Peliosis hepatis overview: Difference between revisions

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{{Peliosis hepatis}}
{{Peliosis hepatis}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} [[Adenike Eketunde]]


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==Historical Perspective==
==Historical Perspective==
There is limited information about the historical perspective of Peliosis hepatis


==Classification==
==Classification==
There is no established system for the classification of Peliosis hepatis


==Pathophysiology==
==Pathophysiology==
The [[pathogenesis]] of peliosis hepatis is unknown. There are several [[Hypothesis|hypotheses]], such as, it arise from [[sinusoidal]] epithelial damage<ref>{{cite journal |author=Gushiken FC |title=Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine |journal=South. Med. J. |volume=93 |issue=6 |pages=625-6 |year=2000 |pmid=10881786}}</ref>, increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular [[necrosis]]<ref name="marvin"/>.
The [[pathogenesis]] of peliosis hepatis is unknown. There are several [[Hypothesis|hypotheses]], such as, it arise from [[sinusoidal]] epithelial damage<ref>{{cite journal |author=Gushiken FC |title=Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine |journal=South. Med. J. |volume=93 |issue=6 |pages=625-6 |year=2000 |pmid=10881786}}</ref>, increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular [[necrosis]]<ref name="marvin" />.


Two [[morphology (biology)|morphologic]] patterns of hepatic peliosis were described by Yanoff and Rawson <ref>{{cite journal |author=YANOFF M, RAWSON AJ |title=PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES |journal=Archives of pathology |volume=77 |issue= |pages=159-65 |year=1964 |pmid=14088761}}</ref>. In the '''phlebectatic''' type, the blood-filled spaces are lined with [[endothelium]] and are associated with [[aneurysm|aneurism]]al dilatation of the central vein; in the '''parenchymal''' type, the spaces have no endothelial lining and they usually are associated with [[haemorrhagic]] [[parenchyma]]l [[necrosis]]. Some considers both pattern 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 phebectatic type. [[Fibrosis]], [[cirrhosis]], regenerative nodules, and [[tumor|tumours]] may also be seen.
Two [[morphology (biology)|morphologic]] patterns of hepatic peliosis were described by Yanoff and Rawson <ref>{{cite journal |author=YANOFF M, RAWSON AJ |title=PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES |journal=Archives of pathology |volume=77 |issue= |pages=159-65 |year=1964 |pmid=14088761}}</ref>. In the '''phlebectatic''' type, the blood-filled spaces are lined with [[endothelium]] and are associated with [[aneurysm|aneurism]]al dilatation of the central vein; in the '''parenchymal''' type, the spaces have no endothelial lining and they usually are associated with [[haemorrhagic]] [[parenchyma]]l [[necrosis]]. Some considers both pattern 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 phebectatic type. [[Fibrosis]], [[cirrhosis]], regenerative nodules, and [[tumor|tumours]] may also be seen.
Line 21: Line 23:
==Causes==
==Causes==


Peliosis hepatitis may be caused by drugs, toxins, chronic wasting disease, malignancy, and infection. Peliosis Hepatitis may develop in individuals with renal or cardiac transplantation, but in about 20-50% of patients, they are no comorbidities.
Peliosis hepatis may be caused by drugs, toxins, chronic wasting disease, malignancy, and infection. Peliosis Hepatitis may develop in individuals with renal or cardiac transplantation, but in about 20-50% of patients, they are no comorbidities.


common causes include  
common causes include  
*[[Corticosteriods]]
*[[Corticosteriods]]
*Oral [[Contraceptives]]
*Oral [[Contraceptives]]
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*[[Diabetes mellitus]]
*[[Diabetes mellitus]]
*[[Necrotizing]] [[vasculitis]]
*[[Necrotizing]] [[vasculitis]]
*Hematologic disorders
*Infection in [[AIDS]], bacillary peliosis caused by Bartonella henselae and Bartonella quintana)
*Hematologic disorders. <ref> https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis </ref>


