Oral contraceptives, smoking and nodular hyperplasia of the liver
Lough, J.; Kinch, R.; Spellman, S.; Shaffer, E.
Canadian Medical Association Journal 118(4): 403-404
1978
ISSN/ISBN: 0008-4409 PMID: 630502 Document Number: 124647
Liver cell adenomas and focal nodular hyperplasia, which appear to be distinctive lesions, have been reported with increasing frequency in younger women and may be associated with the prolonged use of oral contraceptive medication. The vascular changes and the association with cigarette smoking are emphasized in the description of 4 recent cases of focal nodular hyperplasia. The natural history of focal nodular hyperplasia can best be explained as a progressive occlusion of hepatic lobular arteries as a result of either recurrent thrombosis or stimulation of intimal proliferation by contraceptive steroids. Ischemia, infarction and hemorrhage may then occur, followed by rapid development of collateral vessels and nodular regeneration about a central scar. The process is therefore not primarily neoplastic but one of focal postnecrotic cirrhosis; subsequent malignant transformation may occur occasionaly as it does in cirrhosis. It can be anticipated, however, that when the contraceptive steroids are withdrawn the lesions will regress. Women who smoke would be well advised to stop.