Liver oncogenesis and steroids.

Data on 148 cases of liver tumor in women have been registered. Analysis of these data shows that 1) the average age is 30.3 years; 2) 85% of the patients had a history of oral contraceptive use; 3) pain was the most usual symptom followed by incidental discovery during an operation; 4) 19 were hepatomas 56 were adenomas 67 were focal nodular hyperplasia and 6 were unclassified; and 5) 67% of the benign tumors were in the right lobe there were 15 cases of multiple focal nodulat hyperplasia and 11 cases of multiple adenomas and several of the adenomas were only partially encapsulated. The histopathologic differentiation of focal nodular hyperplasia from adenomas can be obtained by detection of the presence of bile duct epithelium in focal nodular hyperplasia; this is always absent in adenoma. Of the 19 patients with hepatomas 12 have died (7 had metastasis 3 deaths were related to the operative status) 2 are near death and 5 are alive following resection. Treatment in most cases was resection or lobectomy but biopsy only was performed in 22 cases of benign tumor. Follow-up of these cases should add to the knowledge about the necessity extent of surgery. The possible relationship of oral contraceptive use to liver oncogenesis is as yet undefined but the incidence of tumors is very low considering the numbers of women who are current users of steroid contraceptives. Benign tumors have been reported to involute after discontinuation of steroidal medication. This therapeutic dilemma may be resolved when the patients in this series who underwent biopsy only have been followed for a longer interval.