Peliosis hepatis is an uncommon vascular condition characterised by multiple, randomly distributed, blood-filled cavities throughout the liver. The size of the cavities usually ranges between a few millimetres and 3 cm in diameter.[1] In the past, it was a mere histological curiosity occasionally found at autopsies, but has been increasingly recognised with wide-ranging conditions from AIDS to the use of anabolic steroids. It also occasionally affects spleen, lymph nodes, lungs, kidneys, adrenal glands, bone marrow, and other parts of gastrointestinal tract.[2]
Peliosis hepatis is often erroneously written "peliosis hepatitis", despite its not being one of the hepatitides. The correct term arises from the Greekpelios, i.e. discoloured by extravasated blood, livid,[3] and the Latinizedgenitive case (hepatis[4]) of the Greekhepar, liver.[5]
Often, peliosis hepatis causes no symptoms (asymptomatic). In other cases, it may be identified after blood tests show abnormalities in liver enzymes.[6]
Less commonly, peliosis hepatis may cause abdominal pain, especially right upper quadrant pain, or jaundice.[6]
Kidney transplants: It can be found in up to 20% patients, can be related to azathioprine or cyclosporine use, and may be associated with increased risk of transplant rejection.[10][11]
The pathogenesis of peliosis hepatis is unknown. Several hypotheses are given, such as it arises from sinusoidal epithelial damage,[13] increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular necrosis.[1]
Peliosis hepatis is associated with infections, cancers, organ transplantation, blood disorders, autoimmune conditions, and certain medications.[6]
Two morphologic patterns of hepatic peliosis were described by Yanoff and Rawson.[14] In the phlebectatic type, the blood-filled spaces are lined with endothelium and are associated with aneurysmal dilatation of the central vein; in the parenchymal type, the spaces have no endothelial lining and they usually are associated with haemorrhagic parenchymal necrosis. Some consider both patterns to be one process, initiated by focal necrosis of liver parenchyma, observed in parenchymal type, progressing into formation of fibrous wall and endothelial lining around haemorrhage of phlebectatic type. Fibrosis, cirrhosis, regenerative nodules, and tumours may also be seen.
Treatment is usually directed towards management of the underlying cause. Withdrawal of azathioprine leads to remission in kidney transplant; bacillary peliosis responds to antibiotics. In rare circumstances partial resection of liver or transplant may be required.
^Haboubi NY, Ali HH, Whitwell HL, Ackrill P (1988). "Role of endothelial cell injury in the spectrum of azathioprine-induced liver disease after renal transplant: light microscopy and ultrastructural observations". Am. J. Gastroenterol. 83 (3): 256–61. PMID3278593.
^Izumi S, Nishiuchi M, Kameda Y, Nagano S, Fukunishi T, Kohro T, Shinji Y (1994). "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. 20 (1): 129–37. doi:10.1016/S0168-8278(05)80479-9. PMID8201214.
^Goldman, Lee (2003). Cecil Textbook of Medicine -- 2-Volume Set, Text with Continually Updated Online Reference. Philadelphia: W.B. Saunders Company. ISBN978-0-7216-4563-6.
^YANOFF M, RAWSON AJ (1964). "Peliosis Hepatis. An Anatomic Study with Demonstration of Two Varieties". Archives of Pathology. 77: 159–65. PMID14088761.
