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Duan XF, Zhao Q. Adult hepatoblastoma: a review of 47 cases. ANZ J Surg 2016; 88:E50-E54. [DOI: 10.1111/ans.13839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Xiao-Feng Duan
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Clinical Research Center for Cancer of Tianjin City; Tianjin China
- Department of Pediatric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Clinical Research Center for Cancer of Tianjin City; Tianjin China
| | - Qiang Zhao
- Department of Pediatric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Clinical Research Center for Cancer of Tianjin City; Tianjin China
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2
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Affiliation(s)
- J P O'Sullivan
- Department of Pathology, St George's Hospital Medical School, London SW1X 7NA
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3
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Celotti A, D'Amico G, Ceresoli M, Tomasoni M, Raimondo S, Baggi P, Baiocchi GL. Hepatoblastoma of the adult: A systematic review of the literature. Surg Oncol 2016; 25:339-347. [PMID: 27566042 DOI: 10.1016/j.suronc.2016.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/06/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
Hepatoblastoma is the most common malignant liver tumor in children. On the other hand in the adult HB is very rare and characterized by unfavorable prognosis. A review of the entire literature was performed: 58 articles and 63 cases of HB were found. The patient's data were collected and analyzed. No correlation with hepatitis virus was found and AFP was elevated in most cases. Usually HB forms a large single mass in the liver and presents aggressive behavior, with local invasiveness and metastatic spread. The current median survival time is 5 months, with a 1-year survival rate near 30%. Surgical resection is the only curative treatment. However major liver resections or extensive demolitions of the adjacent organs are necessary. There are no standardized protocols in the multimodal approach to this tumor.
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Affiliation(s)
- Andrea Celotti
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy.
| | - Giuseppe D'Amico
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy
| | - Marco Ceresoli
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy
| | - Matteo Tomasoni
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy
| | - Stefano Raimondo
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy
| | - Paolo Baggi
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy
| | - Gian Luca Baiocchi
- Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy
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4
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Rougemont AL, McLin VA, Toso C, Wildhaber BE. Adult hepatoblastoma: learning from children. J Hepatol 2012; 56:1392-403. [PMID: 22326463 DOI: 10.1016/j.jhep.2011.10.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 10/17/2011] [Accepted: 10/17/2011] [Indexed: 01/16/2023]
Abstract
Hepatoblastoma is the most common malignant liver tumour in infants and young children. Its occurrence in the adult population is debated and has been questioned. The aim of this paper is to review the histological and clinical features of adult hepatoblastoma as described in the adult literature, and to compare the findings with those of paediatric hepatoblastoma. The developmental and molecular aspects of hepatoblastoma are reviewed and their potential contribution to diagnosis of adult hepatoblastoma discussed. Case reports of adult hepatoblastoma identified by a PubMed search of the English, French, German, Italian, and Spanish literature through March 2011 were reviewed. Forty-five cases of hepatoblastoma were collected. Age at presentation was variable. Survival was uniformly poor, except for the rare patients who presented with the relatively differentiated, foetal type. The common denominator between adult and paediatric cases is the occurrence of embryonal or immature aspect of the tumours. Whether the adult cases of hepatoblastoma represent blastemal tumours, stem cell tumours, or unusual differentiation patterns in otherwise more frequent adult liver tumours remains to be established. Adult tumours labelled as hepatoblastoma are characterised by malignant appearing mesenchymal components. Surgical management is the cornerstone of therapy in children and also appears to confer an improved prognosis in adults. Whether adult hepatoblastoma exists, remains controversial. Indeed, several features described in adult cases are markedly different from hepatoblastoma as it is understood in children, and other differential diagnoses should also be entertained. Nonetheless, hepatoblastoma should be considered in adults presenting with primary liver tumours in the absence of pre-existing liver disease. Adult and paediatric patients with immature hepatoblastoma appear to have worse outcomes, and adults presenting with presumed hepatoblastoma have an overall poorer prognosis than children with hepatoblastoma. In all patients, surgery should be the treatment of choice, neoadjuvant chemotherapy is advisable.
