Hepatocellular Adenoma Associated with Anabolic Steroid Therapy for Two Patients with Aplastic Anemia

• Published in: The Japanese Journal of Pediatric Hematology Vol. 15; no. 3; pp. 178 - 186
• Main Authors: 和田 恵美子, GOTO Keiko, 田村 まり子, KATOH Fumiyo, TSURUTA Toshihisa, MURATA Mitsunori
• Format: Journal Article
• Language: English
• Published: THE JAPANESE SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY 30.06.2001; 特定非営利活動法人 日本小児血液・がん学会
• Subjects: anabolic steroid; aplastic anemia; hepatocellular adenoma
• ISSN: 0913-8706; 1884-4723
• DOI: 10.11412/jjph1987.15.178

We report two patients with aplastic anemia who developed hepatocellular adenoma after long-term therapy with oxymetholone. Patient 1. A 20-year-old male was diagnosed with severe aplastic anemia at 13 years of age. Six years after the start of oxymetholone therapy (total dose 125 g), the patient developed multiple hepatic tumors. These tumors regressed after cessation of oxymetholone, but he died of sepsis. Tumors were confirmed to be hepatocellular adenoma by autopsy. Patient 2. A 22-year-old male was found to be anemic at age 7 and diagnosed as having aplastic anemia. He underwent oxymetholone therapy (226 g) for 14 years. A liver biopsy from the left hepatic lobe was performed. The mass was suspected to be hepatocellular adenoma. A tendency for it to regress was noted after the withdrawal of oxymetholone. The patient underwent bone marrow transplantation from his older brother, and his hematological data recovered. The main cause of death from hepatic tumor occurrence in these cases was sepsis, bleeding tendency, and rupture of the tumors. A follow-up of hepatic tumor by echogram and treatment of the original disorder after the cessation of drugs are important in cases of this kind. 蛋白同化ステロイド (AS) により誘発された肝腫瘍の2例を報告した.症例1は20歳男性.13歳のとき重症再生不良性貧血の診断をうけ, オキシメトロン (OXY) の投与をうけた.約6年後, 肝内に多発性腫瘤を認めた.OXYの総量は125gであった.薬剤中止により, 腫瘤は消失または一部退縮したが, 敗血症のため死亡した.部検により肝腺が確認された.症例2は22歳男性.6歳時再生不良性貧血と診断され, OXYの投与をうけた.約14年後の腹部超音波検査にて, 肝左葉のモザイク様変化と右葉に2個の腫瘤を認めた.OXYの総量は226gであった.肝生検にて肝腺腫が疑われた.薬剤の中止により退縮傾向にある.同胞ドナーから骨髄移植を行い, 血液所見も回復した.ASによる肝腫瘍発生例のおもな死亡原因は, 敗血症と出血および腫瘍破裂であった.画像検査にて経過観察するとともに, 薬剤中止後の原疾患のコントロールが重要である.