Kubota T, Shimizu K, Sonoyama T, Ikeda E, Kurioka H, Ouchi T, Suyama Y, Hosokawa Y, Yamagishi H
Department of Digestive Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan.
Hepatogastroenterology. 2001 Nov-Dec;48(42):1736-9.
Two cases of focal nodular hyperplasia of the liver in mature women treated with the oral contraceptive are described. Radiological investigations in one case revealed the typical findings of focal nodular hyperplasia with computed tomography and magnetic resonance imaging demonstrating central scar structures while spoke-wheel appearance was evident on arteriography, in the other case however findings were atypical. Routine investigations including liver function tests and alpha-fetoprotein levels were normal while hepatitis B surface antigen and hepatitis C virus antibody were negative. The lesions of these two cases enlarged significantly during the follow-up and they were therefore surgically resected. Pathological features of both resected specimens, such as hepatocellular hyperplasia, bile duct proliferation and vascular abnormalities, were compatible with focal nodular hyperplasia. It has been suggested that tumor growth may be augmented by sex hormone stimulation and therefore estrogen and progesterone receptor expressions in the resected tumors were determined by immunocytochemistry. Interestingly, stainings for both receptors were negative. In case 2, the tumor was enlarging although oral contraceptive use had been discontinued for the past 7 years. These results suggest that there is no direct relationship of focal nodular hyperplasia with oral contraceptives. The role of sex hormones in focal nodular hyperplasia of the liver merits further study.
本文描述了两例口服避孕药的成年女性肝脏局灶性结节性增生病例。其中一例经放射学检查，计算机断层扫描（CT）和磁共振成像（MRI）显示典型的局灶性结节性增生表现，可见中央瘢痕结构，动脉造影呈现辐轮状外观；然而另一例表现不典型。包括肝功能检查和甲胎蛋白水平在内的常规检查均正常，乙肝表面抗原和丙肝病毒抗体均为阴性。两例病变在随访期间均显著增大，因此均接受了手术切除。切除标本的病理特征，如肝细胞增生、胆管增殖和血管异常，均符合局灶性结节性增生。有研究表明，性激素刺激可能会促进肿瘤生长，因此通过免疫细胞化学检测了切除肿瘤中的雌激素和孕激素受体表达。有趣的是，两种受体的染色均为阴性。在病例2中，尽管在过去7年已停用口服避孕药，但肿瘤仍在增大。这些结果表明，肝脏局灶性结节性增生与口服避孕药之间没有直接关系。性激素在肝脏局灶性结节性增生中的作用值得进一步研究。