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Affiliation(s)
- Anne-Laure Rougemont
- Division of Clinical Pathology, Geneva University Hospitals, 1211 Geneva 4, Switzerland
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5
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Grazi GL, Vetrone G, d'Errico A, Caprara G, Ercolani G, Cescon M, Ravaioli M, Del Gaudio M, Vivarelli M, Zanello M, Pinna AD. Nested stromal-epithelial tumor (NSET) of the liver: a case report of an extremely rare tumor. Pathol Res Pract 2010; 206:282-286. [PMID: 19487085 DOI: 10.1016/j.prp.2009.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/21/2009] [Accepted: 04/27/2009] [Indexed: 02/06/2023]
Abstract
Malignant mixed tumors of the liver in adults are extremely rare. To our knowledge, only a few cases have been reported in the literature. Nested stromal-epithelial tumors (NSET) of the liver are characterized by non-hepatocytic, non-biliary tumors with nests of epithelial and spindle cells, an associated myofibroblastic stroma, as well as variable calcifications and ossifications. We report a case of NSET of the liver affecting a young woman and provide detailed histological and clinical follow-up data, adding an additional case of this extremely rare pathology to the literature.
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Affiliation(s)
- Gian Luca Grazi
- Department of Surgery and Transplantation, Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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6
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Zheng MH, Zhang L, Gu DN, Shi HQ, Zeng QQ, Chen YP. Hepatoblastoma in adult: review of the literature. J Clin Med Res 2009; 1:13-6. [PMID: 22505959 PMCID: PMC3318863 DOI: 10.4021/jocmr2009.01.1222] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2009] [Indexed: 11/23/2022] Open
Abstract
This study is to review and retrieve data on adult hepatoblastoma (HB) from English literatures in order to gain a better understanding of this disease. We performed Medline, PubMed (from January 1966 to February 2008), and library searches (National Science and Technology Library, Beijing, China, and Wenzhou Medical College Library, from January 1980 to February 2008) using the key words hepatoblastoma in adult, hepatic tumor, hepatoblastoma and adult. Previously reported HB cases were collected and published reviews were also examined. Fifteen cases that met the search criteria were selected. Review of the cases revealed a slight female preponderance. The patients' age ranged from 17 to 82, with median age of 70 for male and 27 for female. The survival time ranged from two weeks to 38 months, and the median survival time was 6 months. In the articles reviewed, HB presented with non-specific initial symptoms, and the diagnosis was not identified until the tumor biopsy after operation or autopsy. Completely surgical resection is still the major treatment for patients with HB and is considered as the only chance of a better prognosis. Due to the rareness of HB in adults, the choice of treatment should be radical resection if possible, and combined with chemotherapy as adopted in children. HB in the adult is extremely rare and the pre-operative diagnosis is often overlooked. The prognosis is so poor that the awareness of the condition in the differential diagnosis in liver tumors could be beneficial.
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Affiliation(s)
- Ming Hua Zheng
- Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China
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7
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Ke HY, Chen JH, Jen YM, Yu JC, Hsieh CB, Chen CJ, Liu YC, Chen TW, Chan DC. Ruptured hepatoblastoma with massive internal bleeding in an adult. World J Gastroenterol 2005; 11:6235-7. [PMID: 16273660 PMCID: PMC4436650 DOI: 10.3748/wjg.v11.i39.6235] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatoblastoma is the most common primary hepatic tumor of children. However, only a very few cases have been reported in adults. Most studies support treatment with chemotherapy followed by surgical resection. We present the first reported case of adult hepatoblastoma in Taiwan. A 52-year-old female suffered from sudden onset of abdominal pain and general weakness for days. Internal bleeding with hemorrhagic shock was suspected and two massive lesions in both lobes of the liver with hemoperitoneum were noted from imaging studies. Surgical resection of the larger left lobe tumor and radio-frequency ablation of the right smaller one were performed. The histopathology diagnosis was of a hepatoblastoma.
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Affiliation(s)
- Hung-Yen Ke
- Division of General Surgery, Tri-Service General Hospital, 325, Sec. 2, Chen-Kung Road, Neihu 114, Taipei, Taiwan, China.
