Peliosis: a morphologic curiosity becomes an iatrogenic problem

Peliosis is a morphologic entity describing a condition of blood filled spaces, most frequently occurring in the liver. In recent years it has evolved from an anatomic curiosity seen at autopsy to a potential clinical problem in view of its association with the administration of anabolic steroid hormones. The pathogenesis and predilection of peliosis for the liver remain unexplained. This article reports five patients with peliosis, four with splenic involvement, all but one of whom received an anabolic steroid preparation. One patient died as a result of rupture of the splenic peliotic spaces. The diagnosis in three cases was established on the basis of surgical material, i.e., liver biopsy or splenectomy. An increased awareness of peliosis in patients at risk, as well as an appreciation for the histopathologic changes in less advanced cases, may become an important issue for the surgical pathologist.