Hepatoma Associated With Anabolic Steroid Therapy

Holder, Lawrence E.; Gnarra, David J.; Lampkin, Beatrice C.; Nishiyama, Hiroshi; Perkins, Patrick

doi:10.2214/ajr.124.4.638

Cited by 29 publications

(2 citation statements)

References 8 publications

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“…reviewed the published work about the relationship between androgens and liver tumors in FA and non‐FA patients . All patients on anabolic steroids are at risk of developing liver tumors, however, FA patients are more susceptible to acquiring HCC, because they developed these liver tumors at a younger age, after smaller amounts of androgens and after shorter terms of androgen exposure . Oxymetholone, a 17‐α‐alkylated androgen (used by our patient), and methyltestosterone are most often associated with the development of HCC, while danazol is more often associated with adenomas .…”

Section: Discussionmentioning

confidence: 90%

“…17 All patients on anabolic steroids are at risk of developing liver tumors, however, FA patients are more susceptible to acquiring HCC, because they developed these liver tumors at a younger age, after smaller amounts of androgens and after shorter terms of androgen exposure. [17][18][19][20][21][22] Oxymetholone, a 17-a-alkylated androgen (used by our patient), and methyltestosterone are most often associated with the development of HCC, while danazol is more often associated with adenomas. 15,17,23,24 As oxymetholone and methyltestosterone are more often used by FA patients and danazol by non-FA aplastic anemia patients, it is difficult to determine if the development of HCC is really related to the type of androgens taken.…”

Section: Discussionmentioning

confidence: 99%

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Living related liver transplantation in an adult patient with hepatocellular adenoma and carcinoma 13 years after bone marrow transplantation for Fanconi anemia: A case report

Colle

Laureys

Raevens

et al. 2013

Hepatology Research

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Fanconi anemia is an inherited bone marrow failure syndrome, characterised by failing DNA repair. Hematopoetic stem cell transplantation, known to be curative for the bone marrow failure, does neither prevent or cure other manifestations such as the development of malignancies. We describe a 26-year-old male patient with known Fanconi anemia and Marfan syndrome who in 1994 underwent a successful bone marrow transplantation of stem cells from his HLA-identical sister. In 2006, three hepatocellular carcinoma (HCC) lesions in the liver were detected and promptly resected. The resection specimen contained 3 lesions, all showing activation of the beta-catenin pathway: a well differentiated steatotic HCC with remnants of the underlying adenoma from which it arose, an adenoma with small foci of well differentiated HCC and a cholestatic adenoma. Known risk factors for developing HCC include Fanconi anemia itself and the use of androgens (oxymetholone) for a period of 3 years preceeding transplantation. Because of the increased risk of developing additional HCC’s, liver transplantation was proposed, taking into account that immunosuppression increases the risk of other malignancies. By using part of the liver of the HLA-identical sister, already acting as bone marrow donor 13 years before, immunosuppression could be avoided. A left lobe liver transplantation was performed without immediate complications for donor and acceptor on July 2, 2007. Nine months after liver transplantation the recipient developed an anastomotic biliary stricture that had to be dilated by percutaneous transhepatic cholangiography. Two months later however, the stenosis recurred, necessitating a surgical reanastomosis (hepaticojejunostomy). Five years after liver transplantation the patient is still doing well. This case report is twofold special being the first case reporting Fanconi anemia linked to Marfan syndrome and being the first reported case of Fanconi anemia who was treated for hepatocellular carcinoma by liver transplantation from a living related HLA-identical donor without the use of immunosuppression.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Living related liver transplantation in an adult patient with hepatocellular adenoma and carcinoma 13 years after bone marrow transplantation for Fanconi anemia: A case report

Colle

Laureys

Raevens

et al. 2013

Hepatology Research

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Multiple Hepatic Tumors and Peliosis Hepatis in Fanconi's Anemia Treated With Androgens

Shapiro¹,

Ikeda²,

Ruebner³

et al. 1977

Arch Pediatr Adolesc Med

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\s=b\We report the case of a 13-year-old boy who was known to have Fanconi's anemia for five years. For treatment of this condition he was given androgens and corticosteroids. Two months before his death, severe varicella developed complicated by pneumonia, jaundice, and prolonged fever; all of which resolved during a five-week hospitalization. Three weeks later he died of Clostridium septicum sepsis caused by necrotizing enterocolitis. At autopsy he was found to have multiple hepatocellular neoplasms. A striking feature of the neoplasms was cholestasis. The liver also showed peliosis hepatis. The association of the use of certain androgenic steroids with hepatic neoplasms histologically resembling hepatocarcinomas, but characterized by lack of metastases and apparent reversibility, suggests the desirability of a new nomenclature for these hepatocellular lesions.

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Fanconi's anemia and malignancies

1996

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Patients with Fanconi's anemia (FA) are at a high risk for development of malignancies. It is well-known that leukemia occurs in-10% of cases, with increasing risk with age. Less commonly recognized is the risk for myelodysplastic syndromes (-5%); the relationship between myelodysplasia and evolution to leukemia remains speculative. What also needs to be emphasized is that older patients have an ever-increasing risk for development of solid tumors, with at least 5% reported to have liver tumors (ma1e:female ratio, 2:l) and an equal number of other cancers (fema1e:male ratio, 3 1 , even afler exclusion of gynecologic malignancies). Hematologists have tended to focus on aplastic anemia and leukemia. As FA patients live longer, more of the other malignancies will occur, perhaps related to cord blood or bone marrow transplant, or treatment with cytokines. This review identifies the types of tumors for which patients with Fanconi's anemia are at risk.

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Hepatoma Associated With Anabolic Steroid Therapy

Cited by 29 publications

References 8 publications

Living related liver transplantation in an adult patient with hepatocellular adenoma and carcinoma 13 years after bone marrow transplantation for Fanconi anemia: A case report

Living related liver transplantation in an adult patient with hepatocellular adenoma and carcinoma 13 years after bone marrow transplantation for Fanconi anemia: A case report

Multiple Hepatic Tumors and Peliosis Hepatis in Fanconi's Anemia Treated With Androgens

Fanconi's anemia and malignancies

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