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Rev Hosp Clin Fac Med Sao Paulo. 1994 Jan-Feb;49(1):30-3.

[Transformation of hepatic adenoma into hepatocellular carcinoma in patients with prolonged use of oral contraceptives].

[Article in Portuguese]

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Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo.


Liver cell adenomas were relatively rare until the use of oral contraceptives. Most of these tumors have occurred in otherwise healthy young women who have been exposed to oral contraceptives. The treatment of this condition remained controversial for a long time. However, bleeding is still a frequent complication and can lead to a significant mortality rate. The better surgical results in hepatic resection, due to technological advances, has contributed to the indication of surgical management as therapeutic option in hepatic cell adenoma. Some authors believe that liver cell adenomas were potentially premalignant and could degenerate into hepatocellular carcinoma but there is very few well documented reports of this transformation. We report our experience in the management of liver cell adenoma.


Two cases of hepatic cell adenoma associated with hepatocellular carcinoma in long-term oral contraceptive (OC) users are described. Hepatic cell adenomas are rare benign tumors whose incidence has increased with the use of OCs. They generally occur in women over age 30 who have used OCs for five years or longer. The preferred treatment is currently hepatic resection, which reduces the risk of intraperitoneal hemorrhage leading to death. A 30-year-old woman with a history of 15 years of OC use and a 37-year-old woman with a history of 20 years of OC use underwent diagnostic procedures followed by laparotomy and resection of hepatic cell adenomas. Histologic examination in both cases revealed hepatic cell adenoma with areas of hepatocellular carcinoma in a liver with otherwise normal parenchyma. Although the causal relationship between OC use and hepatic cell adenoma is well accepted, a similar etiologic relationship between OCs and hepatocellular carcinoma has not been definitively established despite anecdotal evidence and some suggestive epidemiological data. Relatively few well documented cases of malignant transformation of hepatic cell adenoma have been published. Many authors believe that hepatic cell adenomas induced by OC use are potentially premalignant, but the mechanism through which the transformation might occur has not been explained. It is likely that nonspecific pharmacological actions as well as actions mediated by hormonal receptors are involved.

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