Barrows G H, Mays E T, Christopherson W M
Department of Pathology, Saint Francis Medical Center, Hartford, Connecticut.
Princess Takamatsu Symp. 1987;18:47-59.
Prior to the early 1970's, benign liver neoplasms were among the rarest of tumors. The seemingly rapid increase, especially in young females ingesting oral contraceptives, as well as the catastrophic presentation of many of the tumors resulting from liver rupture and hemoperitoneum, stimulated studies by several investigators. In the Liver Tumor Registry at the University of Louisville, we have examined the histologic material, and finalized the data on 227 tumors, the majority in young women. With few exceptions, they had used oral contraceptives or were either pregnant or immediately post-partum and presumably in a hyperestrogenic state. There have been 82 hepatocellular adenomas (HCA), 105 cases of focal nodular hyperplasia (FNH), and 31 hepatocellular carcinomas. The hepatocellular carcinomas occurred in non-cirrhotic livers, and 14 of the 31 cases were of a distinct, but rare type, polygonal cell carcinoma with lamellar fibrosis. While it seems reasonable to believe steroids play a role in adenomas and in FNH it is less certain that they produce hepatocellular carcinomas since malignant liver tumors are not uncommon in this age group without the use of oral contraceptives. With an estimated 50 million women either currently using or who have used oral contraceptives the risk must be very slight.
在20世纪70年代早期之前，良性肝脏肿瘤是最为罕见的肿瘤之一。其发病率看似迅速上升，尤其是在服用口服避孕药的年轻女性中，而且许多肿瘤因肝破裂和腹腔积血而呈现出灾难性表现，这激发了几位研究人员的研究。在路易斯维尔大学的肝脏肿瘤登记处，我们检查了组织学材料，并确定了227例肿瘤的数据，其中大多数为年轻女性。几乎无一例外，她们都服用过口服避孕药，或者处于怀孕或产后状态，推测处于高雌激素状态。其中有82例肝细胞腺瘤（HCA）、105例局灶性结节性增生（FNH）和31例肝细胞癌。肝细胞癌发生在非肝硬化肝脏中，31例中有14例属于一种独特但罕见的类型，即伴有板层状纤维化的多边形细胞癌。虽然有理由认为类固醇在腺瘤和FNH的发生中起作用，但类固醇是否会引发肝细胞癌则不太确定，因为在这个年龄组中，即使不使用口服避孕药，恶性肝脏肿瘤也并不罕见。据估计，目前正在使用或曾经使用过口服避孕药的女性有5000万，因此风险肯定非常小。
