title: Testosterone-receptor positive hepatocellular carcinoma in a 29-year old bodybuilder with a history of anabolic androgenic steroid abuse: a case report.
abstract: BACKGROUND
  Continuous use of anabolic androgenic steroid in high-doses is associated with substantial health risks, including hepatocellular adenoma. Malignant transformation from hepatocellular adenoma to hepatocellular carcinoma after anabolic androgenic steroid abuse has been rarely reported. The morphological distinction of adenoma from well-differentiated hepatocellular carcinoma is challenging and requires elaborated imaging techniques and histology.
  
  
  METHODS
  We report about a 29-year old male professional bodybuilder who presented with mid-epigastric pain at the emergency unit. Ultrasound showed a severe hepatomegaly with multiple lesions. Contrast-enhanced ultrasound revealed a heterogeneous pattern with signs of hepatocellular carcinoma. CT scan of the abdomen confirmed multiple hypervascular lesions and central areas of necrosis without contrast enhancement. Subsequent diagnostics included fine needle aspiration (FNA) of suspicious lesions and mini-laparoscopy to establish the diagnosis of a β-catenin and testosterone-receptor positive hepatocellular carcinoma embedded in multiple adenomas. The patient was subsequently treated by liver transplantation and remains tumor-free 27 month after surgery.
  
  
  CONCLUSIONS
  Hepatocellular carcinoma occurring in association with anabolic androgenic steroid abuse should sensitize physicians and especially professional bodybuilders for the harmful use of high doses of steroids.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany. solbach.philipp@mh-hannover.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Solbach
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany. potthoff.andrej@mh-hannover.de.
authors.forename: Andrej
authors.initials: A
authors.lastname: Potthoff
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medizinische Hochschule Hannover, Hannover, Germany. raatschen.hans-juergen@mh-hannover.de.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Raatschen
authors.affiliation: Department of Pathology, Medizinische Hochschule Hannover, Hannover, Germany. soudah.bisharah@mh-hannover.de.
authors.forename: Bisharah
authors.initials: B
authors.lastname: Soudah
authors.affiliation: Department of Pathology, Medizinische Hochschule Hannover, Hannover, Germany. lehmann.ulrich@mh-hannover.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lehmann
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany. schneider.s.andrea@gmx.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany. gebel.michael@mh-hannover.de.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gebel
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany. manns.michael@mh-hannover.de.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, OE 6810 Carl-Neuberg-Str. 1, 30625, Hannover, Germany. vogel.arndt@mh-hannover.de.
authors.forename: Arndt
authors.initials: A
authors.lastname: Vogel
mesh_terms: D000328:Adult; D045930:Anabolic Agents / Q000009:adverse effects*; D000728:Androgens / Q000009:adverse effects; D014408:Biomarkers, Tumor / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism; D004300:Doping in Sports; D006801:Humans; D008113:Liver Neoplasms / Q000139:chemically induced* / Q000175:diagnosis / Q000378:metabolism; D008297:Male; D058573:Performance-Enhancing Substances / Q000009:adverse effects*; D011944:Receptors, Androgen / Q000378:metabolism*; D013256:Steroids / Q000009:adverse effects; D014891:Weight Lifting
chemical_list: D045930:Anabolic Agents; D000728:Androgens; D014408:Biomarkers, Tumor; D058573:Performance-Enhancing Substances; D011944:Receptors, Androgen; D013256:Steroids