Hepatocellular adenoma in a woman who was undergoing testosterone treatment for gender identity disorder
Hepatocellular adenoma in a woman who was undergoing testosterone treatment for gender identity disorder
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一名因性别认同障碍而接受睾酮治疗的女性的肝细胞腺瘤
DOI：
10.1007/s12328-018-0854-4
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发表时间：
2018
影响因子：
1
通讯作者：
Tsubota A
中科院分区：
文献类型：
--
作者：
Kato K;Abe H;Hanawa N;Fukuzawa J;Matsuo R;Yonezawa T;Itoh S;Sato Y;Ika M;Shimizu S;Endo S;Hano H;Izu A;Sugitani M;Tsubota A
一位32岁的日本女性因诊断和治疗多发性肝脏肿瘤而入院。她在20岁时被诊断为男女性别认同障碍（GID），每两周接受125毫克睾酮酸治疗。超声、计算机断层及磁共振显示肝结节性肿瘤11例，最大直径28mm。肝肿瘤合并肝细胞腺瘤（HCA）采用针活检诊断。左外侧叶节段切除包括2个病变，S6节段亚切除术包括2个病变，S5和S7各肿瘤去核，S4和S7各肿瘤行开放手术射频消融。免疫组化结果显示，肿瘤细胞呈弥漫性谷氨酰胺合成酶强阳性，细胞核β-连环蛋白异位阳性。因此，肿瘤被诊断为β-catenin-activated HCA （b-HCA）。经导管动脉化疗栓塞加射频消融术治疗S4和S8的3个残留病灶。虽然继续使用戊酸睾酮治疗GID，但直到强化治疗至少22个月后才观察到复发。在接受睾酮治疗的患者中，HCA的发展应通过图像检查密切监测。
A 32-year-old Japanese woman was admitted to our hospital for the diagnosis and treatment of multiple liver tumors. She had been receiving 125 mg testosterone enanthate every 2 weeks following female-to-male gender identity disorder (GID) diagnosis at 20 years of age. Ultrasonography, computed tomography, and magnetic resonance imaging showed 11 hepatic nodular tumors with a maximum diameter of 28 mm. Liver tumors with hepatocellular adenoma (HCA) were diagnosed with needle biopsy. Segmentectomy of the left lateral lobe including two lesions, subsegmentectomy of S6 including two lesions, enucleation of each tumor in S5 and S7, and open surgical radiofrequency ablation for each tumor in S4 and S7 were performed. Immunohistochemical specimens showed that the tumor cells were diffusely and strongly positive for glutamine synthetase and that the nuclei were ectopically positive for β-catenin. Thus, the tumors were diagnosed as β-catenin-activated HCA (b-HCA). Transcatheter arterial chemoembolization plus subsequent radiofrequency ablation was performed for the 3 residual lesions in S4 and S8. Although testosterone enanthate was being continued for GID, no recurrence was observed until at least 22 months after the intensive treatments. HCA development in such patients receiving testosterone should be closely monitored using image inspection.