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8
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Heywood G, Burgart LJ, Nagorney DM. Ossifying malignant mixed epithelial and stromal tumor of the liver: a case report of a previously undescribed tumor. Cancer 2002. [PMID: 11920471 DOI: 10.1002/cncr.10345] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Malignant mixed tumors of the liver in adults are rare. To the authors' knowledge, twenty-four cases of primary malignant mixed hepatic tumors have been reported in the literature since the first description by Walter in 1896. Many of the previously reported cases are now considered mixed hepatoblastoma, primary hepatocellular carcinomas with focal sarcomatous metaplasia, or epithelioid hemangioendothelioma. METHODS Clinical, radiologic, histologic and immunohistochemic methods were used to characterize an unusual example of a mixed malignant tumor of the adult liver that the authors descriptively refer to as "ossifying malignant mixed epithelial and stromal tumor" of the liver. RESULTS In contrast to previously reported cases, the tumor in question was morphologically distinct. It was composed of three distinct neoplastic phenotypes: malignant spindle cells, with adenocarcinomatous differentiation, and extensive osteoid formation. The tumor was treated by partial hepatectomy. The patient was alive 8 years postoperatively as of December 2001. The distinctive combination of morphologic features and prolonged survival are much different from previously reported cases of mixed malignant hepatic tumors, which were typically rapidly fatal. CONCLUSIONS The authors believe that the clinical and pathologic features of this patient's tumor are sufficiently distinctive to exclude it from the well-established categories of hepatic neoplasms. Histologically, the authors suggest the descriptive name "ossifying malignant mixed epithelial and stromal tumor of the liver" as a preliminary description for this tumor until the origin and relationship to other hepatic neoplasms are further characterized.
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Affiliation(s)
- Glenroy Heywood
- Division of Gastroenterologic and General Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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9
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Pearl RH, Irish MS, Caty MG, Glick PL. The approach to common abdominal diagnoses in infants and children. Part II. Pediatr Clin North Am 1998; 45:1287-326, vii. [PMID: 9889755 DOI: 10.1016/s0031-3955(05)70092-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Part I (August 1998 issue, Pediatric Clinics), discussed appendicitis and common abdominal diagnoses in infants and in children associated with vomiting, as well as special considerations in the evaluation of immunologically suppressed and neurologically impaired pediatric patients. In this article, the authors continue to discuss the evaluation of constipation, gastrointestinal bleeding, common abdominal masses, and recurrent abdominal pain.
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Affiliation(s)
- R H Pearl
- Department of Surgery, Children's Hospital of Illinois, USA
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10
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Harada T, Matsuo K, Kodama S, Higashihara H, Nakayama Y, Ikeda S. Adult hepatoblastoma: case report and review of the literature. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1995; 65:686-8. [PMID: 7575303 DOI: 10.1111/j.1445-2197.1995.tb00681.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report a case of hepatoblastoma in a 24-year-old woman. The tumour was removed by an extended right lobectomy after transcatheter hepatic arterial embolization. A survey of the literature revealed 31 cases of adult hepatoblastoma. According to these reports there are no characteristic clinical features of the tumour, making a correct diagnosis before surgery or autopsy extremely difficult. Complete removal of the tumour is the only treatment which is potentially curative provided that lesion is confined within the liver capsule.
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Affiliation(s)
- T Harada
- First Department of Surgery, School of Medicine, Fukuoka University, Japan
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11
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Altmann HW. Epithelial and mixed hepatoblastoma in the adult. Histological observations and general considerations. Pathol Res Pract 1992; 188:16-26. [PMID: 1317555 DOI: 10.1016/s0344-0338(11)81151-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two instances of hepatoblastoma in adults are reported, with one case representing a purely epithelial, the other a mixed epithelio-mesenchymal variant. The purely epithelial tumour, consisting entirely of so-called fetal elements, was present in the liver of a 35-year-old woman without any other hepatic changes, whereas the mixed tumour developed in the coarsely nodular liver of a 73-year-old man with a currently inactive cirrhosis. Besides the epithelial component, this case held predominantly indifferent spindle-shaped and histiocytic mesenchymal cells which frequently gave rise to osteoid and to bony trabeculae, and on occasion also to vascular structures, biliary ducts and even to groups of hepatocytes. The cytological and histological picture of both cases is comparable even in its details to that seen in the hepatoblastomas of early childhood. This concordance should be insisted upon as a diagnostic pre-condition if a mixed tumour in the adult, consisting of several components, is to be accepted as a hepatoblastoma. This similarity also enables us to recognize the purely epithelial variant of the hepatoblastoma in the older patient as belonging to this tumour category, and to separate it from other hepatic carcinomas. It is suggested that in these tumours the pluripotent cells, or the cells that have again become pluripotent, are derived from differentiated hepatocytes; no evidence in favour of the existence of a particular cellular subpopulation or of "stem cells" has been found.
