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Peliosis hepatis

Authors
Wissam Bleibel, MD
Michael P Curry, MD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Kristen M Robson, MD, MBA, FACG

INTRODUCTION

Peliosis hepatis is a rare vascular condition of the liver characterized by a proliferation of the sinusoidal hepatic capillaries that results in cystic blood-filled cavities distributed randomly throughout the liver [1,2]. The term originates from the Greek "pelios," which means blue/black or discolored extravasated blood [3]. Peliosis is most commonly found in the liver but can also involve the spleen, bone marrow, lungs, abdominal lymph nodes, and other organs [2,4].

EPIDEMIOLOGY

The epidemiology of peliosis hepatis is incompletely understood since many patients are asymptomatic and remain undiagnosed. Peliosis hepatis is often an incidental finding on abdominal imaging or autopsy. The incidence does not differ by gender [5].

The reported prevalence of peliosis hepatis in patients with associated conditions ranges from 0.2 percent of patients with pulmonary tuberculosis to as high as 22 percent in patients following renal transplant [2,6,7].

ETIOLOGY

First described in patients with advanced cancer and tuberculosis and in users of anabolic steroids [2,8,9], peliosis hepatis is now associated with a variety of conditions (table 1) [10-13]. The mechanisms by which these lead to peliosis hepatis is unknown. Risk factors can be divided into three categories:

Drug–related factors (ie, steroids, oral contraceptives, azathioprine, chemotherapeutic agents).

               

