Anabolic androgenic steroid-induced hepatotoxicity

Anabolic androgenic steroids (AAS) have been abused for decades by both professional and amateur athletes in order to improve physical performance or muscle mass. AAS abuse can cause adverse effects, among which are hepatotoxic effects. These effects include cholestatic icterus and possibly peliosis hepatis and hepatocellular carcinoma or adenoma. In particular, 17α-alkylated AAS appear to be hepatotoxic, whereas nonalkylated AAS appear not to be. The 17α-alkyl substitution retards hepatic metabolism of the AAS rendering it orally bioavailable. The mechanism responsible for the hepatotoxicity induced by 17α-alkylated AAS remains poorly understood. However, oxidative stress has been repeatedly shown to be associated with it. In this manuscript we present a hypothesis which describes a potential mechanism responsible for AAS-induced hepatotoxicity, based on several observations from the literature which suggest oxidative stress being a causal factor.

The N-nitrosodiethylamine mouse model: sketching a timeline of evolution of chemically-induced hepatic lesions

BACKGROUND/AIM

Hepatocellular carcinoma (HCC) is a frequent and aggressive malignancy associated with multiple environmental risk factors. The chemically-induced mouse model of diethylnitrosamine (DEN) provides useful insight into liver carcinogenesis, namely HCC. This work aimed to study the multistep process of hepato-carcinogenesis, providing a systematic framework for animal studies on this subject.

MATERIALS AND METHODS

Male ICR mice were divided into six control and six DEN-exposed groups. Saline solution and DEN were injected intra-peritoneally, respectively, for eight consecutive weeks. Two groups (DEN vs. control) were euthanized at 8, 15, 22, 29, 36 and 40 weeks after the first administration.

RESULTS

Hydropic degeneration, necrosis and apoptosis were acutely induced at eight weeks and onwards. Hyperplastic foci occurred at 29 to 40 weeks along with diffuse dysplastic areas and hepatocellular adenoma. Peliosis hepatis were also identified at 36 and 40 weeks. HCC were only noted at 40 weeks, showing characteristic histological features of malignancy.

CONCLUSION

Results allowed sketching of a timeline of evolution of DEN-induced hepatic lesions in mice, from initial lesions to malignant neoplasms.

Alcohol binging causes peliosis hepatis during azathioprine therapy in Crohn's disease

Patients with inflammatory bowel disease have normal life expectancy and, due to modern immunosuppressive therapies, also a normal quality of life. Since mostly young people are affected, their social behaviour suits this environment. Alcohol binging is an increasingly disturbing factor among young people. We describe a patient with Crohn’s disease, treated with azathioprine, who developed peliosis hepatis after three epsiodes of alcohol binging. Liver toxicity was not observed previously during the course of the treatment. Azathioprine-induced peliosis hepatis is thought to be idiosyncratic in humans. From animal studies, however, it is clear that hepatic depletion of glutathione leads to azathioprine toxicity to the sinusoidal endothelial cells. Damage of these cells causes peliosis hepatis. Since alcohol binging leads to hepatic glutathione depletion, we conclude that in our patient the episodes of binging have reduced liver gluathione content and therefore this has increased azathioprine toxicity causing peliosis hepatis. The problem of alcohol binging has not yet been addressed in IBD patients undertaking immunosuppressive therapy. This should be reviewed in future considerations regarding patients advice.

Peliosis hepatis: microscopic and macroscopic type, time pattern, and correlation with liver cell apoptosis in a model of toxic liver injury

Macroscopic and microscopic types of peliosis hepatis, time pattern, and correlation with hepatocyte and sinusoidal cell apoptosis were investigated. Male Wistar rats were injected with a dose of cadmium (6.5 mg CdCl(2)/kg body weight, intraperitoneally; group I). Putrescine (300 micromol/kg body weight, intraperitoneally; group II) was injected at 2, 5, and 8 hours and vascular endothelial growth factor (VEGF; 400 ng/animal, intravenously; group III) at 2 hours. Animals from each group were humanely killed 0, 6, 12, 24, 48, or 60 hours after cadmium intoxication. Liver tissue was histologically assessed for necrosis, apoptosis, and peliosis. Apoptosis was also quantified by the TUNEL assay for hepatocytes and nonparenchymal liver cells. The discrimination between hepatic cell subpopulations was done histochemically. Sinusoidal cell apoptosis and macroscopic peliosis hepatis evolved in a monophasic pattern and correlated closely. Putrescine or VEGF administration totally reversed macroscopic peliosis. Putrescine exerted a major protective effect on hepatocytes, whereas the protective effect of VEGF was more pronounced for nonparenchymal liver cells. Microscopic peliosis also evolved in a monophasic pattern preceding macroscopic type. The extent of the lesion was reduced by putrescine and almost totally reversed by VEGF. Macroscopic peliosis progresses as a compound lesion closely correlating with nonparenchymal cell apoptosis. Both hepatocyte and nonparenchymal cell injury are prerequisites for the genesis of the lesion. Microscopic peliosis precedes macroscopic peliosis and up to a degree seems to be independent of initial hepatocyte injury, but it seems to depend on nonparenchymal cell injury.