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Affiliation(s)
- H W Altmann
- Pathologisches Institut, Universität Würzburg, FRG
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12
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Oda H, Honda K, Hara M, Arase Y, Ikeda K, Kumada H. Hepatoblastoma in an 82-year-old man. An autopsy case report. ACTA PATHOLOGICA JAPONICA 1990; 40:212-8. [PMID: 2163188 DOI: 10.1111/j.1440-1827.1990.tb03325.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An autopsy case of adult hepatoblastoma is presented. The patient was an 82-year-old male with chronic hepatitis of 7 years' duration. The liver tumor was detected 6 months before death. Autopsy revealed a large hepatic tumor occupying about 80% of the entire liver. Histologically, the tumor showed typical features of mixed epithelial- and mesenchymal-type hepatoblastoma. The epithelial component consisted of fetal and embryonal cell types. The mesenchymal component showed primitive spindle-shaped cells with various degrees of cellularity. Chondroid areas and a few foci of osteoid formation were also present.
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Affiliation(s)
- H Oda
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
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13
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Abstract
Humans are remarkably resistant to many carcinogens that readily produce liver tumours in rodents, particularly the rat. The neoplastic process has been extensively studied in animal experiments, but little is known so far of how it evolves in humans. Few drugs have been shown to cause liver tumours in humans, and the risk appears to be low. The best-known examples are C17-alkylated or ethinylated gonadal sex steroids. Oral contraceptives have now been in use by millions for thirty years, but only a few hundred cases at most of liver cell adenoma have been observed. The role of these substances in liver cell carcinoma remains controversial, and the evidence is weaker still in relation to focal nodular hyperplasia and other tumour-like conditions. Anabolic-androgenic steroids stand out as the major cause of peliosis, but liver cell tumours induced by them seem to be adenomas and not carcinomas as originally suggested. The effect that both oral contraceptives and anabolic-androgenic steroids have on liver vasculature is of great clinical importance as the most important complication of liver tumours is rupture, leading to life-threatening haemorrhage. For this reason, liver tumours arising in users of these drugs should be removed whenever feasible. Thorium dioxide will remain a risk factor for the development of angiosarcoma, liver cell carcinoma and bile duct carcinoma for some time yet, and the number of patients who have been exposed is high--tens of thousands at least. The evidence of a carcinogenic role for many other drugs is anecdotal or weak. Neoplasia in the liver seems to be the least important side-effect of drugs in clinical use.
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14
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Abstract
Hemangiomas are the most common benign tumors occurring in the liver. However, the natural history of hepatic hemangiomas has not been well defined. Four patients (3 women, 1 man) with recurrent giant liver hemangiomas underwent either surgical or radiation therapy as initial treatment for the primary tumor. The average time until recurrence was 14 years, and each tumor weighed more than 600 g. Each of the female patients had been given chronic estrogen (Premarin) replacement therapy. Three of the four patients underwent surgical resection for intractable symptoms or progressive enlargement. It is believed that estrogen replacement therapy may play a role in the pathogenesis of these tumors. Furthermore, operative intervention should be considered in patients with recurrent giant liver hemangioma.
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Affiliation(s)
- R L Conter
- Department of Surgery, UCLA Hospital and Clinics
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15
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Ooi A, Katsuda S, Nakanishi I, Nakamura N, Matsushita F, Tanaka N, Kobayashi K. HEPATOCELLULAR CARCINOMA WITH CHONDROSARCOMATOUS VARIATION. Pathol Int 1987. [DOI: 10.1111/j.1440-1827.1987.tb00434.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Affiliation(s)
- R L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98104
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Abstract
The clinical and pathological features of 14 patients with benign liver tumors are reviewed. There were two males and 12 females in this series of cases. All but one of the females had been on contraceptive steroid therapy for an average of 7.8 years. Abdominal pain was the presenting complaint in 75% of cases, a palpable abdominal mass was present in 22%, while 12.5% of the patients presented with acute hemorrhagic shock due to rupture of a liver cell adenoma. Liver cell adenomas (LCA) were found in 87.5% of the cases and a diagnosis of focal nodular hyperplasia (FNA) was made at histologic examination of the resected tumors in 12.5% of cases. Surgical resection of the liver tumors was performed successfully in 89% of the cases. Hepatic lobectomy was accomplished in four patients, hepatic segmentectomy was possible in three cases, while local wedge resection or focal excision were indicated on seven occasions. There was no operative mortality in this series, but one patient required reoperation for drainage of a complicating subphrenic abscess.
