndrome and PVT. SOS, previously known as hepatic veno-occlusive disease, is mainly seen in North America and Western Europe as a complication of the conditioning regimen for hematopoietic stem cell transplantation. SOS is caused by damage to SECs, and the initiating circulatory blockage occurs because of the embolism of sinusoidal lining cells. Myeloproliferative disorders are an uncommon cause of NRH, which is believed to be caused by uneven perfusion of the liver at the venous or sinusoidal level. Peliosis hepatis is believed to result from damage to SECs and is seen mainly in immunosuppressed patients, patients with a wasting illness, or patients with a drug toxicity.
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Affiliation(s)
- Vijayrama Poreddy
- Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, 2011 Zonal Avenue, HMR 603, Los Angeles, CA 90293, USA
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30
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Cognet F, Dranssart M, Cercueil JP, Peyrou F, Krausé D. [Sinusoidal abnormalities of the liver: MR imaging features]. J Radiol 2002; 83:611-8. [PMID: 12063423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This article reviews the different MR features found in sinusoidal lesions of the liver parenchyma. The diagnosis of these abnormalities is mainly based on the pathologic examination. These diagnoses relate to numerous diseases including veno-occlusive disease, Budd-Chiari disease, peliosis, hepato-portal sclerosis, and portal intra-sinusoidal thrombosis. The use of fast multi-slice acquisitions associated with dynamic enhancement of the liver leads to an efficient examination and allows analysis of both the parenchymal and vascular components of the liver.
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Affiliation(s)
- F Cognet
- Service d'Imagerie Diagnostique et Thérapeutique, Le Bocage, 21034 Dijon, France.
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31
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Abstract
Forty-four free-living stoats were collected from five game estates in England and examined for evidence of disease. All the macroscopic lesions were attributable to the trauma associated with being trapped or shot. There were no significant microscopic lesions in 27 (61 per cent) of the stoats. There was evidence of nematode parasitism in the intestines of six stoats (14 per cent), and in the lungs of five stoats (11 per cent), and of pulmonary granulomatous inflammation or microgranulomas in five stoats. In two of the stoats, blood-filled cavities in the liver were suggestive of peliosis hepatis, possibly associated with infection by Bartonella species or with sublethal exposure to anticoagulant rodenticides.
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Affiliation(s)
- R A McDonald
- School of Biological Sciences, University of Bristol
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32
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Gouya H, Vignaux O, Legmann P, de Pigneux G, Bonnin A. Peliosis hepatis: triphasic helical CT and dynamic MRI findings. Abdom Imaging 2001; 26:507-9. [PMID: 11503089 DOI: 10.1007/s00261-001-0023-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2001] [Accepted: 01/24/2001] [Indexed: 12/28/2022]
Abstract
We report the triphasic helical computed tomographic (CT) and dynamic magnetic resonance imaging (MRI) findings in a unique case of biopsy-proven peliosis of the liver. Several reports have described the CT and MRI findings of this entity without specific appearance. This report discusses the usefulness of dynamic helical CT and MRI for the early diagnosis of peliosis.
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Affiliation(s)
- H Gouya
- Department of Radiology, Université René Descartes, Hôpital Cochin, 27 rue du Fg Saint Jacques, 75679 Paris, Cedex 14, France
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33
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Shim SG, Paik SW, Hyun JG, Choi MS, Lee JH, Rhee PL, Kim JJ, Koh KC, Rhee JC, Choi KW, Park CK. Lipiodol accumulation in focal peliosis hepatis with sinusoidal dilatation. J Clin Gastroenterol 2001; 32:356-8. [PMID: 11276285 DOI: 10.1097/00004836-200104000-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Peliosis hepatis is a rare benign condition that is histologically characterized by multiple cystic blood-filled spaces in the liver. Although the cause is unknown, the condition occurs in association with several diseases or medications. We report a patient who was found to have a lesion with lipiodol accumulation in the liver 2 months after its intraarterial injection. The lesion was diagnosed and treated as a small hepatocellular carcinoma. However, subsequent right hepatic lobectomy and histologic examination confirmed the diagnosis of focal peliosis hepatis.