Peliosis hepatis revealed by biliary colic in a patient with oral contraceptive use

Peliosis hepatis is a rare condition associated with a variety of diseases and drugs. We report a patient who developed peliosis hepatis while taking oral contraceptives. Three months after withdrawal of this oral contraceptive, reduction in size of these lesions was observed.

The hepatoprotective effect of putrescine against cadmium-induced acute liver injury

The hepatoprotective effect of putrescine against cadmium liver injury was investigated. Male Wistar rats were injected with a dose of cadmium (6.5 mg CdCl(2)/kg bodyweight, intraperitoneally). Normal saline (group I) or putrescine (300 micro mol/kg bodyweight; group II) were injected 2, 5 and 8 h later. A number of animals of both groups were killed 0, 12, 16, 24, 48 or 60 h after cadmium intoxication. Liver tissue was histologically assessed for necrosis, apoptosis, peliosis, mitoses, and inflammatory infiltration. Apoptosis was also quantified by the TUNEL assay for hepatocytes and nonparenchymal liver cells. The discrimination between hepatic cell subpopulations was achieved histochemically. The mitotic index in hematoxylin-eosin-stained sections and by the immunochemical detection of Ki67 nuclear antigen, (3)H-thymidine incorporation into hepatic DNA, and hepatic thymidine kinase activity were all used as indices of liver regeneration. Both hepatocyte apoptosis and liver necrosis evolved in a biphasic temporal pattern. Nonparenchymal cell apoptosis and peliosis hepatis evolved in a monophasic pattern and were correlated closely. Putrescine administration totally reversed liver necrosis and hepatocyte apoptosis. The time profile of nonparenchymal apoptosis was altered and peliosis hepatis was also totally attenuated. In conclusion, putrescine protected hepatocytes and modulated the mechanism of cadmium-induced acute hepatotoxicity.

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-induced accumulation of biliverdin and hepatic peliosis in rats

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a widespread, persistent, and highly toxic environmental pollutant. The most TCDD-sensitive and the most TCDD-resistant rat strains (Long-Evans [Turku/AB] and Han/Wistar [Kuopio], respectively) were crossbred to separate the alleles of two genes (Ahrand an unidentified gene "B") mediating resistance against TCDD toxicity. During crossbreeding, a new type of toxicity in livers of both sexes was detected, characterized macroscopically by intense dark green to black color and swelling that appeared most frequently after a large dose (300 micro g/kg or more as a single intragastric dose) and a follow-up period of more than three weeks. Therefore, studies were undertaken to identify the causative pigment chemically and to examine the hepatotoxicity histologically. The pigment fractions were separated by thin layer chromatography and then analyzed by HPLC and electrospray mass spectrometry. The pigment was found to consist of biliverdin and several biliverdin-related compounds. In liver histopathology carried out on male rats, progressive sinusoidal distension and hepatic peliosis with membrane-bound cysts were seen. The clinical manifestations of pigment accumulation were recorded most often in intermediately resistant rat lines such as line B (homozygous for the gene B), but never occurred in rats expressing only the Han/Wistar (Kuopio)-type Ah receptor with an altered transactivation domain structure.