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18
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Abstract
Among primary tumors of the liver, the group classified as malignant hepatic mixed tumor or hepatoblastoma in adult is among the least common. In this report, two rare cases of nonhepatocytic malignant mixed tumor primary in the liver are reported. Diagnosis was established after autopsy in one and surgery in the other, who is still alive 2 years and 8 months after removal of the tumor by hepatic resection and may be the longest survivor among the nonhepatocytic malignant mixed tumor primary in the liver.
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19
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Henderson BE, Preston-Martin S, Edmondson HA, Peters RL, Pike MC. Hepatocellular carcinoma and oral contraceptives. Br J Cancer 1983; 48:437-40. [PMID: 6311235 PMCID: PMC2011476 DOI: 10.1038/bjc.1983.210] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Abstract
A clinicopathologic review of 73 cases of primary liver tumors at Texas Children's Hospital, Houston, and Children's Medical Center, Dallas, has documented important prognostic and therapeutic implications for the histologic classification of hepatoblastoma. The pure "fetal" pattern was associated with cure in every instance that surgical excision was achieved (six of six patients), whereas only two of 19 patients with "embryonal" or other undifferentiated patterns of growth survived five years. The relationship of hepatoblastoma and hepatocarcinoma in childhood to antecedent conditions is discussed in detail. The uncommon liver sarcomas are also reviewed in the light of experience at these two institutions.
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21
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Gala KV, Griffin TW. Hepatomas in young women on oral contraceptives: report of two cases and review of the literature. J Surg Oncol 1983; 22:11-4. [PMID: 6296542 DOI: 10.1002/jso.2930220105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hepatocellular carcinoma (HCC) developed in two women who had ingested oral contraceptives for prolonged duration. One of the patients had hepatoma restricted to the liver, and it was successfully resected. The other patient presented with metastatic HCC to the sacrum and lung, and she died after an initial response to chemotherapy in 12 months. Review of literature showed 23 previously reported cases of HCC associated with "pill" use since 1973. Although the reported instances of HCC in pill users are few in number, the majority of affected females were in their 20s and early 30s, without any preexisting liver disease. Even though the risk of developing HCC on oral contraceptives is low, this association adds to the list of complications induced by oral contraceptives in premenopausal women. Two cases are reported and literature reviewed.
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22
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Demanes DJ, Friedman MA, McKerrow JH, Hoffman PG. Hormone receptors in hepatoblastoma: a demonstration of both estrogen and progesterone receptors. Cancer 1982; 50:1828-32. [PMID: 6288226 DOI: 10.1002/1097-0142(19821101)50:9<1828::aid-cncr2820500929>3.0.co;2-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A case of mixed hepatoblastoma occurring in a four-year-old girl is described. Light and electron micrographs illustrate a predominant mesenchymal component and a less conspicuous epithelial element. The tumor contained specific cytosolic protein receptors for estrogen and progesterone. The estrogen receptor titer was 10.5 fmol/mg cytosol protein and the progesterone receptor titer was 62.2 fmol/mg cytosol protein.
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23
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Goodman ZD, Ishak KG. Hepatocellular carcinoma in women: probable lack of etiologic association with oral contraceptive steroids. Hepatology 1982; 2:440-4. [PMID: 6284630 DOI: 10.1002/hep.1840020408] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
To investigate the possibility of an association between oral contraceptive steroids (CS) and hepatocellular carcinoma (HCC), we reviewed 128 cases of HCC in women collected between 1953 and 1980. There were 48 cases under the age of 40, and 13 of these (27%) had used CS. However, 62% of HCC associated with CS and 58% of HCC in women under 40 not using CS were classified histologically as "fibrolamellar" carcinoma. This subtype of HCC occurs predominantly in young people, both male and female. The apparent increase in HCC in young women can be explained by the presence of cases of fibrolamellar carcinoma in this age group, an the apparent association with CS is probably coincidental.
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24
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Tucker RA. Drugs and liver disease: a tabular compilation of drugs and the histopathological changes that can occur in the liver. DRUG INTELLIGENCE & CLINICAL PHARMACY 1982; 16:569-80. [PMID: 7049646 DOI: 10.1177/106002808201600707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A compilation of drugs and the histopathological changes that can occur in the liver is presented. The purpose of this review is to provide the reader with a comprehensive and reliable source of information on various drugs that have been documented by liver biopsy to cause hepatocellular damage. The morphologic terms used in the tables have been chosen based on past publications dealing with this subject. This review is intended as a concise guide to aid in the identification of drug-induced liver diseases.
