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  • Title: Complete regression of hepatocellular adenoma after withdrawal of oral contraceptives.
    Author: Steinbrecher UP, Lisbona R, Huang SN, Mishkin S.
    Journal: Dig Dis Sci; 1981 Nov; 26(11):1045-50. PubMed ID: 6271517.
    Abstract:
    A 28-year-old woman who complained of mild abdominal pain was found to have a large liver tumor. Angiography and needle biopsy established the diagnosis of hepatocellular adenoma. The tumor was felt to be unresectable because of its size, and no treatment was given other than withdrawal of oral contraceptives. Subsequent hepatic scintiscans documented compete resolution of the tumor over a 12-month period. An obese 28-year old woman presented at the Royal Victoria Hospital on February 23, 1978 because of upper abdominal pain of 2 days duration. The patient had previously given birth 10 years ago and had since been taking an oral contraceptive (OC) containing 0.25 mg d-norgestrel and 0.05 mg ethinyl estradiol (Ovral). She had iron deficiency anemia at age 12, smoked 3 packs of cigarettes/week, rarely consumed alcoholic beverages and was not under any medication. Physical and laboratory examinations revealed a large liver tumor. Angiography and needle biopsy confirmed the diagnosis of hepatocellular adenoma (HCA). Resection was not indicated because of the size of the tumor. OCs were discontinued. Tubal ligation was performed 2 months later as the patient desired no further pregnancies. Complete regression of the tumor over a 12-month period was confirmed by subsequent scintiscans. This case shows that even large HCAs can regress completely with no therapy other than OC withdrawal, confirming the suggestions of others that simple observation after OC withdrawal may be preferable to resection in minimally symptomatic HCAs. A frequent histologic finding both in OC-associated HCA and in normal liver surrounding HCAs is marked sinusoidal dilatation, which suggests a general effect of estrogen therapy. Further studies should be done to determine the mechanisms by which OCs produce these changes and to define their clinical importance. The role of radionuclide imaging techniques, percutaneous liver biopsy, and angiography in the diagnosis of HCAs are very briefly described.
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