Liver cell adenoma at the age of 3 years and transplantation 19 years later after development of carcinoma: A case report

✍ Scribed by Christine H. Janes; Douglas B. McGill; Jurgen Ludwig; Ruud A. F. Krom

• Publisher: John Wiley and Sons
• Year: 1993
• Tongue: English
• Weight: 492 KB
• Volume: 17
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840170409

✦ Synopsis

A 3-yr-old child underwent biopsy of a nonresectable liver cell adenoma. She was well thereafter, but at the age of 22 yr, she underwent orthotopic liver transplantation because the lesion had grown. The a-fetoprotein level was 4,300. The specimen showed poorly differentiated hepatocellular carcinoma in a noncirrhotic liver. At this writing, the patient is well 32 mo after transplantation. (HEPATOLOGY 1993; 17583-585.)

Liver cell adenoma (LCA) is an uncommon tumor often associated with the use of oral contraceptives. Affected females are usually in their early thirties and have used oral contraceptives for an average of 5 yr (1-4). LCA may cause symptoms as a result of central cavitation with hemorrhage and may, uncommonly, progress to malignancy (1, 5, 6). We present a patient who, at the age of 3 yr, had a liver cell tumor that probably was an LCA; 19 yr later, at the age of 22 yr, she underwent orthotopic liver transplantation because of invasive HCC.

When initially seen in 1971, at the age of 3 yr, the patient had a protuberant abdomen. Hepatic arteriographic analysis demonstrated a 9 x 10 cm moderately vascular tumor in the central portion of the liver. The child was examined, but the lesion was judged to be nonresectable. Multiple biopsy samples showed a welldifferentiated liver cell tumor (Fig. 1). Large trabeculae or features of vascular invasion were not present. Nevertheless, pathological opinion at that time favored a diagnosis of low-grade HCC. Treatment with fluorouracil, carmustine and vincristine was instituted; therapy continued through 1973, and clinically the child did very well. Repeated physical examinations failed to reveal the actual size of the lesion, but sequential radionuclide scans showed no change in tumor size. Serum a-fetoprotein was not detected in 1973 and 1974 by the insensitive electrophoretic method available at