Marks W H, Thompson N, Appleman H
Department of Surgery, Yale University School of Medicine, New Haven, CT 0651.
Ann Surg. 1988 Aug;208(2):190-5. doi: 10.1097/00000658-198808000-00010.
Oral contraceptives have been implicated in the development of hepatic cellular adenomas (HCA) and associated in at least one report with focal nodular hyperplasia (FNH). Recurrence of lesions or progression while the patient is no longer receiving exogenous steroids is less well documented. Three cases are reported in which progression or recurrence of HCA after the discontinuance of steroids was documented. In addition, FNH and uterine leiomyomas with HCA were observed in all three cases. The mechanism of tumor formation secondary to the use of oral contraceptives remains undetermined. In two cases, liver tissues were tested for estrogen receptors; both were found to be negative. Although technique as well as the observed progression of these lesions or development of new lesions after the discontinuance of steroids may account for this negative finding, it suggests that induction of this process may be caused by means other than direct cellular stimulation by the exogenous hormones. Finally, these three cases call attention to a potential subgroup of patients having oral contraceptive-associated HCA who may have progression of their liver tumors when no longer receiving steroids and who require an aggressive treatment program and noninvasive follow-up examinations.
口服避孕药与肝细胞腺瘤（HCA）的发生有关，并且至少有一份报告表明其与局灶性结节性增生（FNH）有关。关于患者不再接受外源性类固醇时病变复发或进展的记录较少。本文报告了3例停用类固醇后HCA进展或复发的病例。此外，所有3例均观察到FNH和伴有HCA的子宫平滑肌瘤。口服避孕药继发肿瘤形成的机制尚不清楚。在2例病例中，对肝组织进行了雌激素受体检测，结果均为阴性。尽管检测技术以及停用类固醇后这些病变的进展或新病变的出现可能导致了这一阴性结果，但这表明该过程的诱发可能是由外源性激素直接细胞刺激以外的其他因素引起的。最后，这3例病例提醒人们注意，口服避孕药相关HCA患者中可能存在一个潜在的亚组，这些患者在不再接受类固醇治疗时肝脏肿瘤可能会进展，需要积极的治疗方案和非侵入性随访检查。
