Incidentally diagnosed peliosis hepatis mimicking hepatic adenoma: a rare case report and literature review

Background: Peliosis hepatis is a rare vascular disorder characterized by blood-filled cystic spaces within the hepatic parenchyma. It is often asymptomatic and may radiologically mimic hepatic adenoma or other hypervascular liver tumors, making preoperative diagnosis challenging. Case report: We report a 28-year-old female who presented with mild abdominal pain. An incidental liver mass was detected on ultrasound. Laboratory investigations were unremarkable. Contrast-enhanced computed tomography revealed a large hypervascular mass involving segments III and IV of the liver, suggestive of hepatic adenoma. The patient underwent a left lateral sectionectomy. Histopathological examination unexpectedly revealed peliosis hepatis. Discussion: Peliosis hepatis is an uncommon vascular abnormality of the liver that may mimic hypervascular hepatic tumors on imaging, making diagnosis challenging. Imaging findings are often nonspecific, and a definitive diagnosis usually requires histopathological examination. Although commonly associated with drugs or systemic diseases, idiopathic cases can occur. Surgical resection is often performed when malignancy cannot be excluded or when lesions are large. Conclusion: Peliosis hepatis should be considered in the differential diagnosis of hypervascular hepatic masses, especially when imaging findings are atypical. Definitive diagnosis often requires histopathological confirmation.