Possible cause - effect relation between estrogen and focal nodular hyperplasia . Case report

A 22-year-old female patient sought medical care due to an asymptomatic solid nodule in the liver, incidentally diagnosed by abdominal ultrasound. She reported the use of an estrogen-based oral contraceptive for approximately 3 years. She denied smoking or alcohol drinking. Her mother had a history of nonalcoholic steato-hepatitis and her maternal grandmother had a hepatic hemangioma. Physical examination revealed an asymptomatic patient with discretely painful palpation of the right hypochondrium close to the xiphoid appendix. Ultrasound examination revealed a 5.9 x 4.1 cm hypoechogenic nodule in the left lobule and computed tomography revealed a 5.3 x 6.3 x 4.5 cm focal lesion in the 2/3 segments. Other tests of hepatic function proved to be normal, except for serum gammaglutamyl transferase, which was increased by approximately two times the mean reference value. With a diagnosis of focal nodular hyperplasia, she was submitted to exploratory laparotomy followed by partial hepatectomy (segment III, Figure 1). With a macroscopic diagnosis of hepatic adenoma, the anatomopathological report was focal nodular hyperplasia. At present, after four years of postoperative follow-up, the patient is well and is taking progesterone instead of the estrogen-based anovulatory agent.