However, we believe that subsequent pregnancy and oral contraception should be discouraged in patients who have had such a resection, in light of the risk of recurrence. Since pregnancy is simulated by oral contraceptives, it is tempting to postulate that malignant transformation could occur during pregnancy. The fibrolamellar variant of hepatocellular carcinoma is a distinct clinicopathologic entity associated with a better prognosis than the more common type of hepatocellular carcinoma.17 Classically, patients with the fibrolamellar variant are younger and without the usual risk factors and alpha-fetoprotein levels are usually normal. Absence of other histologic characteristics, such as mitoses, thick cellular trabeculae, infiltrative margins, vascular invasion, or severe atypia, supports the diagnosis of adenoma rather than fibrolamellar hepatocellular carcinoma. Both the fibrolamellar variant and hepatic adenoma have been reported11-14 in pregnancy and were the differential diagnoses in our case.
Hepatic adenomas are usually solitary lesions.
Review of case reports6,19 reveals that a substantial percentage of cases involve more than one lesion. An exact definition with specific criteria for hepatic adenomatosis has not been established, since few well-documented cases have been reported. Other distinguishing features of hepatic adenomatosis are that it occurs equally in men and women and it is not associated with malignant transformation or with the use of oral contraceptives. Our case is unusual in several aspects. Hepatic adenomas are usually solitary and are associated with a history of oral contraceptive use.