Hepatocellular carcinoma associated with long-term anabolic steroid therapy in two patients with aplastic anemia
Oda, K.; Oguma, N.; Kawano, M.; Kimura, A.; Kuramoto, A.; Tokumo, K.
Nihon Ketsueki Gakkai Zasshi Journal of Japan Haematological Society 50(1): 29-36
1987
ISSN/ISBN: 0001-5806 PMID: 3035855 Document Number: 287429
Two patients with aplastic anemia on long-term anabolic steroid therapy developed hepatocellular carcinoma. Patient 1 was a 29-year-old male with a 15-year history of aplastic anemia. He was treated with 109 g of oxymetholone, 59 g of methenolone acetate and 12 g of other anabolic steroids for about 15 years (total dose of anabolic steroids was 180 g). Liver tumor was noted one month before death. Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and hepatitis B surface antigen (HBs-Ag) were all negative. Autopsy revealed three sites of nodular hepatocellular carcinoma. There was no evidence of liver cirrhosis. Patient 2 was a 60-year-old male with a 27-year history of aplastic anemia. He was treated with 77 g of oxymetholone, 20 g of ethylestrenol and 2 g of other anabolic steroids for about 12 years (total dose of anabolic steroids was 99 g). He died of ruptured liver tumor and bacterial liver necrosis. AFP and HBs-Ag were negative. CEA was 23.9 ng/ml. At autopsy, multiple sites of nodular hepatocellular carcinoma with mediastinal lymph nodes metastasis were noted. Hepatocellular carcinoma, in these cases, was thought to be associated with long-term anabolic steroid therapy. We therefore recommend computed tomographic scan and ultrasonographic examination to detect liver lesions in patients on long-term anabolic steroid therapy.