The relationship between estrogen and the development of liver vascular disorders

The liver is central to the metabolic disposition of all drugs and foreign substance. Drug-induced liver injury is a potential complication of estrogen preparations. The primary estrogen-induced vascular disorders are peliosis hepatis and vasculitis. Peliosis hepatis has been described as a rare consequence of taking estrogens and contraceptive. This condition is characterized by the presence of blood-filled spaces. Vasculitis has been noted as necrotizing or non-necrotizing hypersensitivity and an inflammatory infiltrate involving all the wall of a vessel. Vasculitis is usually connected with the presence of increased numbers of eosinophils either in blood or tissues. The aim of the study was to determine the influence of estrogen preparations on liver vascular disorders. The experiment was conducted on female rats of Wistar strain with the initial body weight of 180-300 g/kg of the body weight. After acclimation period, animals were gathered in 5 experimental groups of min. 10 in the group. Oestradiolum benzoicum was used for the purpose of this study. It was given i.m. once a week for 8 weeks in three different doses: E1--0.0075 g/kg, E2--0.0015 g/kg; E3--0.003 g/kg of the body weight. Two control groups were designed: K0--the untreated animals, K1--the animals receiving the adequate quantity of oleum pro injection. Fragments of organ assigned for histological examination were fixed in 10% buffered formaldehyde solution and transformed into paraffin sections. Histological preparations were evaluated in the light microscope. The histological assays were determined using: hematoxylin-eosin, azan and histochemical paS (periodic acid-Schiff) stains. In the described experiment large inflammatory infiltrations and vasculitis (E2, E3) were observed. In the animals treated with higher doses of estrogens diffusely distributed infiltrations around spaces with bloody fluid inside were revealed. The lumen of vessels was dilated. Estrogens can be responsible for the development of vascular disorders described as peliosis hepatis. The observed changes were suggestive of drug related vasculitis. An increased awareness of peliosis hepatis may become an important symptom for a pathologist, especially in patients at risk.

[Peliosis hepatis as the cause of liver affection in a patient treated with immunosuppressive agents]

A case of peliosis hepatis in a 64-year-old woman treated with azathioprine because of a lung transplantation is described. The patient was admitted owing to epigastric pain and jaundice. Sixteen months before admission the patient had had a lung transplantation because of pulmonary emphysema. A liver biopsy showed multiple, dilated, blood-filled liver sinusoids consistent with peliosis hepatis. Besides azathioprine, the patient was treated with cyclosporine and prednisolone, but none of these drugs are known to be responsible for the development of peliosis hepatis. This rare condition, which causes liver affection in patients treated with azathioprine, should be kept in mind.

Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine

Peliosis hepatis is an unusual disorder associated with a variety of diseases and treatments. This is the first report of peliosis hepatis associated with administration of 2-chloro-3'-deoxyadenosine. The literature is reviewed.

Cadmium-induced apoptosis in mouse liver

Apoptosis is a process of active cell death, distinct from necrosis and characterized by specific morphological and biochemical features. Although the acute hepatotoxic effects of cadmium (Cd) are well described, little is known about the occurrence of apoptosis in Cd toxicity. Therefore, mice were injected with 5-60 mumol/kg i.p. of Cd and their livers were removed 1.5-48 h later and examined by light microscopy. Cd induced both a time- and dose-dependent increase in apoptotic index, severity of necrosis, and mitotic index. Apoptotic index peaked at 9-14 h after Cd administration and then decreased. The time course of apoptotic DNA fragmentation index, monitored by quantification of oligonucleosomal DNA fragments, correlated with the results obtained by histopathological analysis and a commercial in situ apoptotic DNA detection kit. Liver necrosis, as demonstrated by histology and serum alanine aminotransferase and sorbitol dehydrogenase assays, was most severe 14-48 h after Cd injection. Apoptosis was decreasing by 24 h while necrosis persisted. Replacement of liver tissue by blood lakes (peliosis hepatis) was observed after 14 h. The mitotic index increased gradually with time, indicating compensatory liver cell regeneration. There was a progressive increase in the severity of necrosis, apoptotic index, and mitotic index with increasing dose of Cd. These data demonstrate that apoptosis is a major mode of elimination of critically damaged cells in acute Cd hepatotoxicity in the mouse, and it precedes necrosis.

