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Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A relationship between exposure to exogenous estrogens and endometrial carcinoma has been reported in numerous studies. The incidence among those so exposed has been estimated to have been increased from 7.5 to 8 times that of those not exposed. Long-term therapy with estrogens for menopausal symptoms has been the usual history. Breast cancer patients treated with estrogens and young women taking sequential oral contraceptives have had increased risks. In this study, the records of Olmsted County, Minnesota, residents with endometrial uterine cancer diagnosed between 1945-1974 at the Mayo Clinic or at other medical facilities were reviewed. There were 122 adenocarcinomas and 23 adenoacanthomas. In 3 instances, adenocarcinomas contained zones of uterine sarcoma. For each of the 146 patients there were 4 age-matched controls. Estrogen use for 6 months or more was recorded for 39 (27%) of the 145 cases and for 163 (28%) of the 580 controls. The controls had more frequent histories of short-term estrogen therapy. Cancer patients had relatively more estrogen use for menopausal symptoms. The relative risk of endometrial cancer tended to increase with the duration of exposure to conjugated estrogens from 2.0 with any exposure to 4.9 (p less than .01) after 6 months or more and to 7.9 after 3 years or more. The risk increased with larger doses (1.25 mg or more) and with continuous administration of conjugated estrogen. Myometrial invasion was superficial in 77 cases and deep in 44 cases. Long-term use of conjugated estrogen was frequently associated with low-stage low-grade superficially invasive endometrial malignancy. The 5-year survival rate of the 145 patients was 85%. Patients with Stage 1 had a 95% relative 5-year survival rate. Those with Stages 2, 3, or 4 had 50% survival rates. Of other risk factors, obesity and nulliparity were noted. Patients had more frequent records of benign cystic adenoma and of adenomatous hyperplasia than controls. The corrected age-specific rate for endometiral cancer increased to a maximum of about 90/100,000 population per year in the group aged 55-64 and then diminished with age. An increase in endometrial cancer among those at risk may have been nullified by an increase in those who have had a hysterectomy. In this study the incidence of endometrial carcinoma in Olmsted County does not show an increase in the last 3 decades. It is noted that the long-term use of conjugated estrogens in this area has been relatively low.
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PMID:Exogenous estrogen and endometrial carcinoma: case-control and incidence study. 19 Aug 87

Histological specimens from 150 women with liver tumors are discussed. Of the 150 patients under consideration, 85% had ingested contraceptive steroids, most for more than 3 years. Of these 64% had taken pills containing mestranol, and 18% had used ethinyl estradiol; 18% had taken both. Average age was about 30 years, and pain was the most common presenting symptom. 19 tumors were malignant (hepatoma), 57 were adenoma, 68 were focal nodular hyperplasia, and 6 were unclassified. To date, 12 of the 19 hepatoma patients have died. In addition to presenting numerous figures depicting the pathology material and a discussion of tumor differentiation difficulties, speculation between steroid ingestation and tumor appearance is considered. Since hepatomas are much more common than benign liver tumors, circumspection is in order before indicting steroids as causative. In this group of women studied, none had cirrhosis, for example, whereas cirrhosis is very common in the general population. The authors call for further investigation of estrogens and primary liver tumores.
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PMID:Relation of steroids to liver oncogenesis. 22 96

Estrogen and/or progestin administration to postmenopausal women with primary hyperparathyroidism lowers serum calcium. We measured cytosolic estrogen receptors (ER) and progesterone receptors (PR) by classical hormone-receptor binding techniques in parathyroid tissue removed from 10 men and 20 women, and ER by immunocytochemistry in tissue from an additional one man and seven women in order to ascertain whether these agents might exert a direct effect upon tissue responsible for hyperparathyroidism. ER were negative (< 3.1 fmol bound estradiol/10 mg tissue) in all 8 adenomas and 4 of 5 secondary hyperplasias removed from men, and from women in 19 of 22 adenomas, 2 of 3 secondary hyperplasias, and 3 of 4 primary hyperplasias. PR were negative (< 10.1 fmol bound progesterone/10 mg tissue) in 7 of 8 adenomas and all 5 secondary hyperplasias removed from men, and from women in 20 of 22 adenomas, all 3 secondary hyperplasias, and all 4 primary hyperplasias. For immunocytochemical studies, quick-frozen specimens were analyzed with a monoclonal antibody (Abbott Laboratory) directed at nuclear ER. All eight samples--five adenoma and three primary hyperplasia--were negative. We conclude that abnormal human parathyroid tissues have nondetectable levels of ER and PR. It is unlikely that estrogen and progesterone exert a direct, ER, or PR-mediated effect upon parathyroid tissue.
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PMID:Measurement of estrogen and progesterone receptors in abnormal human parathyroid tissue. 145 37

