Benign liver tumor in a patient taking contraceptive steroids.

A case report and a review of 24 other reported cases of benign liver tumor are presented. The 28-year-old patient had taken birth control pills for the past 5 years but only intermittently because of nausea vomiting and hypertension. Menorrhagia and dysmenorrhea had been present for a year. A fibroid uterus had been diagnosed. Intermittent diarrhea had also been a complaint. On admission blood pressure was 140/110. The lower edge of the liver was not palpable. There was tenderness to palpation throughout the lower abdomen. Laboratory studies were normal except alkaline phosphatase which was increased. Chest X-ray was normal. A pelvic sonogram showed a large mass in the mid and right pelvis which was found to be an enlarged uterus. Barium enema showed a large pelvic mass pushing the sigmoid colon out of the pelvis. A right upper abdominal mass displaced the hepatic flexure of the colon. At laparotomy an enlarged uterus contained multiple leiomyomas. There was widespread endometriosis and adhesions. A total hysterectomy with bilateral salpingoophorectomy was done. A mass in the right lobe of the liver was also found. Liver biopsy suggested cirrhotic nodule. At a 2nd laparotomy after 5 days a partial right hepatic lobectomy was done. The patients postoperative course was uneventful. The liver specimen weighed 390 gm and contained a golden-yellow nodule with central necrosis and hemorrhage. A tumor capsule was not present. The pathological diagnosis was focal massive hepatocellular adenomatous hyperplasia. A review of the literature reve aled 24 other reports of primary benign liver tumors in young women. These reports are summarized in a table. The average age of patients in this group was 30.6 years. Duration of ingestion of oral contraceptives averaged 5.6 years. Only 1 denied ever having taken oral contraceptives . Intraperitoneal hemorrhage and shock had occurred in 15 (60%). An abdominal mass was present in 8 and severe pain in 6. The tumor was located in the right lobe of the liver in 16 of 20 patients for whom this information was available. A total mortality rate of 37.5% was recorded. Of these 9 patients 5 died in the immediate postoperative period and 4 from hemorrhage due to rupture of the tumor. Liver function tests and blood clotting studies of these patients had been normal. It is impossible to estimate the frequency of similar tumors in women taking oral contrraceptives but the risk is considered to be small.