Hepatic adenoma

Warning associated with the administration of estrogen include an increased risk of endometrial cancer, gallbladder disease, hypertension, hepatic adenoma (a benign tumor of the liver), cardiovascular disease, increased risk of thromboembolic disease and hypercalcemia in those with breast cancer and bone metastases. 

Acute or chronic hepatocellular disease with abnormal liver function, cirrhosis, hepatic adenomas, or hepatic carcinomas... 

Gallbladder disease, hepatic adenoma, pancreatitis, thrombosis of abdominal artery or vein Endometrial, cervical, or vaginal cancer Deep vein thrombosis... 

Hepatic adenoma Benign hepatic adenomas appear to be associated with the use of oral contraceptives (OCs). 

Hepatic lesions (adenomas, focal nodular hyperplasia, hepatocellular carcinoma, etc) Rarely, benign and malignant hepatic adenomas have been associated with the use of hormonal contraceptives. Severe abdominal pain, shock, or death may be due to rupture and hemorrhage of a liver tumor. 

Experience with long-term therapy with danazol is limited. Peliosis hepatis and benign hepatic adenoma have been observed with long-term use. Peliosis hepatis and hepatic adenoma may be silent until complicated by acute, potentially life-threatening intra-abdominal hemorrhage. Therefore, alert the physician to this possibility. Attempts should be made to determine the lowest dose that will provide... 

Hepatic events Experience with long-term therapy with danazol is limited. Peliosis hepatis and benign hepatic adenoma have been observed with long-term use (see Black..Box.WamlDfl). 

It also appears that the incidence of hepatic adenomas is increased in women taking oral contraceptives. Ischemic bowel disease secondary to thrombosis of the celiac and superior and inferior mesenteric arteries and veins has also been reported in women using these drugs. 

A Japanese girl aged 20 years, who had been legitimately treated with oxymetholone (30 mg/day) for 6 years for aplastic anemia, developed a hepatic adenoma (53). In this case, in contrast to some earlier reports, there was a predisposing factor in the form of familial adenomatous polyposis. 

Nakao A, Sakagami K, Nakata Y, Komazawa K, Amimoto T, Nakashima K, Isozaki H, Takakura N, Tanaka N. Multiple hepatic adenomas caused by longterm administration of androgenic steroids for aplastic... 

Kumar AR, Wagner JE, Auerbach AD, Coad JE, Dietz CA, Schwarzenberg SJ, MacMillan ML. Fatal hemorrhage from androgen-related hepatic adenoma after hematopoietic cell transplantation. J Pediatr Hematol Oncol 2004 26 16-18. 

Diethylstilbestrol can cause hepatic adenomas and carcinomas in experimental animals (10), and hepatocellular carcinoma has been reported in a man who took a total of 668 g over 12 years for suspected carcinoma of the prostate (11). 

Oral contraceptives, estrogens, and benign liver tumors The effects of oral contraceptives on the liver include not only benign liver tumors (focal nodular hyperplasia, hepatic adenoma, and hemangioma) (74) and hepatocellular carcinoma, but also peliosis hepatis (75), sinusoid dilatation (76), and such probably unrelated shorter-term complications as jaundice and gallstones. 

Marks WH, Thompson N, Appleman H. Failure of hepatic adenomas (HCA) to regress after discontinuance of oral contraceptives. An association with focal nodular hyperplasia (FNH) and uterine leiomyoma. Ann Surg 1988 208(2) 190-5. 

Q17 There are some major problems associated with oestrogen-replacement therapy. These include pulmonary embolism, thromboembolism, seizures, hepatic adenoma and risk of stroke. There is also now evidence of an increased incidence of breast, ovarian and endometrial cancer, which is related to the duration of HRT use. Approximately 14 in every 1000 women aged 50-64 years not using HRT develop breast cancer. Use of oestrogen-only HRT for five years in this age group increases the incidence of breast cancer to about 15.5 in every 1000 women this represents a relatively small increase in risk. 

Hepatic adenomas, benign neoplasms consisting of hepatocytes, appear to be linked to the use of oral contraceptives, and before 1960 were rarely described. The incidence of hepatic adenomas has since increased, reflecting increased use of oral contraceptives, and in 1977 was estimated at five cases per million women aged 15-45 years. Hepatic adenomas have been detected in patients taking the pill continuously for a period of six months to four years [15]. To date, mestranol has been the constituent predominantly implicated [12]. 

In 80-90% of cases, focal nodular hyperplasia shows a typical, radial (spoke-like) arrangement of coiled vessels in the area of the tumour, which originate from a circular artery. Occasionally, fine a.v. shunts are present. The smooth-edged lesion is hypervascular. The parenchymal phase, with its homogeneous concentration of contrast medium, allows the lesion to be clearly demarcated from healthy liver tissue. (156) Hepatic adenoma is generally hypervascular. Displaced vessels are frequently visible. 

Hepatic adenomas and focal nodular hyperplasia dynamic CT study Radiology 1986 160 53-58... 

Hepatic adenoma consists of atypical, strand-like hepa-tocytes. It is characterized by normal perfusion and an extensive absence of Kupffer cells as well as irregularity of the bile ducts. Scintigraphically, it is possible to demonstrate that there is no elimination of iminodiacetates from the adenoma and that uptake of the radioactive tracer is prolonged compared with the normal liver parenchyma ( trapping on IDA scans). (38) No colloidal albumin or Tc-colloid is taken up - this allows differentiation of an adenoma from focal nodular hyperplasia. The use of the SPECT technique increases sensitivity. 

Adenoma The potential association of hepatic adenoma with the long-term use of oral contraceptives was first suggested by I.K. BAUMetal. in 1973. Although the detection of adenoma was extremely rare before 1954, more than 400 cases were published by 1985. This figure has probably risen even further, but such findings have sel-... 

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