Liver and intrahepatic bile ducts-nontumor

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Liver and intrahepatic bile ducts-nontumor

Vascular disorders

Peliosis hepatis

Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 15 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Multiple blood filled cysts in liver or spleen
● Associated with steroids (anabolic, contraceptive), danazol, azathioprine, Bartonella henselae infection in HIV+ patients
● Also associated with liver or renal transplants, Castleman’s disease, nodular regenerative hyperplasia, leukemia / lymphoma, vinyl chloride exposure
● Usually incidental finding at autopsy, but may cause fatal intra-abdominal hemorrhage
● May be due to hepatocellular necrosis, veno-occlusive disease

Treatment
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● Erythromycin or doxycycline for Bartonella henselae infections

Gross description
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● Honeycombed liver with multiple round, red-purple, blood filled spaces, 0.2 to 5 cm

Micro description
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● Blood lakes surrounded by hepatic cords with variable endothelium
● Spaces may be continuous
● Sinusoidal dilation away from pools
● May have herniation of hepatocytes into central veins; also fibrosis, organizing thrombus, hepatocellular necrosis
● B. henselae patients have small blood vessel proliferation and spindle cells in liver and spleen

Positive stains
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● Warthin-Starry (Bartonella henselae infection / bacillary angiomatosis in HIV patients)

Differential diagnosis
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● Hemangiomas, involvement of the spleen in hairy-cell leukemia

Additional references
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● Forensic Sci Int 2005;149:25, Arch Pathol Lab Med. 2004;128:1283 Arch Pathol Lab Med 1986;110:611

End of Liver and intrahepatic bile ducts-nontumor > Vascular disorders > Peliosis hepatis

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