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  • Title: Oral contraceptives and benign tumors of the liver.
    Author: Fitz JG.
    Journal: West J Med; 1984 Feb; 140(2):260-7. PubMed ID: 6730471.
    Abstract:
    The prevalence of benign tumors of the liver in users of oral contraceptives (OCs) has increased to the point that they must be considered in the differential diagnosis of a variety of symptoms in women at risk. It is important to distinguish hepatic adenoma from focal nodular hyperplasia because the former may be complicated by severe hemorrhage and is clearly linked to prolonged OC use. The annual incidence of hepatic adenoma has been estimated at 3.4 cases/100,000 OC users. Focal nodular hyperplasia generally appears as a single nodule (78%) measuring less than 5 cm in diameter (84%). On cut section there is a characteristic central, stellate, fibrous core that radiates to the periphery of the lesion, dividing the tumor into a number of nodules. Proliferating bile ducts and inflammatory cells are often seen in the fibrous areas. Hepatic adenoma is easily distinguished by gross and microscopic inspection. It usually appears as a single (71%), large (36% larger than 10 cm), fleshy tumor without any internal structure. The absence of bile ducts is noteworthy. Data show strong association between OCs and the development of hepatic adenoma but no association with focal nodular hyperplasia. If women use OCs for more than 6 years, hepatic adenoma is 25 times more likely to develop than in nonusers. Patients with hepatic adenoma usually present with life-threatening hemorrhage as the initial manifestation of the tumor. Hormonal factors are very important in the pathogenesis and clinical presentation of hepatic adenoma; hemorrhage frequently occurs in association with menstruation. By contrast, patients with focal nodular hyperplasia generally have no symptoms and the prognosis is excellent. Use of OCs should be stopped in all patients who may have hepatic tumors because tumor regression usually occurs after withdrawal of the drug. Evidence indicates that synthetic estrogens do not cause tumors directly but can enhance the growth of neoplastic cells.
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