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Literature review current through: Jul 2017. | This topic last updated: Jun 27, 2017.
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References
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  1. Biswas S, Rolain JM. Bartonella infection: treatment and drug resistance. Future Microbiol 2010; 5:1719.
  2. ZAK FG. Peliosis hepatis. Am J Pathol 1950; 26:1.
  3. Degott C, Rueff B, Kreis H, et al. Peliosis hepatis in recipients of renal transplants. Gut 1978; 19:748.
  4. Zafrani ES, Cazier A, Baudelot AM, Feldmann G. Ultrastructural lesions of the liver in human peliosis. A report of 12 cases. Am J Pathol 1984; 114:349.
  5. Crocetti D, Palmieri A, Pedullà G, et al. Peliosis hepatis: Personal experience and literature review. World J Gastroenterol 2015; 21:13188.
  6. Atila K, Coker A, Uçar D, et al. A rare clinical entity misdiagnosed as a tumor: peliosis hepatis. Ulus Travma Acil Cerrahi Derg 2007; 13:149.
  7. Izumi S, Nishiuchi M, Kameda Y, et al. Laparoscopic study of peliosis hepatis and nodular transformation of the liver before and after renal transplantation: natural history and aetiology in follow-up cases. J Hepatol 1994; 20:129.
  8. Zafrani ES, von Pinaudeau Y, Dhumeaux D. Drug-induced vascular lesions of the liver. Arch Intern Med 1983; 143:495.
  9. YANOFF M, RAWSON AJ. PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES. Arch Pathol 1964; 77:159.
  10. Wakabayashi T, Onda H, Tada T, et al. High incidence of peliosis hepatis in autopsy cases of aplastic anemia with special reference to anabolic steroid therapy. Acta Pathol Jpn 1984; 34:1079.
  11. Degos F, Degott C, Bedrossian J, et al. Is renal transplantation involved in post-transplantation liver disease? A prospective study. Transplantation 1980; 29:100.
  12. Chopra S, Edelstein A, Koff RS, et al. Peliosis hepatis in hematologic disease. Report of two cases. JAMA 1978; 240:1153.
  13. Scoazec JY, Marche C, Girard PM, et al. Peliosis hepatis and sinusoidal dilation during infection by the human immunodeficiency virus (HIV). An ultrastructural study. Am J Pathol 1988; 131:38.
  14. Matsumoto T, Yoshimine T, Shimouchi K, et al. The liver in systemic lupus erythematosus: pathologic analysis of 52 cases and review of Japanese Autopsy Registry Data. Hum Pathol 1992; 23:1151.
  15. Ahsan N, Holman MJ, Riley TR, et al. Peloisis hepatis due to Bartonella henselae in transplantation: a hemato-hepato-renal syndrome. Transplantation 1998; 65:1000.
  16. Xiong WJ, Hu LJ, Jian YC, et al. Focal peliosis hepatis in a colon cancer patient resembling metastatic liver tumor. World J Gastroenterol 2012; 18:5999.
  17. Pan W, Hong HJ, Chen YL, et al. Surgical treatment of a patient with peliosis hepatis: a case report. World J Gastroenterol 2013; 19:2578.
  18. Cavalcanti R, Pol S, Carnot F, et al. Impact and evolution of peliosis hepatis in renal transplant recipients. Transplantation 1994; 58:315.
  19. Ahsan N, Rao KV. Hepatobiliary diseases after kidney transplantation unrelated to classic hepatitis virus. Semin Dial 2002; 15:358.
  20. Bagheri SA, Boyer JL. Peliosis hepatis associated with androgenic-anabolic steroid therapy. A severe form of hepatic injury. Ann Intern Med 1974; 81:610.
  21. Ruebner BH, Watanabe K, Wand JS. Lytic necrosis resembling peliosis hepatis produced by lasiocarpine in the mouse liver. A light and electron microscopic study. Am J Pathol 1970; 60:247.
  22. Zafrani ES, Feldmann G. [Does a characteristic hepatic sinusoid pathology exist?]. Gastroenterol Clin Biol 1986; 10:105.
  23. Zafrani ES, Bernuau D, Feldmann G. Peliosis-like ultrastructural changes of the hepatic sinusoids in human chronic hypervitaminosis A: report of three cases. Hum Pathol 1984; 15:1166.
  24. Leong SS, Cazen RA, Yu GS, et al. Abdominal visceral peliosis associated with bacillary angiomatosis. Ultrastructural evidence of endothelial destruction by bacilli. Arch Pathol Lab Med 1992; 116:866.
  25. DeLeve LD. Hepatic microvasculature in liver injury. Semin Liver Dis 2007; 27:390.
  26. Tzirogiannis KN, Papadimas GK, Kondyli VG, et al. Peliosis hepatis: microscopic and macroscopic type, time pattern, and correlation with liver cell apoptosis in a model of toxic liver injury. Dig Dis Sci 2006; 51:1998.
  27. Haboubi NY, Ali HH, Whitwell HL, Ackrill P. Role of endothelial cell injury in the spectrum of azathioprine-induced liver disease after renal transplant: light microscopy and ultrastructural observations. Am J Gastroenterol 1988; 83:256.
  28. Buffet C, Cantarovitch M, Pelletier G, et al. Three cases of nodular regenerative hyperplasia of the liver following renal transplantation. Nephrol Dial Transplant 1988; 3:327.
  29. Hung NR, Chantrain L, Dechambre S. Peliosis hepatis revealed by biliary colic in a patient with oral contraceptive use. Acta Chir Belg 2004; 104:727.
