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Can Med Assoc J. 1982 May 15;126(10):1149-50.

Liver lesions and oral contraceptives.



The association of cavernous hemangioma, focal nodular hyperplasia, and hemangiomatosis of the liver has not previously been described in the literature. A case report of a patient who presented with these 3 lesions simultaneously is reviewed. The 32-year-old obese woman presented with upper abdominal pain of recent onset. No liver abnormality had been noted at the times of cholecystectomy and cesarean section, each performed some years before. She had taken oral contraceptives (OCs) 6 years earlier for about 6 months. Now the liver was enlarged and contained a firm, nontender mass that extended to 1 handsbreadth below the right costal margin and across the epigastrium. No bruit was noted. Results of hematologic and biochemical investigations were within normal limits. Ultrasonography revealed a solic mass, and selective celiac arteriography showed that the mass occupied the right lobe of the liver and was predominantly avascular, with small areas of pooling of contrast material. An operation revealed, in addition to the mass, many irregular purplish areas 2-4 mm in diameter in both lobes of the liver. Close to the free edge of the left lobe was a yellowish brown and slightly modular firm mass. The pathological report listed a giant cavernous hemangioma of the right lobe, several disseminated cavernous hemangiomata, multiple disseminated vascular ectasiae (hemangiomatosis) and 1 lesion of focal nodular hyperplasia in the left lobe. 27 days after the operation, scintiscanning revealed evidence of good liver regeneration. Another scan 3 years later revealed regeneration of the liver to normal size and no focal abnormalities. Due to the fact that increasing numbers of cases of focal nodular hyperplasia and liver cell adenomas have been reported in association with OCs and in view of the possible association between these drugs and hemangioma, caution in prescribing these drugs is recommended.

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