Hepatocellular adenoma in a woman who was undergoing testosterone treatment for gender identity disorder

  • Keizo Kato
  • Hiroshi Abe
  • Noriko Hanawa
  • Junya Fukuzawa
  • Ryota Matsuo
  • Takeshi Yonezawa
  • Sadahiro Itoh
  • Yoshiyuki Sato
  • Makiko Ika
  • Shohei Shimizu
  • Shinji Endo
  • Hiroshi Hano
  • Asami Izu
  • Masahiko Sugitani
  • Akihito Tsubota
Case Report
First Online:
Received:
Accepted:

Abstract

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.

Keywords

β-Catenin-activated hepatocellular adenoma Gender identity disorder Testosterone 
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Notes

Compliance with ethical standards

Conflict of interest

Keizo Kato, Hiroshi Abe, Noriko Hanawa, Junya Fukuzawa, Ryota Matsuo, Takeshi Yonezawa, Sadahiro Ito, Yoshiyuki Sato, Makiko Ika, Shohei Shimizu, Shinji Endo, Hiroshi Hano, Asami Izu, Masahiko Sugitani, and Akihito Tsubota declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Keizo Kato
    • 1
    • 2
  • Hiroshi Abe
    • 2
  • Noriko Hanawa
    • 2
  • Junya Fukuzawa
    • 3
  • Ryota Matsuo
    • 3
  • Takeshi Yonezawa
    • 2
  • Sadahiro Itoh
    • 2
  • Yoshiyuki Sato
    • 2
  • Makiko Ika
    • 2
  • Shohei Shimizu
    • 2
  • Shinji Endo
    • 2
  • Hiroshi Hano
    • 4
  • Asami Izu
    • 5
  • Masahiko Sugitani
    • 5
  • Akihito Tsubota
    • 1
  1. 1.Liver Disease Control UnitThe Jikei University School of MedicineTokyoJapan
  2. 2.Divisions of Gastroenterology and HepatologyShinmatsudo Central General HospitalChibaJapan
  3. 3.Division of SurgeryShinmatsudo Central General HospitalChibaJapan
  4. 4.Department of PathologyJikei University School of MedicineTokyoJapan
  5. 5.Department of PathologyNihon University School of MedicineTokyoJapan

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