Hepatic Tumors Induced by Sex Steroids

Abstract

Our study of more than 250 women with hepatic tumors, accessioned in our tumor registry at the University of Louisville, disclosed three types of tumor: FNH , HCA, and HCC. The ingestion of sundry kinds of sex steroids by the majority of these women, chiefly for purposes of preventing conception, warrants the suspicion that such hormones induced these different types of hepatic tumors. Publications by others reporting similar hepatic tumors in men using male sex steroids lends support to this hypothesis. Rupture of the hepatic tumor and consequent hemorrhage, producing hemoperitoneum, is a major risk factor. Other presenting symptoms are pain and palpable mass. Symptomatic women using OCs should be subjected to a CT or technetium hepatic scan as an initial screening assessment. Because of the imminent possibility of rupture, large turgid vascular tumors should be resected without biopsy. Biopsy-proved HCC should also be removed surgically. All other tumors, including small multiple tumors, will usually regress when exogenous sex steroids are withdrawn and pregnancy avoided. Other significant hepatic changes observed in this study are peliosis hepatis, periportal sinusoidal dilation, and vascular lesions. The branches of the hepatic artery and the tributaries of the portal vein show combinations of intimal and smooth muscle proliferation, vascular thickening, occlusive intimal thickening, and, at times, obstructing thrombosis. Similar smooth muscle proliferation in the afferent vessels of the livers of animals treated with sex steroids suggests that there is a cause and effect relationship in women using OCs.

Sex Hormone-Related Functions in Regenerating Male Rat Liver

“…In this regard, estrogens are known to be inducers of the hepatic synthesis of many serum transport proteins (32), a function that is likely to be critical during regeneration. Moreover, the presence of a massive estrogenic effect during the proliferative phase of regeneration is reminiscent of the observations that estrogens promote development of certain hepatic neoplasms associated with an increased mitogenic activity (1,21,33).…”

Management of liver adenomatosis: Results with a conservative surgical approach

“…Moreover, none of our patients had involution or disappearance of adenomas after withdrawal of OCs. Thus, unlike solitary hepatic adenomas, in which the majority of lesions express ERs, albeit in a nonuniform manner, 39 estrogen does not appear to have a dominant role in the development and growth of adenomas in patients with LA. Based on these data, we no longer advocate tamoxifen therapy or oophorectomy in these patients.…”

Peliod Hepatocellular Carcinoma in a Domesticated Ferret (Mustela Putorius Furo)

“…1,9 In addition, androgenic and estrogenic steroids have been implicated in the development and course of several liver diseases in humans including hepatocellular carcinoma. 2,11 Estrogens are well known as hyperplastic agents in the liver, and have been implicated in cases of hepatic adenoma and focal nodular hyperplasia in males and females. It has been suggested that estrogen and estrogen receptor are involved in the early stages of hepatocarcinogenesis.…”

“…2,11 Clear association among peliosis hepatis, hepatocellular hyperplasia, or neoplasia and estrogen therapy has been established for human patients. 11 Interestingly, adrenocortical tumors and/or nodular adrenocortical hyperplasia commonly cause increased plasma estradiol concentration in ferrets. Variable degrees of estradiol reactivity in such hyperplastic, benign, and malignant adrenocortical lesions in ferrets have been confirmed by immunohistochemical evaluation.…”