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  • Title: [Hepatic adenoma and oral contraceptives: personal case].
    Author: Cassinelli GB.
    Journal: Ann Ital Chir; 1985; 57(2):101-7. PubMed ID: 3004281.
    Abstract:
    A 38-year-old Italian patient complained of dyspeptic disturbances and a feeling of postprandial swelling or weight. She had been taking oral contraceptives (OCs) for about 6 years. Ultrasound showed a small rotund formation in the liver. Surgery began and a tumor about the size of a tangerine was found and removed. After the surgery OC use was discontinued and she returned home totally healed on the 14th day after the surgery. The hypothesis on the association between benign liver tumors and OCs 1st appeared in 1973; later on, this was confirmed as a fact by the numerous cases reported. Hepatic adenoma, while rare in children, men, and women after menopause, is not a rare finding in fertile women who utilize OCs. Although there is a definite tie between the use of OCs and hepatic adenoma, the risk involved is minimal. Out of 35 million women using OCs, only 2000 experienced this side effect and in many of those who were affected the tumor regressed upon discontinuation of the contraceptive. The adenoma itself appears as a neoformation, for the most part round, of variable volume from the size of a nut to that of a grapefruit or larger. Also in about 10% of the cases it turns out to be plurifocal. The most frequent complications are hemoperitoneum and intratumoral hemorrhage due to necrosis of the newly formed tissue, and in 8% of these cases they can lead to death. These complications can come on quite unexpectedly and surgery is usually indicated. In surgery the echo-scanner is used to determine if the tumor is plurifocal. Surgery consists of exeresis of the tumor with resection on the healthy hepatic parenchyma. In cases of hepatic bleeding, simple suturing of the liver is usually suggested. If the tumor is large it is best to utilize a segmentary hepatic resection or in rare cases a lobectomy. After surgery OC discontinuation is necessary and assures a definite recovery.
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