Transforming growth factor-alpha (TGF alpha) has been localized to the anterior pituitary, specifically to the lactotroph and somatotroph cell populations, by our previous studies. Since pituitary lactotrophs are known to undergo growth in response to estrogens, we have used an estradiol-induced pituitary hyperplasia/adenoma model. Estradiol treatment resulted in induction of TGF alpha mRNA in anterior pituitary, evident by 48 h, preceding actual macroscopic growth, which attained a maximum greater than 500% by 12 weeks. This rapid effect of estradiol also enhanced PRL mRNA, but did not affect other species of mRNA encoding for proenkephalin, D2 receptor mRNA, or hexosaminidase-A. TGF alpha mRNA remained elevated for the duration of rapid pituitary growth. D2 receptor activation by its agonist bromocriptine resulted in marked attenuation of TGF alpha mRNA preceding regression of growth. Coadministration of bromocriptine with estradiol resulted in an involution of pituitary size, indicating the overriding influence of dopamine in spite of a continued estrogenic stimulus. Epidermal growth factor receptor mRNA was not affected by any of these manipulations, suggesting that the receptor was not coregulated in this tissue similarly to TGF alpha. Estradiol also induced uterine TGF alpha mRNA and marked growth of the organ, but TGF alpha in this location was not regulated by dopamine. These results indicate that TGF alpha in the anterior pituitary is rapidly induced by estrogen in a time course preceding the growth of the gland. Estrogen-induced TGF alpha is rapidly attenuated by D2 dopamine receptor activation and is accompanied by a regression of pituitary growth. Interaction between these opposing hormonal/transmitter responses will determine the growth potential of the anterior pituitary.
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PMID:Dopamine receptor activation inhibits estrogen-stimulated transforming growth factor-alpha gene expression and growth in anterior pituitary, but not in uterus. 153 40

Estrogen receptors (ER) in human gallbladders were examined immunohistochemically using a specific monoclonal antibody against human ER. ER immunoreactivity was positive in 6 (19.4%) of 31 cases of cholelithiasis, 6 (33.3%) of 18 cases of epithelial polyp, 14 (53.8%) of 26 cases of adenoma, and 26 (22.8%) of 114 cases of adenocarcinoma. ER immunoreactivity was located at the nucleus of the epithelium of both non-neoplastic and neoplastic tissues, although the number of ER-immunoreactive cells was small. There was no sex difference in the incidence of ER immunoreactivity. No significant difference in survival rates could be demonstrated between ER-positive and ER-negative carcinomas. Epithelial polyps, adenomas and carcinomas were divided into metaplastic type and non-metaplastic type based on the presence or absence of metaplastic changes for comparison of the incidence of ER immunoreactivity. The incidence of ER immunoreactivity in the metaplastic type was significantly higher than that in the non-metaplastic type. We conclude that ER are present in the gallbladder mucosa in various disease states and suggest that the presence of ER is related to metaplasia of the gallbladder mucosa.
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PMID:Immunohistochemical analysis of estrogen receptors in human gallbladder. 231 69

Clinical and laboratory evidence of an association of oral contraceptive (OC) use with the subsequent development of benign and malignant hepatobiliary neoplasia is growing. The authors present a case in which an adenoma within a large, multicentric anaplastic spindle cell carcinoma occurred in a woman with a long history of OC use. The patient, a 38-year-old gravida 2, para 2, was diagnosed following low-grade fevers and right upper quadrant pain. A partial hepatectomy was performed with no complications; however, a follow-up examination 2 months later revealed widespread intra-abdominal tumor recurrence histologically identical to the original tumor. Immunostaining for alpha 1 antitrypsin and keratin was strongly positive in tumor cells, indicating a biliary derivation. Electron microscopy indicated an epithelial derivation as well, including the presence of intracellular lumens, intermediary filaments, and numerous intercellular junctions. Estrogen and progesterone receptors were negative in the tumor. The tritiated thymidine labeling index was 5.05%, with an estimated potential doubling time of 11 days. This woman had no history of hepatitis, no family or personal history of neoplasms, and no known hepatotoxin exposure. The only medication used by the patient was Norlestrin, an OC containing 1 mg norethindrone and 50 mcg ethinyl estradiol that she had taken continuously for the past 8 years.
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PMID:Hepatic adenoma within a spindle cell carcinoma in a woman with a long history of oral contraceptives. 243 48

