Possible cause-effect relation between estrogen and focal nodular hyperplasia. Case report

Abstract

A 22-year-old female patient sought medical care due to an asymptomatic solid nodule in the liver,incidentally diagnosed by abdominal ultrasound. She reported the use of an estrogen-based oral contraceptive for approximately 3 years. She denied smoking or alcohol drinking. Her mother had a history ofnonalcoholic steato-hepatitis and her maternal grandmother had a hepatic hemangioma. Physical examination revealed an asymptomatic patient with discretely painful palpation of the right hypochondriumclose to the xiphoid appendix. Ultrasound examination revealed a 5.9 x 4.1 cm hypoechogenic nodule inthe left lobule and computed tomography revealed a 5.3 x 6.3 x 4.5 cm focal lesion in the 2/3 segments.Other tests of hepatic function proved to be normal, except for serum gammaglutamyl transferase, whichwas increased by approximately two times the mean reference value. With a diagnosis of focal nodularhyperplasia, she was submitted to exploratory laparotomy followed by partial hepatectomy (segment III,Figure 1). With a macroscopic diagnosis of hepatic adenoma, the anatomopathological report was focalnodular hyperplasia. At present, after four years of postoperative follow-up, the patient is well and istaking progesterone instead of the estrogen-based anovulatory agent.