Liver adenomatosis with granulomas in two patients on long-term oral contraceptives

Am J Surg Pathol. 1992 Oct;16(10):982-7. doi: 10.1097/00000478-199210000-00009.

Abstract

We report two cases of liver cell adenomatosis associated with granulomatous hepatitis, both developed in white women (52 and 39 years of age) on long-term oral contraceptives (for 18 and 12 years, respectively). The first patient underwent surgery for five hepatic tumors 1-7 cm in diameter; the other patient had a partial segmentectomy for a 4-cm hepatic nodule of the right lobe. In both cases, dissection of the liver showed many other diffuse and smaller nodules. Histologically, all tumors were benign liver cell adenomas, with cellular atypia in the largest tumor and associated in both cases with granulomatous hepatitis, with numerous noncaseating epithelioid and giant cell granulomas located either only in the tumors (case 1) or diffusely in the tumoral and nontumoral hepatic parenchyma (case 2). During follow-up, ultrasound showed new nodular lesions in case 2, whereas in case 1 evolution was uneventful. In estroprogestative-associated liver diseases, adenomas are common, but adenomatosis and granulomas are rare. An association of these latter two conditions would seem to be exceptional. The prognosis for adenomatosis remains uncertain.

Publication types

  • Case Reports

MeSH terms

  • Adenoma / chemically induced*
  • Adenoma / complications
  • Adenoma / pathology
  • Adult
  • Contraceptives, Oral / adverse effects*
  • Ethinyl Estradiol / adverse effects
  • Female
  • Granuloma / chemically induced*
  • Granuloma / complications
  • Granuloma / pathology
  • Humans
  • Levonorgestrel / adverse effects
  • Liver Neoplasms / chemically induced*
  • Liver Neoplasms / complications
  • Liver Neoplasms / pathology
  • Middle Aged
  • Multiple Endocrine Neoplasia / chemically induced*
  • Multiple Endocrine Neoplasia / complications
  • Multiple Endocrine Neoplasia / pathology
  • Norethindrone / adverse effects
  • Time Factors

Substances

  • Contraceptives, Oral
  • Ethinyl Estradiol
  • Levonorgestrel
  • Norethindrone