The objectives of this article on epidemiological studies of health risks from oral contraceptives (OCs) is to review major studies of the association between OCs and circulatory disease and cancer. It is also to emphasize methodologic limitations of the existing data, and to identify unresolved and important questions. A brief discourse on the nature and imputation of relative risk is provided. Cardiovascular diseases covered include ischemic heart disease, stroke, and thromboembolism. Current studies on low dose pills from 3 large US populations reveal that there is no impact of death from use of OCs. A Great Britain and the Walnut Creek study from the US found a slight but not statistically significant increase in ischemic heart disease. These studies also found a statistically significant 3-fold increase in stroke among OC users and, from another study, a 2-fold increase. These studies were based on high levels of ethinyl estradiol where the risk becomes apparent. The risk for idiopathic venous thromboembolism was 3- 8 fold for current OC users. The accuracy of these findings is questioned when the data reflect such heterogeneity. Cancer is differentiated as breast cancer, endometrial cancer, ovarian cancer, cervical cancer, malignant melanoma, and hepatocellular adenoma. For breast cancer, both case control studies as well as cohort studies found no increase in breast cancer. Future additional research will continue to explore unanswered questions about this association. Beneficial effects of OCs occur for endometrial cancer for as long as 15 years after taking the pill. Only 1 year's use resulted in a 50% reduction in risk of endometrial cancer regardless of pill dose and particularly for nulliparous women, who have an increased risk. The longer duration of use of the OCs results in a protective effect against ovarian cancer, i.e., 5 years of use yields as relative risk of below 0.5 and the results of a protective effect can be seen as early as 3 months after pill use. There is about 40% protection against ovarian cancer even with low dose pills; the effect lasts 15 years after cessation of OC use. Cervical cancer studies have shown mixed results. The human papilloma viruses 16 and 18 have been shown to be related to cervical cancer but further research is needed to identify the association with OCs. Data are inconclusive but lean in the direction of no association with malignant melanoma. Hepatocellular adenoma has not been identified in large vital statistics studies, although several small studies have suggested an increased risk. It has been shown by Fortney et al. that with a 50% increase in cervical cancer risk and a 3-4 fold increase in cardiovascular disease risk that OC use for 5 years before the age of 30 years adds 4 days to a health women's life.
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PMID:Results of oral contraceptive epidemiologic studies regarding neoplastic and cardiovascular effects. 257 54

A 36 year old obese and hypertensive woman visited her family physician because she felt dizzy and generally weak for 3 days. Even though she had been advised to stop taking the combined oral contraceptive (OC) containing 50 ug ethinyl estradiol and .5 mg norgestrel, at the time she consulted the physician she had been using it for 6 years. Upon admission to a South Carolina hospital, she stopped taking the OC. After appropriate treatment, her condition soon stabilized. The next day, however, she had a fever of 39.44 degrees Celsius, abdominal pain, generalized abdominal tenderness, and rebound tenderness. These symptoms continued through a 2nd day and a laparotomy was warranted. A 15x10 cm hepatic cell adenoma on the right lobe of the liver caused hemorrhaging in the peritoneal cavity. In addition, a 5-6 cm mass was found on the inferior surface of the left lobe. A liver spleen scan 3 weeks following surgery indicated diminished activity at the tumor site on the right lobe. 1 1/2 years later, physicians excised the now reduced tumor (4x2 1/2 cm) on the left lobe and the right lobe adenoma had necrotized and regressed. 15 months following excision of the left lobe tumor, a needle liver biopsy showed a mild, fatty change in the liver. No further liver problems have developed. Research demonstrates that prolonged use of OCs predisposes women to the development of hepatic cell adenoma, and large multiple tumors are associated with especially lengthy use. Research also indicates that when OC use stops, these tumors regress, but can reoccur if OC use or any estrogen therapy is reinstituted or if pregnancy occurs.
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PMID:Liver tumor in long-term user of oral contraceptives. 284 28

