LIVER-TRANSPLANTATION FOR VOLUMINOUS HEPATOCELLULAR ADENOMA IN A PATIENT WITH IDIOPATHIC PORTAL-HYPERTENSION PREVIOUSLY TREATED BY A PORTACAVAL-SHUNT

Patient: A patient, born in 1955, presented with episodes of documente d variceal bleeding in 1978 due to portal hypertension. Liver function tests were normal. An end-to-side portacaval shunt was performed in 1 980. The liver was reported to be macroscopically subnormal. A liver biopsy was interpreted as 'incomplete cirrhosis' without inflammation. Results: Six years later, the patient developed a voluminous tumour ( 9.5 cm in diameter) occupying the entire right liver lobe. Surgical re moval of the tumour was necessary since it was a large hepatocellular adenoma with a possibility of fatal uncontrollable haemorrhage and eve ntual malignant transformation. In the non-tumoral liver, the parenchy ma showed varying abnormalities with the characteristic features of id iopathic portal hypertension. The atrophied state of the liver and low indocyanine green clearance, combined with the fact that it was impos sible to partially restore portal blood flow to increase the liver mas s, ruled out a right hepatectomy. An orthotopic liver transplant, ther efore, was performed. This patient has never been exposed to either oe strogens or androgens. Conclusions: This case could be another example of hepatocellular adenoma secondary to an increase in the production of oestrogens by non-ovarian sources as a result of portacaval shunt.