Peritoneoscopy of peliosis hepatis

Five cases of peliosis hepatis diagnosed by peritoneoscopy (two confirmed by liver biopsy) are presented. The patients were 4 males and one female, and their ages ranged from 31 to 43 years. Each patient had had an episode of jaundice with fever in the past. At peritoneoscopy, the lesions appeared as reddish-purple spots measuring up to 2.0 mm in diameter. These spots did not show protrusion or retraction, and had no clear relationship with the lobular markings formed by portal triads. In one case, spots were connected to form irregular meshworks in places. In other cases, spots were found or oblong. Histologically, a spot obtained with a punch biopsy forceps had dilated sinusoids filled with red blood cells. Similar dilated sinusoids were observed in deep tissues of the liver obtained with a Vim-Silverman needle. Reconstruction studies of a liver biopsy specimen proved that peliosis lesions were collections of dilated sinusoids. The lesions formed ellipsoids with an irregular margin and were located in the central and intermediate zones of a liver lobule. Other histological features of the liver, mainly observed in the central area were: central fibrosis, fatty metamorphosis, slight liver cell necrosis, and cholestasis. Peliosis hepatis in cases with acute hepatitis and chronic alcoholic liver injury as in the present series is a new finding. The lesion was also seen in a case of primary liver cancer.