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Affiliation(s)
- S G Shim
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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34
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Ferrozzi F, Tognini G, Zuccoli G, Cademartiri F, Pavone P. Peliosis hepatis with pseudotumoral and hemorrhagic evolution: CT and MR findings. Abdom Imaging 2001; 26:197-9. [PMID: 11178700 DOI: 10.1007/s002610000131] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Peliosis hepatis is an uncommon benign disorder characterized by blood-filled cavities within the liver. We describe the sonographic, computed tomographic, and magnetic resonance appearance of a patient affected by peliosis hepatis with pseudotumoral and hemorrhagic evolution and direct demonstration of the ectatic vascular components.
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Affiliation(s)
- F Ferrozzi
- Istituto di Scienze Radiologiche, Università degli Studi di Parma, Viale Gramsci, 14 Parma, I-43100 Italy
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35
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Wasser K, Hofmann WJ, Singer R, Essig M, Delorme S. [Puzzling liver findings. Peliosis hepatis]. Radiologe 2001; 41:95-8. [PMID: 11220105 DOI: 10.1007/s001170050933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- K Wasser
- Abteilung für Radiologische Diagnostik, Deutsches Krebsforschungszentrum, Heidelberg
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36
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Leinung S, Gütz U, Stölzel U, Klengel S, Schwarze J. [Peliosis hepatis: problems of differential diagnosis]. Rontgenpraxis 2000; 52:295-301. [PMID: 10936959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Peliosis hepatis is a syndrome manly known to internists and pathologists. It is described as roundish blood cysts up to 1 cm large to the found in the hepatic parenchyma and correlated to the hepatic sinusoids. The pathogenesis is still unclear. The presumably essential disturbance of the structure of the reticular fibres is etiologically associated with anabolic and androgenic steroid therapy. Peliosis hepatis is pathognomonic for treatment with contraceptives and for severe chronic diseases, as tuberculosis or tumour. Little is known of therapeutic methods on the diagnostic of peliosis alterations in the liver. As peliosis-type hepatic lesions are apt to involution, it is generally recommended just to wait and see, with controlling examinations for imaging diagnostics. A case is described where a female patient, aged 42, otherwise healthy, came to see the doctor for obscure pain in the upper abdomen. Sonography of the upper abdomen indicated multiple lesions. The diagnostic method is described taking into account possible malign differential diagnoses or associated malign results which finally lead to partial resection of the liver.
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Affiliation(s)
- S Leinung
- Chirurgische Abteilung, Kreiskrankenhaus Oschatz gGmbH.
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37
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Vignaux O, Legmann P, de Pinieux G, Chaussade S, Spaulding C, Couturier D, Bonnin A. Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation. Eur Radiol 1999; 9:454-6. [PMID: 10087115 DOI: 10.1007/s003300050691] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component. On MR imaging, the multiple peripheral lesions were hypointense on T1-weighted and hyperdense on T2-weighted images, with bright foci on all sequences suggesting subacute blood. Angiography showed no evidence of tumor or vascular malformation; multiple nodular vascular lesions filling in the parenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endothelial lining, characteristic of the parenchymal type of peliosis. Knowledge of the imaging features of hemorrhagic necrosis due to peliosis hepatis is important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage.