==Differentiating Peliosis hepatis from Other Diseases==
==Differentiating Peliosis hepatis from Other Diseases==
Peliosis hepatis must be differentiated from [[Hepatic Adenoma]], [[Hemangioma]], Focal Nodular Hyperplasia, [[Hepatic]] [[Abscess]], [[Hypervascular]] [[Metastases]], and [[Hepatocellular]] [[Carcinoma]].<ref> https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis </ref> [[Polycystic liver disease]], [[Congenital hepatic fibrosis]], Solitary [[congenital cysts]], [[Hydatid cyst]], [[Von Meyenburg complexes]], [[Caroli disease]] (type V [[choledochal cyst]]).<ref> https://www.ncbi.nlm.nih.gov/books/NBK554470/</ref>


==Epidemiology and Demographics==
==Epidemiology and Demographics==
 
The prevalence of Peliosis hepatis is approximately 0.2 percent of patients with pulmonary tuberculosis and about 22 percent in patients following renal transplant. It is most commonly associated with renal transplants. <ref> <ref> https://www.ncbi.nlm.nih.gov/books/NBK554470/</ref><ref>https://www.uptodate.com/contents/peliosis-hepatis#:~:text=The%20reported%20prevalence%20of%20peliosis,2%2C6%2C7%5D<nowiki><ref>.</nowiki><nowiki><ref>.</nowiki>
==Risk Factors==
 
==Screening==
 
==Natural History, Complications, and Prognosis==
===Natural History===
 
===Complications===
*'''Infections:''' [[HIV]], Bacillary peliosis (caused by genus  ''[[Bartonella]]'', bacteria responsible for [[cat-scratch disease]] which are identified histologically adjacent to the peliotic lesions<ref>{{cite journal |author=Koehler JE, Sanchez MA, Garrido CS, Whitfeld MJ, Chen FM, Berger TG, Rodriguez-Barradas MC, LeBoit PE, Tappero JW |title=Molecular epidemiology of bartonella infections in patients with bacillary angiomatosis-peliosis |journal=N. Engl. J. Med. |volume=337 |issue=26 |pages=1876-83 |year=1997 |pmid=9407154}}</ref>), ''[[Staphylococcus aureus]]''<ref>{{cite journal |author=Perkocha LA, Geaghan SM, Yen TS, Nishimura SL, Chan SP, Garcia-Kennedy R, Honda G, Stoloff AC, Klein HZ, Goldman RL |title=Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection |journal=N. Engl. J. Med. |volume=323 |issue=23 |pages=1581-6 |year=1990 |pmid=2233946}}</ref>
*'''Chronic conditions:'''  End stage [[renal failure]], [[Kwashiorkor]], [[tuberculosis]] and other chronic infections.
*'''Malignancy:''' [[Monoclonal gammopathy|Monoclonal gammopathies]] ([[multiple myeloma]] and [[Waldenstrom macroglobulinemia]]), [[Hodgkin's disease]], [[malignant histiocytosis]], [[seminoma]], [[hepatocellular adenoma]] and [[Hepatocellular carcinoma|hepatocarcinoma]],<ref>{{cite journal |author=Haboubi NY, Ali HH, Whitwell HL, Ackrill P |title=Role of endothelial cell injury in the spectrum of azathioprine-induced liver disease after renal transplant: light microscopy and ultrastructural observations |journal=Am. J. Gastroenterol. |volume=83 |issue=3 |pages=256-61 |year=1988 |pmid=3278593}}</ref>
* '''Renal 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]]<ref>{{cite journal |author=Izumi S, Nishiuchi M, Kameda Y, Nagano S, Fukunishi T, Kohro T, Shinji Y |title=Laparoscopic study of peliosis hepatis and nodular transformation of the liver before and after renal transplantation: natural history and aetiology in follow-up cases |journal=J. Hepatol. |volume=20 |issue=1 |pages=129-37 |year=1994 |pmid=8201214}}</ref><ref>{{cite journal |author=Cavalcanti R, Pol S, Carnot F, Campos H, Degott C, Driss F, Legendre C, Kreis H |title=Impact and evolution of peliosis hepatis in renal transplant recipients |journal=Transplantation |volume=58 |issue=3 |pages=315-6 |year=1994 |pmid=8053054}}</ref>.
*'''Drugs and toxins:''' [[Corticosteroids]], [[androgens]], [[methyltestosterone]], [[azathioprine]], [[tamoxifen]]<ref>{{cite book | last = Goldman | first = Lee | title = Cecil Textbook of Medicine -- 2-Volume Set, Text with Continually Updated Online Reference | publisher = W.B. Saunders Company | location = Philadelphia | year = 2003 | isbn = 0721645631 }}</ref>
 
===Prognosis===


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===
Peliosis Hepatis is primarily diagnosed based on the clinical presentation like [[jaundice]], [[hepatomegaly]], and [[liver failure]]. There are no established criteria for the diagnosis of Peliosis Hepatis. It is usually asymptomatic.


