Abstract

Background: Peliosis hepatis is a rare hepatic condition characterized by the presence of blood-filled cavities within the liver parenchyma, which may mimic malignant lesions on imaging studies. Case Presentation: We report a case of a 42-year-old male presenting with multiple hepatic lesions detected during the evaluation of transverse colon cancer. Contrast-enhanced CT and MRI demonstrated multiple hepatic lesions with imaging features suspicious for malignancy, raising suspicion for hepatic metastases; however, PET/CT demonstrated no FDG uptake in the liver. Initial core needle biopsy revealed no evidence of malignancy, showing mainly necrosis and congestion. Following surgical resection of the colon tumor and intraoperative liver biopsy, histopathological examination demonstrated blood-filled cavities without a distinct endothelial lining, consistent with peliosis hepatis. Conclusion: This case highlights that peliosis hepatis can closely mimic hepatic metastases, particularly in patients with underlying malignancy, posing significant diagnostic challenges. A multidisciplinary approach integrating clinical, radiological, and histopathological findings is essential to establish an accurate diagnosis and avoid unnecessary treatment.