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Affiliation(s)
- O Vignaux
- Department of Radiology A, Cochin Hospital, 27 rue du Fg St. Jacques, F-75674 Paris, France
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38
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Gunji T, Ohnishi S, Hippo Y, Miura H, Aburatani H, Ohtomo K, Kitamura K, Yazaki Y. [A case of severe drug-induced peliosis hepatis with radiologically confirmed healing]. Nihon Shokakibyo Gakkai Zasshi 1998; 95:1378-81. [PMID: 9889548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- T Gunji
- Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo
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39
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Krastev N, Dinkov L, Genov Y, Mendizova A, Churchev Y, Donov M. [Nodular regenerative hepatic hyperplasia in the differential diagnosis of focal hepatic lesions. Case report and review of the literature]. Khirurgiia (Mosk) 1998; 53:47-9. [PMID: 11247070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- N Krastev
- University Hospital "Queen Joanna," Clinical Center of Gastroenterology, Sofia, Bulgaria
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40
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Yoshioka K, Sato T, Ishii T, Tanaka S, Kioka K, Harihara S, Imamoto S, Haze K, Inoue T, Fujii S. Peliosis hepatis associated with idiopathic restrictive cardiomyopathy. Intern Med 1998; 37:51-5. [PMID: 9510400 DOI: 10.2169/internalmedicine.37.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A rare case of peliosis hepatis associated with idiopathic restrictive cardiomyopathy is reported. A 75-year-old man was admitted for evaluation of marked edema and jaundice. Serum total bilirubin was elevated above 20 mg/dl. The liver biopsy under laparoscopy revealed marked sinusoidal dilatation and retention of red blood cells, which was consistent with a diagnosis of peliosis hepatis. Cardiac catheterization revealed right ventricular filling disturbance without specific findings on endomyocardial biopsy, suggesting idiopathic restrictive cardiomyopathy. The level of serum total bilirubin decreased in association with improvement of edema after drip infusion of furosemide therapy.
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Affiliation(s)
- K Yoshioka
- Department of Internal Medicine, Osaka City General Hospital, Miyakojima, Osaka
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41
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Abstract
Sinusoidal dilatation is a hallmark of peliosis hepatis, a rare vascular disorder that can be either drug induced or of infectious origin. Here we report a patient with peliosis hepatis of unknown etiology. An hepato-pulmonary syndrome developed which was reversible following liver transplantation.
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Affiliation(s)
- L Bindl
- Zentrum für Kinderheilkunde, Universität Bonn, Deutschland
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42
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Abstract
A 31-year-old woman was admitted because of persistent remittent fever. Tricuspid valve endocarditis due to Staphylococcus aureus was identified as the cause of fever. The patient had no history of intravenous drug abuse, oral contraceptives or predisposing cardiac disease. Huge hepatomegaly was found without any signs of congestive heart failure. Liver enzyme abnormalities were not detected throughout the entire course of therapy. The liver biopsy specimen revealed peliosis hepatis. Treatment with panipenem/betamipron was successful, although recurrent septic pulmonary embolism occurred. The cause of the huge hepatomegaly encountered in the present case may be attributable to peliosis due to severe infection.
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Affiliation(s)
- T Ogo
- Department of Internal Medicine, Shin-kokura Hospital, Fukuoka, Kitakyushu
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43
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Nadal D, Zbinden R. [Illnesses caused by Bartonella. Cat-scratch disease, bacillary angiomatosis, bacillary peliosis hepatis, endocarditis]. Internist (Berl) 1996; 37:890-4. [PMID: 8964682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Nadal
- Universitäts-Kinderklinik Zürich
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44
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Abstract
A 35 year old woman with right upper quadrant abdominal pain was found to have peliosis hepatis. This was attributed to oral contraceptive use and 6 month follow up after cessation of oral contraceptives showed these lesions to have reduced in extent.
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Affiliation(s)
- P G Staub
- Mackay Medical Imaging, Mater Misericordiae Hospital, Queensland, Australia
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45
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46
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Mohle-Boetani JC, Koehler JE, Berger TG, LeBoit PE, Kemper CA, Reingold AL, Plikaytis BD, Wenger JD, Tappero JW. Bacillary angiomatosis and bacillary peliosis in patients infected with human immunodeficiency virus: clinical characteristics in a case-control study. Clin Infect Dis 1996; 22:794-800. [PMID: 8722933 DOI: 10.1093/clinids/22.5.794] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Clinical characteristics associated with bacillary angiomatosis and bacillary peliosis (BAP) in patients with human immunodeficiency virus (HIV) infection were evaluated in a case-control study; 42 case-patients and 84 controls were matched by clinical care institution. Case-patients presented with fever (temperature, > 37.8 degrees C; 93%), a median CD4 lymphocyte count of 21/mm3, cutaneous or subcutaneous vascular lesions (55%), lymphadenopathy (21%), and/or abdominal symptoms (24%). Many case-patients experienced long delays between medical evaluation and diagnosis of BAP (median, 4 weeks; range, 1 day to 24 months). Case-patients were more likely than controls to have fever, lymphadenopathy, hepatomegaly, splenomegaly, a low CD4 lymphocyte count, anemia, or an elevated serum level of alkaline phosphatase (AP) (P < .001). In multivariate analysis, a CD4 lymphocyte count of < 200/mm3 (matched odds ratio [OR], 9.9; P < .09), anemia reflected by a hematocrit value of < 0.36 (OR, 19.7; P < .04), and an elevated AP level of > or = 2.6 mukat/L (OR, 23.9; P < .05) remained associated with disease after therapy with zidovudine was controlled for. BAP should be considered an AIDS-defining opportunistic infection and should be included in the differential diagnosis for febrile, HIV-infected patients with cutaneous or osteolytic lesions, lymphadenopathy, abdominal symptoms, anemia, or an elevated serum level of AP.