[Autopsy findings of retroperitoneal cystic tumor and peliosis hepatis in lymphangiomyomatosis]

A 40-year-old woman who worked as a nurse and had suffered from progressive exertional dyspnea for about 14 years underwent open lung biopsy with surgical treatment for pneumothorax. The diagnosis was lymphangiomyomatosis and she was treated with danazol to suppress ovarian function. Her condition improved temporarily, but she died of respiratory failure when she was 47 years old. The survival time after the onset of respiratory symptoms was 21 years, and after the biopsy it was 8 years. At autopsy a retroperitoneal cystic tumor was found (9 x 7 x 5 cm), which had been evident clinically. Histologic examination showed that the tumor was an extrapulmonary manifestation of the lumphangiomyomatosis lesion. Some paraaortic lymph nodes has similar lesions. Aggregates of small red spots were seen on acute surface of the liver. These were diagnosed as peliosis hepatis, they may have been caused by the danazol.

Peliosis hepatis associated with oral contraceptive use

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.

[An intrahepatic hematoma secondary to peliosis hepatis in a female patient treated with oral contraceptives]

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.

Peliosis hepatis in a young adult bodybuilder

Peliosis hepatis, an unusual condition characterized by blood-filled spaces within the hepatic parenchyma, usually occurs in a variety of chronic wasting diseases such as tuberculosis or malignancy. It has been described in patients undergoing therapy with anabolic steroids in pharmacologic doses over extended periods of time. To our knowledge it has not been described in athletes who utilize them for performance enhancement. This report concerns a 27-yr-old bodybuilder with peliosis hepatis, which developed after chronic intermittent use of anabolic steroids.

Liver disease from surreptitious administration of urethane

We report subacute necrosis, peliosis hepatis, venoocclusive disease and hepatic angiosarcoma after long-term administration of urethane. We take this to be the 12th case of urethane-induced hepatitis and the first associated with vascular liver tumor.

Peliosis hepatis: a case report

A 54-year-old man who presented with marked hepatomegaly and a liver scan suggestive of an infiltrative malignancy was found to have peliosis hepatis caused by androgenic steroids. A detailed and repeated drug history is necessary for making the correct diagnosis. Withdrawal of the offending drug is indicated and may result in reversal of this serious form of hepatic toxicity.

[Liver tumors caused by androgenic steroids]

11 hepatocellular tumours associated with the long term use of androgenic steroids were reported. Three of the tumours were seen on the basis of diffuse peliosis hepatis. One of the 11 tumours was benign hepatocellular adenoma. In one case malignant transformation of an adenoma was observed. Nine tumours proved to be highly differentiated hepatocellular carcinomas. Metastases were observed in three cases. Histological and electron microscopical peculiarities of the tumours were the accumulation of glycogen in the cytoplasm of tumour cells, nuclear inclusions, and great number of peculiar formed vessels. The last case is a rarity. One year after the needle biopsy implantation of hepatocellular carcinoma was observed with several tumorous metastases at the site of the previous biopsy. The authors suggest regular hepatic control by ultrasound examinations of patients on sexual steroid hormones.

[Peliosis hepatis in dermatomyositis treated with azathioprine and corticoids]

We report a case of peliosis hepatis in a 47-year old male patient with dermatomyositis treated with azathioprine and corticosteroids. Three months after the combined treatment was initiated, the patient developed right thoracic herpes zoster, agranulocytosis and liver enlargement with signs of portal hypertension. Needle biopsy of the liver revealed peliosis. Azathioprine was withdrawn. The clinical and laboratory abnormalities disappeared progressively. The main causes of peliosis hepatis are considered. Up to now, azathioprine had been held responsible for peliosis hepatis only in renal transplant recipients.

[Hepatic peliosis. Review of the literature]

Hepatic peliosis is a morphologic entity characterized by the presence in the liver of blood-filled cystic spaces. These can be single or multiple, and of variable size. The internal surface of these cavities is covered by endothelial cells and adjacent hepatocytes can be normal or show atrophic or degenerative changes. The cavities contain liquid blood, suggesting that it circulates. Its etiology is unknown but it has been related to drugs, ingestion of toxins and diverse tumoral or inflammatory diseases. The morphogenesis of peliosis is also controversial. For some it is the consequence of increased sinusoid pressure because of difficulties in blood outflow from the liver. For others it is the result of the disappearance, by necrosis of liver cells, while for others it is due to sinusoid wall weakness. The lesion can be silent so that it is probable that its prevalence is higher than has been estimated. Eventually the cysts originate complication particularly hemoperitoneum. Only in these cases is the adoption of specific therapeutic measures, concretely hepatectomy, justified.