===History and Symptoms===
===History and Symptoms===
The majority of patients with Peliosis Hepatis are asymptomatic. Sign and symptoms of Peliosis Hepatis may include [[jaundice]], [[hepatomegaly]], [[liver failure]], [[fever]], and [[abdominal pain]], imaging is necessary to rule out other differential diagnoses.<ref name="pmid32119357">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=32119357 | doi= | pmc= | url= }} </ref>


===Physical Examination===
===Physical Examination===
Line 61: Line 53:


===Laboratory Findings===
===Laboratory Findings===
There are no diagnostic laboratory findings associated with Peliosis Hepatis


===Imaging Findings===
===Imaging Findings===
[[Ultrasound]] appears non-specific, usually demonstrating an irregular hypoechoic region or mass,<ref name="pmid16037541">{{cite journal| author=Savastano S, San Bortolo O, Velo E, Rettore C, Altavilla G| title=Pseudotumoral appearance of peliosis hepatis. | journal=AJR Am J Roentgenol | year= 2005 | volume= 185 | issue= 2 | pages= 558-9 | pmid=16037541 | doi=10.2214/ajr.185.2.01850558 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16037541  }} </ref> and on [[Computerized Tomography]] (CT scan) shows multiple hypoattenuating lesions of variable size. Central bleeding may lead to areas of hyperattenuating and even [[dystrophic calcification]].<ref> https://doi.org/10.1148/rg.287085067
/</ref> [[Magnetic resonance imaging]] (MRI) may typically show hypointense, hyperintense, or enhancement, usually centrifugal (from the center outward). [[Angiography]] may  show hypervascularity with multiple vascular [[nodules]]. <ref> https://radiopaedia.org/articles/hepatic-peliosis?lang=us/</ref>


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with Peliosis Hepatis


==Treatment==
==Treatment==
=== Medical Therapy ===
===Medical Therapy===
* Bacillary peliosis hepatitis (peliosis hepatis caused by ''Bartonella spp.'')<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
 
*Bacillary peliosis hepatitis (peliosis hepatis caused by ''Bartonella spp.'')<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>


:*Preferred regimen (1): [[Clarithromycin]] 500 mg bid for 4 months
:*Preferred regimen (1): [[Clarithromycin]] 500 mg bid for 4 months
:*Preferred regimen (6): [[Erythromycin]] 500 mg PO qid for 4 months
:*Preferred regimen (6): [[Erythromycin]] 500 mg PO qid for 4 months
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months
*Special Consideration
*Special Consideration
:*Severe disease
:*Severe disease
::* Preferred regimen: [[Doxycycline]] 100 mg PO/IV bid for 4 months {{and}} [[Rifampin]]  300 mg PO bid for 4 months
::*Preferred regimen: [[Doxycycline]] 100 mg PO/IV bid for 4 months {{and}} [[Rifampin]]  300 mg PO bid for 4 months


===Surgery===
===Surgery===
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===Prevention===
===Prevention===


== See Also ==
==See Also==
*[[Polycystic Liver Disease]]  
 
*[[Polycystic Liver Disease]]
*Solitary congenital cysts
*Solitary congenital cysts
*[[Congenital hepatic fibrosis]]
*[[Congenital hepatic fibrosis]]

Latest revision as of 15:11, 5 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adenike Eketunde

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Overview

Peliosis Hepatis is an uncommon vascular condition characterised by randomly distributed multiple blood-filled cavities throughout liver. Size of the cavities usually ranges between a few millimetres to 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 Greek pelios, i.e. discoloured by extravasated blood, livid[3], and the Latinized Genitive case (hepatis[4]) of the Greek hepar, liver[5].

Historical Perspective

There is limited information about the historical perspective of Peliosis hepatis

Classification

There is no established system for the classification of Peliosis hepatis

Pathophysiology

The pathogenesis of peliosis hepatis is unknown. There are several hypotheses, such as, it arise from sinusoidal epithelial damage[6], increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular necrosis[1].