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Affiliation(s)
- J C Mohle-Boetani
- Childhood and Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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47
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Abstract
We measured MR images of the liver of Long-Evans Cinnamon (LEC) rats with pathologic correlation and assessed the effectiveness of MR imaging (MRI) for diagnosis of noncancerous hepatic lesions. T1- and T2-weighted images of their livers were obtained, and the dynamic and delayed studies after intravenous gadolinium injection were also performed. Cholangiofibrosis showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The T2 relaxation time of cholangiofibrosis was significantly prolonged (p < .01), and the signal intensity ratio of this lesion to muscle on T1-weighted images was significantly lower than that of normal liver parenchyma to muscle (p < .01). The lesion was enhanced immediately after gadolinium injection and the enhancement was prolonged. Among three cases of peliosis hepatis identified, one showed heterogeneous intensities on both T1- and T2-weighted images and the other two showed similar intensity pattern to cholangiofibrosis. The characteristic MR appearance of cholangiofibrosis may be useful to distinguish it from hepatocellular carcinoma (HCC).
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Affiliation(s)
- H Yoshioka
- National Institute for Environmental Studies, Tsukuba, Ibaraki 305, Japan
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48
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Colagrande S, Tonarelli A, Leone F. [Peliosis hepatis: semiology with ultrasonography, computerized tomography, and magnetic resonance. Report of 2 cases]. Radiol Med 1995; 89:897-900. [PMID: 7644754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- S Colagrande
- Dipartimento di Fisiopatologia Clinica, Università degli Studi di Firenze
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49
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Abstract
Peliosis is an uncommon condition characterized by multiple-blood-filled cavities mostly involving the liver. Although the etiology is unknown the condition may be associated with several disease states and medications. We report the MR findings of peliosis hepatis in a patient with Fanconi anemia who had been treated with anabolic androgenic steroids for 3 years. The MR examination of the upper abdomen was performed on a 0.5 T system. The signal intensity of the right lobe of the liver was diffusely increased in all sequences. Within the enlarged liver, multiple foci of brighter signal were seen involving both right and left lobes. The lesions showed contrast enhancement. A cystic cavity with an enhancing rim was seen representing a haematoma cavity. The spleen was spared the patient died of sepsis and the postmortem examination confirmed the diagnosis of peliosis hepatis.
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Affiliation(s)
- I Saatci
- Department of Diagnostic Radiology, Hacettepe University Hospital, Ankara, Turkey
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50
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Gisbert PJ, González A, Moreira V, Sanromán LA, Hernández F, Cano A. [An intrahepatic hematoma secondary to peliosis hepatis in a female patient treated with oral contraceptives]. Rev Esp Enferm Dig 1994; 85:475-7. [PMID: 8068426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The case of a patient is reported, who developed peliosis hepatis during contraceptive steroid therapy. This was clinically manifested as a spontaneous hepatic hematoma. No underlying liver tumor could be detected by both invasive and non-invasive investigations. Oral contraceptives should be listed among the potential albeit exceptional cases of liver hematoma, and this clinical presentation of peliosis hepatis added to the possible manifestations of that obscure condition.
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Affiliation(s)
- P J Gisbert
- Departamento de Gastroenterología, Hospital Ramón y Cajal, Universidad Alcala de Henares, Madrid
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