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Abstract
A 23-year-old woman was seen with an acute hemoperitoneum caused by rupture of a hepatocellular carcinoma. She died two years after hepatic artery ligation. The patient had been taking oral contraceptives for periods of one year and ten months, separated by a pregnancy. The association between oral contraceptive steroids and hepatocellular carcinoma is briefly reviewed.
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26
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Honan RP, Haqqani MT. Mixed hepatoblastoma in the adult: case report and review of the literature. J Clin Pathol 1980; 33:1058-63. [PMID: 6255014 PMCID: PMC1146336 DOI: 10.1136/jcp.33.11.1058] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A case of mixed hepatoblastoma in a woman is described. A survey of the English literature reveals 13 cases acceptable as mixed hepatoblastoma; these have been described and published under a variety of names. Difficulties in nomenclature and the histology of these cases are discussed. Diagnosis depends on the identification of both malignant mesenchymal and malignant epithelial elements. The former include myxoid connective tissue resembling primitive mesenchyme and areas resembling adult fibrosarcoma. Mature fibrous tissue with calcification and bone formation may be seen. Epithelial areas show tissue resembling fetal liver, poorly differentiated epithelial cells, and/or areas of adenocarcinoma. The current view on histogenesis is also given.
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27
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Altmann HW. Drug-induced liver reactions: a morphological approach. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1980; 69:69-142. [PMID: 7016468 DOI: 10.1007/978-3-642-67861-5_3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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28
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Christopherson WM, Mays ET. Relation of steroids to liver oncogenesis. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH 1979; 5:207-30. [PMID: 224196 DOI: 10.1080/15287397909529746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Experience with pathological material from 150 women with liver tumors is reviewed. The features of liver cell adenoma and focal nodular hyperplasia are sufficiently different that the vast majority of the benign tumors can be easily subclassified. Although most occurred in women ingesting steroids, the wide usage of oral contraceptives makes it difficult to prove a causative role. Nineteen of the tumors were malignant and, to date, 12 of those patients have died of their disease. Since hepatomas are much more common than benign liver tumors, one must be even more circumspect in indicting steroids in their causation. In this group of women none had cirrhosis, whereas in the general population cirrhosis is a very common precedent lesion. Further investigation of estrogens and primary liver carcinoma would be timely.
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Ishak KG. Hepatic neoplasms associated with contraceptive and anabolic steroids. RECENT RESULTS IN CANCER RESEARCH. FORTSCHRITTE DER KREBSFORSCHUNG. PROGRES DANS LES RECHERCHES SUR LE CANCER 1979; 66:73-128. [PMID: 219453 DOI: 10.1007/978-3-642-81267-5_3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
The increased incidence of liver tumors in women of childbearing age who have been using oral contraceptives for many years suggests an environmental causation. The causative agent may be the steroidal oral contraceptives. Two lesions are recognized: focal nodular hyperplasia and hepatic adenoma. This paper concentrates on focal nodular hyperplasia, with two cases added to the four previously described cases. It is postulated that the estrogen component causes vascular lesions characterized by myointimal hyperplasia and thrombosis, leading to infarct, necrosis, and subsequent nodular hepatic regeneration. The clinical feature highlighted is the long history of gastrointestinal disturbance associated with negative gastrointestinal investigation with the possible exception of cholelithiasis. It is suggested that gray-scale ultrasonography is an effective screening method that also aids in a definitive diagnosis. As these tumors are often incidental findings it is emphasized that the liver should always be inspected at laparoscopy. Ultimately, diagnosis by biopsy or excision is essential as it may well be possible to treat cases of focal nodular hyperplasia of the liver conservatively, once oral contraceptives have been discontinued.
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Ham JM, Stevenson D, Liddelow AG. Hepatocellular carcinoma possibly induced by oral contraceptives. ACTA ACUST UNITED AC 1978. [DOI: 10.1007/bf01072485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gattanell PN, Perloff M, Holland JF. Hepatocellular carcinoma in a young woman with prolonged exposure to oral contraceptives. MEDICAL AND PEDIATRIC ONCOLOGY 1978; 4:99-103. [PMID: 207962 DOI: 10.1002/mpo.2950040203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A case of hepatocellular carcinoma in a young female is presented in which the apparent etiology was the use of oral contraceptives for 5 1/2 years. Sequential therapeutic trials with intraarterial 5-fluorouracil, intraarterial adriamycin, and intravenous 1,3 bis[2-chloroethyl]-1-nitrosourea (BCNU) were unsuccesful. The adverse effects of oral contraceptives on the structure and function of hepatic tissue are reviewed.
