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- W2921451424 abstract "Introduction: Hepatic adenomatosis (HA) is a rare disorder carrying significant risk for malignant transformation. It is associated with anabolic steroid and oral contraceptive (OCP) use. In this case we present the first reported case of hepatic adenomatosis complicated by comorbid steroid dependent Ulcerative colitis (UC). Case description: 33-year-old female with history of Diabetes Type 2, OCP use and UC who presented with uncontrolled symptoms of rectal bleeding and diarrhea. Colonoscopy revealed active Mayo grade 2 pancolitis while on golimumab therapy with previous failure to infliximab and adalimumab. She remained dependent on budesonide 9 mg daily for symptom control for five years prior to presentation with abdominal imaging showing multiple liver lesions described as at least 12 uniformly enhancing bilobar hepatic masses reaching a maximum size of 1.2 cm. Upon presentation to subspecialized UC clinic, repeat abdominal imaging revealed progression in number and size of the lesions reaching a maximum size of 5 cm. The patient underwent a CT-guided liver biopsy revealing a well-differentiated hepatocellular lesion consistent with hepatic adenoma of unclassified subtype. Diagnosis was confirmed as hepatic adenomatosis based on number of lesions and histologic confirmation. OCPs were replaced with IUD, and budesonide was discontinued while golimumab was replaced by vedolizumab for UC treatment. The patient was referred to liver surgery clinic given the high risk of hemorrhage and malignant transformation and was recommended surveillance imaging. Liver MRI at 3 and 6 month follow up showed a mild decrease in size of the lesions. Steroid-free clinical remission of UC was achieved. Discussion: HA carries a significant risk of complications including malignant transformation (reported incidence 7%-30%). Uncontrolled UC also carries risk of colon dysplasia and colectomy. This is the first reported case of comorbid HA and UC. It highlights the multiple concerns and queries regarding the safety of UC treatments in the setting of HA, especially the risk of steroid use (even low-systemic bioavailability budesonide) and the undefined potential risk of malignant progression with biologic therapy.2314 Figure 1. MRI. Multiple intrinsically T1 hyperintense lesions, consistent with hepatic adenomatosis." @default.
- W2921451424 created "2019-03-22" @default.
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- W2921451424 date "2018-10-01" @default.
- W2921451424 modified "2023-09-25" @default.
- W2921451424 title "Hepatic Adenomatosis Complicated by Comorbid Steroid Dependent Ulcerative Colitis" @default.
- W2921451424 doi "https://doi.org/10.14309/00000434-201810001-02313" @default.
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