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Malignant transformation of hepatocellular adenoma in a young female patient after ovulation induction fertility treatment:A case report

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World Journal of Gastrointestinal Surgery 2019年第4期11卷 229-236页

作者： Juan Glinka Rodrigo Sanchez Clariá eugenia fratanoni Juan Spina Eduardo Mullen Victoria Ardiles Oscar Mazza Juan Pekolj Martín de Santiba?es Eduardo de Santiba?es Department of General Surgery Hepatobilio-pancreatic Unit Hospital Italiano de Buenos Aires Department of Radiology Hospital Italiano de Buenos Aires Department of Surgical Pathology Hospital Italiano de Buenos Aires

BACKGROUND Hepatocellular adenoma(HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception.Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications CASE SUMMARY A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging(MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up.,CONCLUSION HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.

关键词： Hepatocellular adenoma Malignant transformation Focal liver lesion Adenoma Ovulation induction Case report

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