[Primary malignant tumour of the liver associated with the ingestion of oral contraceptives (author's transl)]. / Tumeur maligne primitive du foie associée à la prise d'estro-progestatifs.

A 42-year-old woman, who had been taking oral contraceptives for 10 years, developed a primary carcinoma of the liver. The diagnosis was made by biopsy under laparoscopic control. Twenty one cases have already been reported in the literature. The aetiological role of contraceptives in the development of generally benign (approximately 200 published cases) and sometime malignant hepatic lesions, has not been definitely proven. The regression of certain benign tumours when contraceptives are stopped is the essential argument. In some patients, the association of benign lesions and of hepatic carcinoma suggests a single pathogenesis. The early recognition of such lesions justifies their being sought routinely in patients taking oral contraceptives (palpation of the liver, questioning concerning pain in the hepatic region). A national register will be required in order to determine their exact prevalence.

PIP: A 42 year old woman who had been on oral contraceptives (OCs) for 10 years was admitted to the hospital for pains in the hepatic region. Laparoscopy showed an enlarged liver, and biopsy confirmed the diagnosis of primary carcinoma. The patient died. The literature on the subject has reported on 22 similar cases; common signs of alarm are pain and enlarged liver. The length of contraception and the type of contraceptive do not seem to be of primary importance. It is impossible to state that OCs are carcinogenic although it is highly probable. Hepatic lesions are usually benign, but sometimes they are malignant, and it is possible that genetic predisposition plays a role in such cases. It is also possible that OCs, by diminishing biliar excretion, may augment the hepatic concentration of toxic metabolites. The essential argument against OCs is the regression of benign tumors after use of contraceptives is stopped. Women on OCs should be checked routinely for early recognition of benign or malignant lesions. A national register of cases would be helpful in determining the prevalence of tumors.

[Esophageal localizations of Crohn's disease]. / Localisations oesophagiennes de la maladie de Crohn

Oesophageal localisations of Crohn's disease are perhaps not as rare as is classically supposed. The chance discovery of an oesophageal localisation of Crohn's disease led the authors to undertake routine study of the oesophagus in their last 18 patients suffering from the disorder. Each patient underwent endoscopic examination of the oesophagus with multiple biopsies. In 3 of them an oesophageal localisation of Crohn's disease could be demonstrated histologically with in addition, evidence of an epithelioid granuloma in 2 patients out of 3. The value of endoscopic biopsy thus appears to be certain in the diagnosis of this localisation, the influence of which on the course of the disease is not precisely known.