Two morphologic patterns of hepatic peliosis were described by Yanoff and Rawson [7]. In the phlebectatic type, the blood-filled spaces are lined with endothelium and are associated with aneurismal 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 considers both pattern 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 phebectatic type. Fibrosis, cirrhosis, regenerative nodules, and tumours may also be seen.

Causes

Peliosis hepatis may be caused by drugs, toxins, chronic wasting disease, malignancy, and infection. Peliosis Hepatitis may develop in individuals with renal or cardiac transplantation, but in about 20-50% of patients, they are no comorbidities.

common causes include

Differentiating Peliosis hepatis from Other Diseases

Peliosis hepatis must be differentiated from Hepatic Adenoma, Hemangioma, Focal Nodular Hyperplasia, Hepatic Abscess, Hypervascular Metastases, and Hepatocellular Carcinoma.[9] Polycystic liver disease, Congenital hepatic fibrosis, Solitary congenital cysts, Hydatid cyst, Von Meyenburg complexes, Caroli disease (type V choledochal cyst).[10]

Epidemiology and Demographics

The prevalence of Peliosis hepatis is approximately 0.2 percent of patients with pulmonary tuberculosis and about 22 percent in patients following renal transplant. It is most commonly associated with renal transplants.

Physical Examination

The condition is typically asymptomatic and is discovered following evaluation of abnormal liver function test. However, when severe it can manifest as jaundice, hepatomegaly, liver failure and haemoperitoneum.

Laboratory Findings

There are no diagnostic laboratory findings associated with Peliosis Hepatis

Imaging Findings

Ultrasound appears non-specific, usually demonstrating an irregular hypoechoic region or mass,[11] and on Computerized Tomography (CT scan) shows multiple hypoattenuating lesions of variable size. Central bleeding may lead to areas of hyperattenuating and even dystrophic calcification.[12] Magnetic resonance imaging (MRI) may typically show hypointense, hyperintense, or enhancement, usually centrifugal (from the center outward). Angiography may show hypervascularity with multiple vascular nodules. [13]

Other Diagnostic Studies

There are no other diagnostic studies associated with Peliosis Hepatis

Treatment

Medical Therapy

  • Bacillary peliosis hepatitis (peliosis hepatis caused by Bartonella spp.)[14]
  • Preferred regimen (1): Clarithromycin 500 mg bid for 4 months
  • Preferred regimen (6): Erythromycin 500 mg PO qid for 4 months
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months
  • Special Consideration
  • Severe disease
  • Preferred regimen: Doxycycline 100 mg PO/IV bid for 4 months AND Rifampin 300 mg PO bid for 4 months

Surgery

Prevention

See Also

References

  1. 1.0 1.1 Sleisenger, Marvin (2006). Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Philadelphia: W.B. Saunders Company. ISBN 1416002456. Chapter 80
  2. Ichijima K, Kobashi Y, Yamabe H, Fujii Y, Inoue Y (1980). "Peliosis hepatis. An unusual case involving multiple organs". Acta Pathol. Jpn. 30 (1): 109–20. PMID 7361545.
  3. "Henry George Liddell, Robert Scott, A Greek-English Lexicon". Retrieved 2007-06-11.
  4. "Charlton T. Lewis, Charles Short, A Latin Dictionary". Retrieved 2007-07-02.
  5. "Henry George Liddell, Robert Scott, A Greek-English Lexicon". Retrieved 2007-07-02.
  6. Gushiken FC (2000). "Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine". South. Med. J. 93 (6): 625–6. PMID 10881786.
  7. YANOFF M, RAWSON AJ (1964). "PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES". Archives of pathology. 77: 159–65. PMID 14088761.
  8. https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis
  9. https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis
  10. https://www.ncbi.nlm.nih.gov/books/NBK554470/
  11. Savastano S, San Bortolo O, Velo E, Rettore C, Altavilla G (2005). "Pseudotumoral appearance of peliosis hepatis". AJR Am J Roentgenol. 185 (2): 558–9. doi:10.2214/ajr.185.2.01850558. PMID 16037541.
  12. https://doi.org/10.1148/rg.287085067 /
  13. https://radiopaedia.org/articles/hepatic-peliosis?lang=us/
  14. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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