Oral contraceptive-associated sinusoidal ectasia is a rare lesion of unknown pathogenesis. We describe the case of a 31-year-old woman who had used oral contraceptives for 10 years and was found to have abnormal liver function tests on "routine" examination. A single 9 x 5 x 4 cm hypervascular lesion was demonstrated radiographically. The hepatic immuno-diacetic acid and liver-spleen scans were normal. One subcapsular lesion was identified in the resected right hepatic lobe; it was characterized by focal marked dilatation of the sinusoidal spaces associated with rare hepatocyte necrosis and early intrasinusoidal fibrosis. The subcapsular location and the vascular nature of this wedge-shaped lesion suggest it may represent the telangiectatic precursor of a centrally scarred focal nodular hyperplasia.
PIP: A 31-year old mother of a 3-year old child visited a rheumatologist complaining of pain in both wrists, nose bleeding, and headaches. Since her delivery her weight dropped 12 kg and she has taken Synthroid daily. Before her pregnancy, she took the combined oral contraceptive (OC) Norinyl for 7 years. After childbirth, she took the OC Ortho Novum 1/80. She did not smoke or abuse drugs or alcohol. She did not have a history of hepatic or gastrointestinal diseases. Her alkaline phosphatase and glutamyl transferase levels were higher than normal (632 IU/L and 142 IU/L vs. =or 110 IU/L and =or 55 IU/L, respectively). Other liver function tests, her electrolytes, and her complete blood cell count were not unusual. She underwent an abdominal computed tomography scan and ultrasonography which indicated a single right hepatic lobe lesion (9 cm in diameter). It was well vascularized and circumscribed (12 x 10.5 cm) with big arteries leading to the immediate subcapsular region. The veins and arteries of the other lobe and the spleen appeared normal. Based on these tests, surgeons removed a segment of the right liver. She recovered well. 18 months after surgery, she was in good health. Pathologic examination of the 748 gm segment revealed that endothelial cells lined the sinusoidal spaces indicating true sinusoidal ectasia. The segment also exhibited individual hepatocyte atrophy and necrosis and inflammatory reaction and early fibrosis. Bile ducts had proliferated many portal spaces. Hepatic sinusoidal ectasia may be a forerunner of focal nodular hyperplasia.