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J Surg Oncol. 1985 Jul;29(3):193-7.

Hepatic tumors and oral contraceptives: surgical management.

Abstract

The clinical and pathological features of 14 patients with benign liver tumors are reviewed. There were two males and 12 females in this series of cases. All but one of the females had been on contraceptive steroid therapy for an average of 7.8 years. Abdominal pain was the presenting complaint in 75% of cases, a palpable abdominal mass was present in 22%, while 12.5% of the patients presented with acute hemorrhagic shock due to rupture of a liver cell adenoma. Liver cell adenomas (LCA) were found in 87.5% of the cases and a diagnosis of focal nodular hyperplasia (FNA) was made at histologic examination of the resected tumors in 12.5% of cases. Surgical resection of the liver tumors was performed successfully in 89% of the cases. Hepatic lobectomy was accomplished in four patients, hepatic segmentectomy was possible in three cases, while local wedge resection or focal excision were indicated on seven occasions. There was no operative mortality in this series, but one patient required reoperation for drainage of a complicating subphrenic abscess.

PIP:

This paper reviews the clinical and pathologic features in the 14 cases of benign liver tumors seen at 7 New Orleans hospitals in 1973-82. 11 of the 12 females in this series had been taking oral contraceptives (OCs) for an average duration of 7.8 years. The range of OC use was 4-14 years. Abdominal pain was the presenting complaint in 75% of cases, a palpable abdominal mass was present in 22%, and 13% of patients presented with acute hemorrhagic shock due to rupture of a liver cell adenoma. Liver cell adenomas were found in 88% of the cases, and a diagnosis of focal nodular hyperplasia was made at histologic examination of the resected tumors in 13%. Surgical resection was performed successfully in 89% of the cases, and there was no operative mortality. Earlier studies have found that the risk of benign liver tumors increases with prolonged duration of OC use and with increased potency of the preparation used. Hormonal effects and their interaction with hepatic glycogen storage appear to provide the basic mechanism in the pathogenesis of liver cell adenoma and focal nodular hyperplasia. The sudden onset of abdominal pain in a young OC user should raise suspicion about the possibility of a liver cell adenoma. In cases of uncomplicated benign liver adenoma or focal nodular hypertrophy, it is appropriate to discontinue OC use and see if regression of the tumor occurs.

PMID:
3001424
[Indexed for MEDLINE]

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