  30. Simon DM, Krause R, Galambos JT. Peliosis hepatis in a patient with marasmus. Gastroenterology 1988; 95:805.
  31. Berzigotti A, Magalotti D, Zappoli P, et al. Peliosis hepatis as an early histological finding in idiopathic portal hypertension: A case report. World J Gastroenterol 2006; 12:3612.
  32. Chawla SK, Patel HD, Mahadevia SD, LoPresti PA. Portal hypertension in peliosis hepatis. Report of the first case. Am J Proctol Gastroenterol Colon Rectal Surg 1980; 31:11.
  33. Choi SK, Jin JS, Cho SG, et al. Spontaneous liver rupture in a patient with peliosis hepatis: a case report. World J Gastroenterol 2009; 15:5493.
  34. Hyodo M, Mogensen AM, Larsen PN, et al. Idiopathic extensive peliosis hepatis treated with liver transplantation. J Hepatobiliary Pancreat Surg 2004; 11:371.
  35. Kim EA, Yoon KH, Jeon SJ, et al. Peliosis hepatis with hemorrhagic necrosis and rupture: a case report with emphasis on the multi-detector CT findings. Korean J Radiol 2007; 8:64.
  36. Khadilkar UN, Prabhu S, Sharma D. Peliosis hepatis presenting as hemoperitoneum. Indian J Med Sci 2008; 62:236.
  37. Maréchal R, Taccone FS, Bourgeois N, Hittelet A. [Spontaneous intrahepatic haemorrhage due to peliosis hepatis]. Rev Med Brux 2005; 26:451.
  38. Hayward SR, Lucas CE, Ledgerwood AM. Recurrent spontaneous intrahepatic hemorrhage from peliosis hepatis. Arch Surg 1991; 126:782.
  39. Wang SY, Ruggles S, Vade A, et al. Hepatic rupture caused by peliosis hepatis. J Pediatr Surg 2001; 36:1456.
  40. Lozano F, Corzo JE, León EM, et al. Massive hemoperitoneum: a new manifestation of bacillary peliosis in human immunodeficiency virus infection. Clin Infect Dis 1999; 28:911.
  41. Plettenberg A, Lorenzen T, Burtsche BT, et al. Bacillary angiomatosis in HIV-infected patients--an epidemiological and clinical study. Dermatology 2000; 201:326.
  42. Radin DR, Kanel GC. Peliosis hepatis in a patient with human immunodeficiency virus infection. AJR Am J Roentgenol 1991; 156:91.
  43. Chen JF, Chen WX, Zhang HY, Zhang WY. Peliosis and gummatous syphilis of the liver: a case report. World J Gastroenterol 2008; 14:1961.
  44. Iannaccone R, Federle MP, Brancatelli G, et al. Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol 2006; 187:W43.
  45. Kim SH, Lee JM, Kim WH, et al. Focal peliosis hepatis as a mimicker of hepatic tumors: radiological-pathological correlation. J Comput Assist Tomogr 2007; 31:79.
  46. Xu HX, Xie XY, Lu MD, et al. Unusual benign focal liver lesions: findings on real-time contrast-enhanced sonography. J Ultrasound Med 2008; 27:243.
  47. Yekeler E, Dursun M, Tunaci A, et al. Diagnosing of peliosis hepatis by magnetic resonance imaging. J Hepatol 2004; 41:351.
  48. Steinke K, Terraciano L, Wiesner W. Unusual cross-sectional imaging findings in hepatic peliosis. Eur Radiol 2003; 13:1916.
  49. Oŕiordan K, Blei A, Vogelzang R, et al. Peliosis hepatis with intrahepatic hemorrhage: successful embolization of the hepatic artery. HPB Surg 2000; 11:353.
  50. Battal B, Kocaoglu M, Atay AA, Bulakbasi N. Multifocal peliosis hepatis: MR and diffusion-weighted MR-imaging findings of an atypical case. Ups J Med Sci 2010; 115:153.
  51. Kim SB, Kim DK, Byun SJ, et al. Peliosis hepatis presenting with massive hepatomegaly in a patient with idiopathic thrombocytopenic purpura. Clin Mol Hepatol 2015; 21:387.
  52. Kleger A, Bommer M, Kunze M, et al. First reported case of disease: peliosis hepatis as cardinal symptom of Hodgkin's lymphoma. Oncologist 2009; 14:1088.
  53. Dai W, Zhong D. Peliosis hepatis mimicking cancer: A case report. Oncol Lett 2013; 6:960.
  54. Iwai M, Muramatsu A, Tanaka S, et al. Macroscopic and microscopic findings of livers in malignant hematologic disorders, biopsied under peritoneoscopy. J Clin Gastroenterol 2002; 35:262.
  55. Cohen GS, Ball DS, Boyd-Kranis R, et al. Peliosis hepatis mimicking hepatic abscess: fatal outcome following percutaneous drainage. J Vasc Interv Radiol 1994; 5:643.
  56. Abdelli N, Bouhnik Y, Lavergne-Slove A, et al. [Peliosis hepatitis during intestinal lymphomatous polyposis treated with chemotherapy and radiotherapy. Regression after antibiotic therapy]. Gastroenterol Clin Biol 1995; 19:537.
  57. Testa G, Panaro F, Sankary H, et al. Peliosis hepatis in a living related liver transplantation donor candidate. J Gastroenterol Hepatol 2006; 21:1075.
  58. Adler M, Delhaye M, Deprez C, et al. Hepatic vascular disease after kidney transplantation: report of two cases and review of the literature. Nephrol Dial Transplant 1987; 2:183.
  59. Rolain JM, Brouqui P, Koehler JE, et al. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother 2004; 48:1921.
  60. Kallel L, Matri S, Karoui S, et al. [Idiopathic peliosis hepatis complicated by a hepatopulmonary syndrome]. Gastroenterol Clin Biol 2008; 32:88.
  61. Cimbanassi S, Aseni P, Mariani A, et al. Spontaneous hepatic rupture during pregnancy in a patient with peliosis hepatis. Ann Hepatol 2015; 14:553.