Relation of steroids to liver oncogenesis

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.

PIP: Histological specimens from 150 women with liver tumors are discussed. Of the 150 patients under consideration, 85% had ingested contraceptive steroids, most for more than 3 years. Of these 64% had taken pills containing mestranol, and 18% had used ethinyl estradiol; 18% had taken both. Average age was about 30 years, and pain was the most common presenting symptom. 19 tumors were malignant (hepatoma), 57 were adenoma, 68 were focal nodular hyperplasia, and 6 were unclassified. To date, 12 of the 19 hepatoma patients have died. In addition to presenting numerous figures depicting the pathology material and a discussion of tumor differentiation difficulties, speculation between steroid ingestation and tumor appearance is considered. Since hepatomas are much more common than benign liver tumors, circumspection is in order before indicting steroids as causative. In this group of women studied, none had cirrhosis, for example, whereas cirrhosis is very common in the general population. The authors call for further investigation of estrogens and primary liver tumores.