This article describes a case of focal pedunculated nodular hyperplasia, a rare form of benign liver tumor, and reviews the literature on focal nodular hyperplasia (FNH) and hepatocellular adenoma. Focal pedunculated nodular hyperplasia is the rarest form of FNH and accounts for fewer than 20% of cases. Hepatocellular adenoma is usually a single encapsulated tumor ranging in size from 1-30 cm in diameter. FNH is usually also a single tumor which is always polylobed and multinodular. The size is variable and it is well defined although not encapsulated. Microscopically neither FNH nor hepatocellular adenoma has normal portal spaces or centrolobular veins. A peliose (intratumoral pseudomicrocysts) is often observed in oral contraceptive (OC) users in both cases. Atypical, dysplasic, or neoplasic cells are observed in about 10% of cases of hepatocellular adenoma but have never been reported in FNH. Considerable hypervascularization is found in hepatocellular adenoma but not in FNH, although in FNH large vascular pedicel may be observed at the periphery. Both tumors are most frequently seen in fertile aged women. Over 1/3 of cases of hepatocellular adenoma are discovered due to intraperitoneal bleeding. FNH is asymptomatic in 73.5% of cases and hemoperitoneum is very rare. The case reported was that of a 40-year-old woman with no significant medical history who had used a combined OC containing ethinyl estradiol and norgestrel for 6 years until 2 years previously, when she terminated use due to subsequently controlled hypertension. A 6-month history of menorrhagia was uncontrolled despite use of an OC containing levonorgestrel only. The liver tumor was discovered in the course of a total hysterectomy performed because of a large polymyomatous uterus associated with significant menorrhagia. The FNH was surgically removed 2 months later. The tumor was highly vascularized and connected to segment 4 by a voluminous pedicel containing numerous thick vascular elements. The postoperative course was smooth. The relationship between OC use and benign hepatic tumors is now well established. Their overall frequency has been estimated at 4.9/million women aged 15-45. The duration of exposure to OCs seems to be a determining factor. The risk is negligible at durations of OC use under 1 year but is multiplied by 7 for FNH and by 5 for hepatocellular adenoma after 5 years. EE, mestranol, and 19 norsteroids all seem to play etiologic roles. 58% of hepatocellular adenomas in OC users are discovered because of hemoperitoneum following rupture. Bleeding is usually massive and the mortality rate is about 6%. FNH is revealed by bleeding in 15% of cases in OC users and is asymptomatic in 49% of users. Tumor development depends on whether OC use is continued. It is not currently known whether the tumors tend in the long run to degenerate into hepatic carcinoma, and whether OC use plays a role. The occurrence of liver cancer in OC users does not seem to be greater than in the general population, but OC users are younger at diagnosis, their survival time is longer, and alpha fetoprotein levels are not elevated. Surveillance of OC users is difficult because FNH is so often asymptomatic. Periodic sonograms after 5 years of OC use may be indicated.
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PMID:[A rare form of benign tumor of the liver possibly related to the use of oral contraceptives: focal pediculated nodular hyperplasia]. 299 1

Mechanism of action, indications, side effects and contraindications of oral contraceptive agents (OCA) are reviewed. OCA can be divided into two groups: consecutive and combined agents. Combined OCA contain both estrogens and gestagens and are taken for 3 weeks, while consecutive OCA contain only estrogens and are taken for 2 weeks followed by 1 week of combined OCA until the onset of menstruation. Biological activity of synthetic gestagens is estimated by a dosage which results in a delay of menstruation by 2 weeks. Gestagens norethindrone and norethynodrel were shown to be equally effective, while ethinodiol diacetate and norgestrel were 15-30 times more effective. Estrogen component of OCA is represented by ethinyl estradiol or mestranol. Combined OCA are more effective than consecutive OCA; probability of undesirable pregnancy during administration of combined OCA does not exceed 0.2%. The most frequent side-effects of OCA include nausea, headache, uterine hemorrhage, and changes in libido. OCA can affect the endocrine and reproductive systems. Major endocrine effects of OCA include changes in the cortisol metabolism in the adrenal glands, increase in the level of thyroid-binding globulin in the thyroid gland, changes in the glucose metabolism in the pancreas, inhibition of the luteinizing hormone releasing hormone in the hypothalamus with simultaneous decrease in the production of pituitary gonadotropins and inhibition of the ovulation. The most serious side-effects of OCA include cholelithiasis, thrombophlebitis, thromboembolism, liver adenoma, and myocardial infarction. Absolute contraindications to the use of OCA include hypertension, hyperlipidemia, breast or endometrial cancer, pregnancy, cardio-vascular diseases, liver diseases, and kidney insufficiency.
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PMID:[Principles of the use of oral contraceptive preparations]. 307 80


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