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Hyson EA, Burrell M, Toffler R. Drug-induced gastrointestinal disease. GASTROINTESTINAL RADIOLOGY 1977; 2:183-212. [PMID: 355045 DOI: 10.1007/bf02256497] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The gastrointestinal tract is a common target for adverse drug reactions. The resultant changes are often nonspecific (e.g., mucosal ulceration, intestinal infarction, motility disturbance) and in many cases no radiographically detectable lesion may occur. A comprehensive review of the reported drug-induced disorders of the digestive organs is herein presented and their radiographic manifestations are described.
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Hernandez-Nieto L, Bruguera M, Bombi J, Camacho L, Rozman C. Benign liver-cell adenoma associated with long-term administration of an androgenic-anabolic steroid (methandienone). Cancer 1977; 40:1761-4. [PMID: 198105 DOI: 10.1002/1097-0142(197710)40:4<1761::aid-cncr2820400454>3.0.co;2-c] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 19-year-old man with paroxysmal nocturnal hemoglobinuria treated for 3 years with Methandienone was admitted to the hospital with hemoperitoneum due to the rupture of an hepatic tumor. Histology revealed that it was a benign liver cell adenoma, with a pathologic appearance and mode of clinical presentation closely resembling those of cases observed to develop in association to contraceptive steroids.
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Abstract
Numerous small hepatic adenomas and hepatocellular carcinoma developed in a man after 11 years of methyl testosterone ingestion. The man presented with an acute surgical abdomen and a large filling defect in the liver. Laparotomy disclosed hemoperitoneum and a large hepatic hematoma. Focal hemorrhagic infarction in the excised right liver lobe involved both adenomas and normal parenchyma. Review of the English literature reveals no other case of both a benign and a malignant hepatocellular neoplasm associated with anabolic steroid therapy. Hemorrhagic benign liver tumor must be considered in the differential diagnosis in both female and male patients on hormone therapy who present with acute abdominal pain.
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Sykes S, Dennis PM. Electroradioimmunoassay: a sensitive method for the quantitation of alpha-fetoprotein. Clin Chim Acta 1977; 79:309-16. [PMID: 70284 DOI: 10.1016/0009-8981(77)90423-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A sensitive technique, electroradioimmunoassay has been adapted for the estimation of alpha1-fetoprotein in normal adult human plasma and serum. Commercially available antisera were used and a 10-fold increase in sensitivity was obtained in comparison with two conventional radioimmunoassays. Plasma alpha 1-fetoprotein levels of 2.6 +/- 1.2 microgram/1 (mean and standard deviation) were found in a normal population as compared with levels of 4.1 +/- 2.6 microgram/l in a group of 49 patients with alcoholic liver disease.
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Abstract
A 32-year-old woman on oral contraceptives for 12 years developed a hepatocellular carcinoma, which resulted in death 15 months after initial diagnosis. The possible association between this malignant hepatic tumor and the long-term use of oral contraceptives is reviewed.
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Abstract
For sixteen years (1954 to 1970) oral steroids had been used for contraception by millions of women. We were unable in this time span to find any cases of liver neoplasms in women using oral contraceptives. However, since 1970, there have been 138 cases reported in the English literature. We will add nine cases to this number, including an unusual case report. Evidence for the oral contraceptive as an etiologic agent in causing liver neoplasms is circumstantial but but nevertheless substantial. The literature is reviewed, and our case is presented. At present, the etiology of liver neoplasms is an enigma. Close clinical surveillance with an awareness of this potentially fatal pathologic entity is essential in women who have ingested oral contraceptives.
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Fechner RE. Benign hepatic lesions and orally administered contraceptives. A report of seven cases and a critical analysis of the literature. Hum Pathol 1977; 8:255-68. [PMID: 192659 DOI: 10.1016/s0046-8177(77)80022-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A consecutive series of 12 benign hepatic lesions in women consisted of six cases of focal nodular hyperplasia and six cases of liver cell adenoma. Five of the six women with liver cell adenoma and two of the six with focal nodular hyperplasia had taken orally active contraceptive hormones. These few cases reflect a similar impression gained from a critical analysis of the literature, namely, that focal nodular hyperplasia may be unrelated to the oral administration of contraceptive hormones, whereas the increase in liver cell adenoma reported in recent years is probably related to such therapy. Two women with liver cell adenomas were asymptomatic six and four years after incomplete resection of the tumor. These are the longest intervals thus far reported for uncomplicated survival in incompletely resected liver cell adenoma.
