Prior to the early 1970's, benign
liver neoplasms were among the rarest of
tumors. The seemingly rapid increase, especially in young females ingesting
oral contraceptives, as well as the catastrophic presentation of many of the
tumors resulting from liver
rupture and
hemoperitoneum, stimulated studies by several investigators. In the Liver
Tumor Registry at the University of Louisville, we have examined the histologic material, and finalized the data on 227
tumors, the majority in young women. With few exceptions, they had used
oral contraceptives or were either pregnant or immediately post-partum and presumably in a hyperestrogenic state. There have been 82
hepatocellular adenomas (HCA), 105 cases of
focal nodular hyperplasia (FNH), and 31
hepatocellular carcinomas. The
hepatocellular carcinomas occurred in non-cirrhotic livers, and 14 of the 31 cases were of a distinct, but rare type, polygonal cell
carcinoma with lamellar
fibrosis. While it seems reasonable to believe
steroids play a role in
adenomas and in FNH it is less certain that they produce
hepatocellular carcinomas since malignant liver
tumors are not uncommon in this age group without the use of
oral contraceptives. With an estimated 50 million women either currently using or who have used
oral contraceptives the risk must be very slight.