Abstract | Revitalizing Women's Healthcare Together

September 29-30, 2023 

Correspondence to: wilder.calmet.r@upch.pe 
Wilder Rodrigo Calmet-Rocca1; Gisela Valer-Chávez, MD2

1Universidad Peruana Cayetano Heredia. Alberto Hurtado Faculty of Medicine, Lima, Peru.

2Private practice Naprotecnología y Fertilidad Natural Perú., Lima, Peru.

Author Affiliations

Title: Hepatocellular adenoma linked to long term oral-contraceptive pills use, a case report in Lima-Peru.

Background: The hepatocellular adenoma (HCA) is defined as a rare benign liver lesion that develops in an otherwise healthy liver. Despite being an uncommon hepatic tumor, it is very well known the association between them and the exposure to estrogens, as oral contraceptive pills (OCPs). The incidence is 1 to 1.3 per million in non-OCP users and 30 - 40 per 100,000 in long-term OCP users, especially in women in their 30-50s. It is also strongly associated with anabolic androgen steroids and obesity. HCAs are usually unique lesions that are found often incidentally, however sometimes they can be related to life-threatening situations resulting from tumor rupture and subsequent intraabdominal hemorrhage.

This lesion may also suffer malignant transformation to hepatocellular carcinoma, rising the risk according to the tumor subtype: Inflammatory adenoma, inactivated adenoma and beta-catenin adenoma (higher risk, up to 46%). This, reinforces the importance of a prompt diagnosis, follow up and treatment.

Design: Case report and literature review.

Setting: Private practice in Lima-Peru.

Patient: 35 y/o female consults after incidental finding of a liver mass during a routine ultrasound.

Past medical history: Contraceptive pills use from 2002 to 2022, interrupted two times: 2013- 2014, and 2015-2016, 19 months each during pregnancy and lactation.

Physical examination: BMI: 19, stable. Unremarkable findings, no abdominal mass.

Laboratory: Unremarkable findings.

Imaging:
1. Ultrasound 7/30/22: 1.9 x 1.5 x 1.6 cm doppler positive liver mass at VI segment
2. CT 8/13/22: Hypodense 1.5cm liver mass at the VI segment, homogenous enhancement on arterial phase and homogenization with liver parenchyma on late venous phase.
3. MRI 8/26/22: Hyper vascularized 1.5cm nodule on VI segment. Persistent arterial enhancement on late venous phase. T2 with peripheral nodular formation around the lesion.
4. Ultrasound 3/1/23: 1.8 x 1.5 liver mass at VI segment.
5. Ultrasound 6/27/23: 1.5 x 1.9 cm hyperechogenic nodule with no apparent malignant characteristics.

Results: Cessation of OCPs and surgical referral, suspecting hepatic adenoma. Laboratory tests and imaging, findings corresponded to a hepatocellular inflammatory adenoma, induced by long-term oral contraceptive pills use. According to the findings (size/morphology), OCP cessation was suggested. Two follow up ultrasounds, at 8 and 10 months, revealed the HCA remained stable, even with a size bias in the most recent one, due to an enlarged liver from a Dengue virus infection.

Main Outcome Measures: Description and discussion of clinical, laboratory and imaging findings.

Conclusions: We emphasize the need to evaluate any liver mass in a young female using OCPs to be a possible adenoma, consider the risks associated, and the need for follow-up imaging to avoid complications as malignant transformation and bleeding. This is the first report of a hepatocellular adenoma secondary to long term OCP use in Peru. We consider that besides lifestyle intervention and OCP cessation, all woman should be aware about the side effects of OCP consumption and have access to fertility awareness based methods (FABMs) as a main tool for family planning.

Keywords: Recurrent pregnancy loss, inherited thrombophilias, chromosomal polymorphism, methylene tetrahydrofolate reductase (C677T).