Peliosis Hepatis: Causes, Symptoms, Treatment, Diagnosis

What is Peliosis Hepatis?

Peliosis hepatis is recognized as a rare condition where the person suffering from it has several randomly-distributed cavities all throughout the liver. These cavities do range in size between some millimeters to three centimeters in diameter. Peliosis hepatis disease is linked with the usage of anabolic steroids and various other hormones, like oral contraceptive pills. Again, it has been witnessed related to both malignant and benign liver tumors. Commonly, peliosis hepatis affects a person’s lymph nodes, spleen, bone marrow, adrenal glands, kidneys, and portions of the gastrointestinal tract.

Though peliosis hepatis happens to be a rare tumor-like abrasion which comprises several blood-filled cavities within a person’s liver parenchyma, yet, at times, it becomes tough to distinguish it from various other liver conditions by just imaging tests, like metastases, abscess, or carcinoma.(1, 2)

Symptoms of Peliosis Hepatis

Measuring only some millimeters to nearly three centimeters in diameter; the cysts remain non-existent in cell lining and get enclosed by hepatocytes. At times, a few of them possess an endothelial cell lining too along with dilated hepatic sinusoids. Commonly, peliosis hepatis is asymptomatic; however, at times, the cysts rupture and it results in hemorrhage, and, in worst conditions, death. A few patients get affected with overt liver disease and it becomes apparent with hepatomegaly, liver failure, and jaundice. The mild cases might be incidentally detected at the time of imaging tests as liver function test results become a little abnormal(1). A CT or Ultrasonography is capable of detecting cysts while otherwise, the majority of the cases go untreated.

Causes of Peliosis Hepatis

The etiology of peliosis hepatis continues to remain unknown though it has been observed that it is linked with malignancies or infections.

Nonetheless, the real cause of peliosis hepatis remains unclear in 20-50% of patients. Peliosis hepatis is often found to be associated with anabolic steroid use. It is also found in people who are HIV-positive and are infected with Bartonella henselae.(3)

Diagnosis of Peliosis Hepatis

As noted in a 2013 study, a nineteen-year-old male diagnosed with upper right quadrant pain which lasted for 3 days. This patient was a student and had no earlier medical history. Ultrasonography and CT indicated a neoplasm in the patient’s right liver and eventually a diagnosis of liver cancer was made because of this disease’s manifestations. The patient’s treatment was successful with only an uneven right Hemihepatectomy and he was found to be in good health at 6 months. The obtained tissue specimen was sent for pathological examinations and immunohistochemistry, which lead to the diagnosis of peliosis hepatis.(4)It can thus be said that in similar cases, peliosis hepatis should always be considered as a differential diagnosis and evaluations must be done to check its presence.(5)

Diagnosis of peliosis hepatis can be done through Computerized Tomography (CT) scan, Magnetic Resonance Imaging (MRI) scan, pathological examinations and immunohistochemistry of the tissue specimen obtained by biopsy or surgical removal of the cysts. An angiography can also be done to diagnose the condition.(6)

Treatment of Peliosis Hepatis

There is no particular treatment of peliosis hepatis. Popular treatment methods include liver transplantation, transhepatic artery embolization, and partial hepatectomy(2, 6). When a patient has been taking drugs, like oral contraceptives and anabolic steroids, then drugs need to be discontinued as soon as possible. In the case of hepatic failure along with cirrhosis, liver transplantation emerges as the sole choice for saving the lives of the patients. In patient with worsening status, arresting the hemorrhage might be needed besides transarterial embolization which is less invasive. As the finest treatment for this disease remains unidentified, hence treatment methods depend on the presenting complain and its management. Nonetheless, transarterial embolization happens to be a substitute procedure for operative intervention in patients suffering from hemorrhage(2). In case of patients who are HIV-positive, a prolonged course of antibiotics is found to be helpful. If it is focal and hemorrhagic, surgery is beneficial(6, 7). It must also be noted that peliosis hepatis should never be drained, by mistaking it to be hepatic abscess, as the hemorrhage can lead to life-threatening conditions.(8)

Conclusion

Although peliosis hepatis continues to be an uncommon disease, yet it might be considered when images display a typical liver features that are caused by augmented immunosuppression drugs meant for HIV infection and renal or liver transplantation. Peliosis hepatis remains to be one of the highly complicated cases making it even more complicated due to the delay in diagnosis and the condition mimicking the symptoms of several other disorders.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380268/
  2. https://www.internationalsurgery.org/doi/full/10.9738/CC43.1
  3. “Liver Cysts” by Stanley Martin Cohen, Phillip Y. Chung, in Encyclopedia of Gastroenterology, 2004
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796433/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3646152/
  6. https://radiopaedia.org/articles/hepatic-peliosis
  7. Iannaccone R, Federle MP, Brancatelli G et-al. Peliosis hepatis: spectrum of imaging findings. AJR Am J Roentgenol. 2006;187 (1): W43-52.
  8. Cohen GS, Ball DS, Boyd-kranis R et-al. Peliosis hepatis mimicking hepatic abscess: fatal outcome following percutaneous drainage. J Vasc Interv Radiol. 5 (4): 643-5.

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