Benign liver-cell adenoma associated with long-term administration of an androgenic-anabolic steroid (methandienone)

Abstract

A 19-year-old man with paroxysmal nocturnal hemoglobinuria treated for 3 years with Methandienone was admitted to the hospital with hemoperitoneum due to the rupture of an hepatic tumor. Histology revealed that it was a benign liver cell adenoma, with a pathologic appearance and mode of clinical presentation closely resembling those of cases observed to develop in association to contraceptive steroids. " Doubt has been raised about the histologic diagnosis of the latter, for the data presented are not always convincing as to the malignant nature of these growths.' Recently, a patient with a hepatic adenoma after prolonged treatment with oxymetholone was described. 2 ' We report a patient with a benign liver cell adenoma associated with Methandienone treatment, who seems to be the second recorded case of adenoma associated with androgenicanabolic steroids. CASE REPORTA 19-year-old man, treated for paroxysmal nocturnal hemoglobinuria (PNH) with Methandienone for 3 years, was admitted to hospital in May, 1975 patient was included in a cooperative therapeutic trial of the effect of androgenic-anabolic steroids on bone marrow insufficiency* and administered Methandienone in a dose of 65 mg daily. After 20 months of treatment a slight improvement of the pancytopenia was noted. In January, 1975, he had the first crisis of PNH, which reappeared in April, in spite of the treatment. In May, 1975, he was readmitted to the hospital complaining of left hypocondrial pain. Physical examination showed signs of peritonitis and an abdominal tap revealed the presence of blood. At laparotomy two small tumors were found in the left lobe of the liver. One of the tumors was ruptured and was responsible for the hemoperitoneum. Resection of the affected liver was done and the postoperative course was uneventful. Serum alpha-1-fetoprotein was negative in blood taken immediately after operation. Histological ExaminationAt microscopic examination both tumors, 10 X 60 X 30 cm and 80 X 45 X 25 mm in size, were pale and capsulated. The larger one had an extensive area of hemorrhagic necrosis at the surface.Microscopic examination showed a well-differentiated lesion, composed of liver cells resembling normal hepatocytes, arranged in plates thicker than in normal liver. Within the tumor there were no portal tracts, or biliary structures. Many dilated sinusoids and large spaces containing blood were seen, some of them with endothelium layer and other with no wall, as well as large areas of hemorrhagic necrosis (Fig.

Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature

“…[5][6][7] HA are not malignant tumours, but surgical intervention may be required if sudden massive bleeding or liver failure occurs; rupture of HA with haemoperitoneum can be a life threatening complication. [8][9][10][11] HA are hypervascular tumours containing multiple sinusoids of capillaries with thin walls in which the pressure is exclusively arterial. The connective tissue support is poor and, therefore, bleeding tends to spread diffusely throughout the entire tumour.…”

“…The connective tissue support is poor and, therefore, bleeding tends to spread diffusely throughout the entire tumour. 10 A non-surgical approach should be considered for androgen induced HA, given that some tumours have regressed after AAS administration was stopped. 4 7-9 12 One of the problems that HA present is differentiation between HA and hepatocellular carcinomas (HCC).…”

Multiple hepatic adenomas caused by long-term administration of androgenic steroids for aplastic anemia in association with familial adenomatous polyposis

“…1,2 There have been increasing reports of hepatic neoplasms in young women taking oral contraceptives, and, in some rare cases, in individuals of both sexes taking anabolic androgenic steroids. [3][4][5][6][7][8][9] Although most of these tumors are benign, early detection is important for avoiding the associated risks of life-threatening hemorrhage 5,8 and malignant degeneration. 7 We report a case of hepatic adenomas in a 20-year-old Japanese girl treated with anabolic androgens for aplastic anemia over a long term.…”

Development of Hepatocellular Carcinoma Associated with Anabolic Androgenic Steroid Abuse in a Young Bodybuilder: A Case Report

“…A correlation between AAS use and HCA has been increasingly recognised in athletes taking AAS [5, 12, 13]. While danazol is associated with HCA formation, other preparations like oxymetholone, respectively, methyltestosterone can lead to HCC [8].…”