Peliosis hepatis induced by 6-thioguanine administration

A patient with acute myeloblastic leukaemia developed jaundice revealing peliosis hepatis after receiving 6-thioguanine for two months. Peliosis hepatis was severe and was associated with mild lesions of centrilobular veins. Withdrawal of 6-thioguanine was followed by a progressive improvement of liver dysfunction. This report shows that 6-thioguanine, a thiopurine already reported to be responsible for veno-occlusive disease of the liver, can induce peliosis hepatis. This suggests that some liver vascular disorders caused by thiopurines (6-thioguanine, azathioprine and 6-mercaptopurine), particularly peliosis hepatis, veno-occlusive disease, sinusoidal dilatation and perisinusoidal fibrosis, might be related syndromes caused by similar lesions at different sites.

Generalized peliosis hepatis and cirrhosis after long-term use of oral contraceptives

Peliosis hepatis, a condition characterized by the presence of blood-filled lacunar spaces in the liver, has been described primarily in patients on androgenic steroid medication and patients with tuberculosis. It has never been reported as a complication of the use of oral contraceptives, except in association with and localized in contraceptive-induced hepatic tumors. The present report concerns a 43-yr-old woman with generalized peliosis hepatis that developed during long-term use of oral contraceptives. Extensive examination did not reveal a hepatic tumor. Liver cirrhosis and portal hypertension developed, although the oral contraceptives had been withdrawn. She finally underwent successfully an orthotopic liver transplantation.

Drug-induced vascular and sinusoidal lesions of the liver

Drugs can induce various vascular and sinusoidal lesions of the liver, in particular hepatic vein thrombosis, veno-occlusive disease, sinusoidal dilatation, peliosis hepatis, hepatoportal sclerosis and angiosarcoma. None of these lesions is specific of drug-induced injury and all of them can be determined by causes other than drugs. However, for one of these lesions, veno-occlusive disease, chemotherapy (and/or irradiation) represents the main aetiology.

[Genesis of atraumatic liver hemorrhages]

Hepatic hemorrhages are not unusual after sharp or blunt abdominal traumata. They are of particular interest when deadly hepatic hemorrhages are under discussion as the single or contributory cause of death in forensic investigations, for instance after reanimation or acts of violence. The test results in rabbits demonstrate that artificial and specific enzyme-assimilation conditions can cause atraumatic hepatic hemorrhages in only a few days. With and without concomitant injuries, liver bleeding may have an atraumatic genesis. An additional human case report shows the possibility of confusion with atraumatic rhexis hemorrhage in the liver.

Peliosis hepatis after long-term androgen therapy

Peliosis hepatis is a recognized, but rare, complication of androgen replacement therapy. We herein report such a complication with necropsy study of the liver so involved.

Peliosis-like ultrastructural changes of the hepatic sinusoids in human chronic hypervitaminosis A: report of three cases

In addition to hypertrophy of Ito cells and perisinusoidal fibrosis, previously unrecognized ultrastructural abnormalities of the hepatic sinusoids were observed in three patients with chronic hypervitaminosis A: 1) large areas of communication between the sinusoidal lumina and the perisinusoidal spaces, allowing extravasation of blood cells; 2) marked dilation of the perisinusoidal spaces; and 3) swelling and clarification of endothelial cells. Most of these changes, along with some other sinusoidal barrier alterations previously reported in chronic hypervitaminosis A (i.e., bleb formation on the sinusoidal membrane of the hepatocytes and the presence of multiple cellular layers lining the sinusoids), are strikingly similar to those observed in peliosis hepatis. The present findings suggest that sinusoidal barrier abnormalities might constitute a major event in the pathophysiology of vitamin A-induced liver injury as well as of peliosis hepatis.

[Hepatic cell adenoma and peliosis hepatis in women using oral contraceptives]

A case of hepatic cell adenoma associated with peliosis hepatis is reported. Both these conditions developed in a 41 year-old woman after the patient was under oral contraceptive therapy for 13 years. The relation between the use of oral contraceptives and these hepatic conditions are briefly discussed.