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Balázs M. Electron microscopic study of benign hepatoma in a patient on oral contraceptives. BEITRAGE ZUR PATHOLOGIE 1976; 159:299-306. [PMID: 189749 DOI: 10.1016/s0005-8165(76)80172-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Electron microscopic studies of a benign hepatoma in a 31-year-old women who was on contraceptive pills are presented. The electron microscopic picture showed highly differentiated liver cells with regularly developed bile canaliculi. The mitochondrial polymorphism, the formation of paracristalloids and the appearance of giant mitochondria were striking. The main change was the occurence of the numerous capillaries of varying caliber which were highly differentiated and formed an integral part of the tumor. On the basis of these finding the tumor is regarded as a benign mixed tumor. The well developed capillary system explaines the arteriographic characteristics and the frequent bleeding complications noted in the literature.
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Brander WL, Vosnides G, Ogg CS, West IE. Multiple hepatocellular tumours in a patient treated with oral contraceptives. Virchows Arch 1976; 370:69-76. [PMID: 179194 DOI: 10.1007/bf00427311] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A case of multiple hepatic tumours in a patient treated for four years with high doses of oral contraceptives is described. Solitary hepatocellular lesions associated with conventional doses of oral contraceptives have been reported previously in twenty nine cases. Haemorrhage has been a common mode of presentation and is attributed to the marked vascularity of the lesions, an appearance referred to as peliosis hepatis. Radiographic studies show this term to be inappropriate as the vessels are of arterial origin. Another finding not previously reported is the presence of diffuse hyperplasia in the non-tumourous parts of the liver.
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Grabowski M, Stenram U, Bergqvist A. Focal nodular hyperplasia of the liver, benign hepatomas, oral contraceptives and other drugs affecting the liver. ACTA PATHOLOGICA ET MICROBIOLOGICA SCANDINAVICA. SECTION A, PATHOLOGY 1975; 83:615-22. [PMID: 171910 DOI: 10.1111/j.1699-0463.1975.tb01388.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Due to the claim of an association between focal nodular hyperplasia of the liver, benign hepatomas and oral contraceptives, the files in the departments of pathology at the university hospitals in Lund and Malmö were examined for these two diagnoses made since 1945 and 1957, respectively. 26 cases of focal nodular hyperplasia of the liver and 7 benign hepatomas were found, 18 and 2, respectively, in women. Since 1963, the year before oral contraceptives were introduced in Sweden, focal nodular hyperplasia has been diagnosed in 8 women in the reproductive period of life; 4 of these had taken oral contraceptives. The 4 diagnoses were established in 1972-1974. At most, 25 per cent of Swedish females between the ages of 15 and 44 years have been on oral contraceptives. The Swedish series of 28 patients with focal nodular hyperplasia comprised 3 epileptics and 3 diabetics. At least two of the epileptics had been treated with barbiturates and/or hydantoins. The prevalence of drug-treated epilepsy in Sweden is 0.4-0.5 per cent, and of diabetes about 2 per cent. The possible aetiological role of drugs provoking an increase of the smooth-surfaced endoplasmic reticulum of the liver and proliferation of vascular fibrous tissue in a part of the liver which preveiously may have been damaged by vascular disturbances or trauma, is considered. No relationship between benign hepatomas and drugs was found. The observations support the notion that oral contraceptives may be of aetiological importance in the development of focal nodular hyperplasia of the liver, although the material is too small for epidemiological and statistical analysis.
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Stenwig AE, Solgaard T. Ruptured benign hepatoma associated with an oral contraceptive. A case report. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1975; 367:337-43. [PMID: 170733 DOI: 10.1007/bf01239340] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A ruptured benign hepatoma is described in a woman at full-term pregnancy. The patient had used an oral contraceptive for eight years before she became pregnant. According to several recent reports it seems likely that there is a relationship between the use of oral contraceptive agents and the development of liver cell tumours. Twentythree such cases have been found in the literature. Fourteen of these were not diagnosed before rupture. The present tumour differed from previously described lesions by containing foci of haematopoietic cells. As there were no signs of blood or bone marrow disease, it is suggested that the extramedullary haematopoiesis is a constituent of the tumour tissue.
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