High incidence of peliosis hepatis in autopsy cases of aplastic anemia with special reference to anabolic steroid therapy

The livers were collected from 47 autopsy cases of aplastic anemia aiming to study the correlation between the use of androgenic anabolic steroid and the formation of peliosis hepatis. Association of peliosis hepatis was found in 7 cases out of 19 cases with anabolic steroid therapy, while peliotic cavities were found only in one case out of the remaining 28 cases without anabolic steroid therapy. Out of 7 cases specified above, peliotic cavities in 5 cases were phlebectatic; phlebectatic and parenchymal types of peliotic cavities coexisted in one case, and one case was parenchymatous. Besides these cavity formations, remarkable dilatation of sinusoids often distinct at the periphery of the hepatic lobule was found in the 7 cases.

Computed tomography of fatal hepatic rupture due to peliosis hepatis

Hepatic rupture with subcapsular hematoma and hemoperitoneum is shown by CT in a patient with peliosis hepatis. Peliosis hepatis is pathologically characterized by blood-filled cystic spaces in the liver associated with the administration of anabolic androgenic steroids or oral contraceptive agents, particularly those with large components of estrogen. We report a fatal case in a patient receiving diethylstilbestrol for 3 years. In patients receiving these medications, peliosis hepatis should be considered in the differential diagnosis of low attenuation areas in the liver by CT. These patients are subject to increased risk of spontaneous hepatic rupture.

Veno-occlusive disease and peliosis of the liver after thorotrast administration

A case of veno-occlusive disease and peliosis of the liver without coexisting liver malignancy 35 years after thorotrast administration is presented. In the liver four main widely distributed lesions were found: Veno-occlusive disease (VOD), peliosis, fibrosis and thorotrast deposits. Whether the VOD and the peliotic lesions are pathogenetically related or totally independent cannot be determined in the present case. However, the VOD and the peliosis are possibly related to the protracted alpha-emitting effect of thorotrast deposited in the liver parenchyma.

[Hepato-biliary complications of estro-progestin therapy]

A brief account of the most frequently observed side-effects of the protracted administration of oestroprogestinic substances is followed by a detailed explanation of the damage they may cause to the hepatobiliary apparatus: cholestatic icterus; cholesterolic biliary lithiasis; benign and malignant liver neoplasias. Reference is made to the liver diagnosis problems the practitioner may encounter when dealing with patients treated with these substances. Stress is laid on the need for close monitoring of tolerance and the possible effects of oestroprogestinic management on liver and bile function.

Peliosis hepatis and oral contraceptives. A case report

Peliosis hepatis associated with prolonged usage of oral contraceptives occurred in a patient. This paper presents the clinical picture and pathologic findings. Liver palpation in patients using birth control pills is very important. Peliosis hepatis may be reversible when oral contraceptives are discontinued.

[Peliosis hepatis. A clinical status inventory]

Peliosis hepatis is a rare condition, recognizable by macroscopical view. It is characterized by multiple blood-filled cystic spaces in the liver parenchyma. According to 49 out of 152 more recent case reports (1951-1981/82) its spontaneous occurrence is frequently associated with malignant and toxic processes. However, in about 70% peliosis may be induced by the action of certain drugs, especially by 17 alpha-alkylated steroids. Usually peliosis is found by chance at autopsy or peritoneoscopy, as the clinical picture does not provide sufficient conclusive criteria to allow a definite diagnosis. The striking macroscopical appearance contrasts to the dispute on the as yet unestablished natural history. As most important complication spontaneous intraabdominal bleeding can occur in occasional cases. On the other hand, the patients predominantly die of their underlying diseases and not of a peliosis hepatis.

Peliosis hepatis. Report of two autopsy cases with a review of literature

Two cases of peliosis hepatis, treated with a large dose of predonine for aplastic anemia and multiple myeloma, respectively, were reported. Case 1 showed no abnormal liver function, but, in Case 2 hepatomegaly, retention of ICG, and elevation of LDH level despite the normal serum transaminase were noted. In both cases, peliotic lesions were incidentally observed at autopsy. In Case 1, the lesion was localized in the right lobe only, but, in Case 2 the lesion was present throughout the entire lobes of the liver involving also a part of the spleen and bone marrow of the sternum. Innumerable blood-filled cavities were surrounded by incomplete reticulin or injured hepatocytes. In smaller lesions observed in Case 1, focal necrosis, hemorrhage, inflammation, and thrombi were prominent features. On the other hand, in extensive lesions, as in Case 2, a marked liver cell dissociation with sequent irregular reticulin arrangement was present. Though the etiology and peliosis hepatis is still uncertain in these cases, it was assumed that a large dose of predonine might have some correlation to the occurrence.