Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Possible association between peliosis hepatis and diethylstilbestrol Anjaneya R. Puppala MB & Jae A. Ro MD To cite this article: Anjaneya R. Puppala MB & Jae A. Ro MD (1979) Possible association between peliosis hepatis and diethylstilbestrol, Postgraduate Medicine, 65:5, 277-281, DOI: 10.1080/00325481.1979.11715157 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715157
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [University of Newcastle, Australia]
Date: 22 March 2017, At: 04:26
CASE REPORT
Possible association between peliosis hepatisand d iethylsti 1bestrol Report of two cases
POSTGRADUATE MEDICINE invites submission ofbrief case reports, especially those related to ambulatory medical care. Illustrations and references should be included only when essential.
Anjaneya R. Puppala, MB JaeA.Ro,MD
Peliosis hepatis is characterized by cystic spaces in the Jiver which are filled with blood and do not have distinct walls. It has been associated with various diseases and with administration of androgenic anabolic steroids. In the two cases reported here, peliosis occurred with Jong-term administration of diethylstilbestrol for prostatic carcinoma. Case 1 In 1973 a 74-year-old man was seen at Veterans Administration Hospital, North Chicago, Illinois, because of acute urinary retention of four da ys' duration. Results of physical examination were normal. Urinalysis showed a 2+ reaction for protein, occult blood, an increased number of leukocytes, and bacteria. Other laboratory results were as follows: hemoglobin 13.3 gm/ 100 I:Til, hematocrit 38.8%, WBCs 6,500jcu mm, and acid phosphatase 32.5 lU/liter. BUN, glucose, and liver enzyme values were normal. Intravenous pyelography showed a poorly functioning right kidney, and cystoscopy showed bladder neck obstruction. Retropubic prostatectomy, wedge resection of the bladder neck, and bilateral vasectomy
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
Figure 1. Section of li ver showing hemangiomatous foci.
were do ne with use of spinal anesthesia, and infiltrating adenocarcinoma of the prostate was confirmed histologically. No metastases were found. Diethylstilbestrol, 1 mg1 day orally, was prescribed. In 1975 the patient experienced progressive weakness and pain radia ting dawn the right leg. He also had urinary and fecal incontinence. On physical examination, the liver was enlarged to 2 cm below the right costal margin and smooth. The alkaline phosphatase value was 234 1Ut liter, SGOT 21 1U j liter, and total bilirubin
0.6 mg/ 100 ml. X-ray films showed spinal cord compression. Liver scan was normal, but bane scan showed metastases in the left shoulder, ribs, vertebrae, pelvis, and femurs. Warfarin sodium was given for deep vein thrombophlebitis, and diethylstilbestrol therapy was continued. The patient's condition deteriorated, and he died. At autopsy the liver was large ( 1.600 gm), smooth. and covered with dark-reddish and blackish a reas. Sections showed distinct dark-reddish hemangiomatous foci. continued
277
CASE REPORT CONTINUED
Figure 2. Photomicrographs ofliver showing cys tic space fi lied with blood. Space has no wall and is lined with hepatocytes showing extensive fa tt y changes. (Top x 100. bottom x450)
278
Case 2 ln 1974 a62-year-old man wasseenat Veterans Administration Hospital because of urinary frequency and urgency of three years' duration. He had !ost 40 lb during the previous four months and had had low-back pain for four weeks. On physical examination,left supraclavicular lymph nodes were palpable and the prostate was enlarged. Laboratory findings were as follows: hemoglobin 11.6gm(IOO ml, hematocrit 35.6%, WBCs 5,500/cu mm, and alkaline phosphatase 189 lU (liter. Results of urinalysis and li ver enzyme tests were normal. Bone scan showed increased uptake consistent with metastases of skull, shoulders, ribs, left iliac crest, sacroiliac joints, and femurs. Needle biopsy of the prostate confirmed adenocarcinoma, and transurethral resection was performed. Biopsy ofaleftsupraclavicular lymph node showed metastasis. Diethylstilbestrol, 1 mg/ day orally, was prescribed. ln 1975 the patient feil and sustained a subtrochanteric fracture of the left femur. Laboratory findings were as follows: hemoglobin 9 gm( 100 ml, hematocrit 28.2%, alkaline phosphatase 19 lU (liter, albumin 2.9 gm;' 100 ml, SGOT20 lU /liter, SGPT 16 1U /liter, and total bilirubin 0.3 mg; lOO ml. The fracture was treated with open reduction and internai fixation. Bone marrow showed myelophthisic anemia and metastasis. Fluorouracil, 1,000 mg intravenously weekly for two months, followed by continued
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
Darvocet-NIIIl 50
and
@
Darvocet-NIIIl100 propoxyphene napsylate with acetaminophen
CASE AEPOATCONTINUED
Description: Each tablet of Darvocet~N 50 conta1ns 50 mg propoxyphene napsylate and 325 mg aceta~ minophen. Each tablet of Darvocet~N 100 contains 100 mg propoxyphene napsylate and 650 mg acetammophen. lndlc•tlon: These products are indicated for the relief of mild ta moderate pain, either when pa1n is present alone or when it is accompanied by fever. Contr•lndlc•tlons: Hypersensitivity ta propoxy~ phene or to acetaminophen. W•rnlngs: CN S. Addit1ve Effects and Overdosag~ - Propoxyphene in combination with alcohol, tran~ quilizers, sedative-hypnotics, and ether central· nervous-system depressants has additive depressant effects, and the patient should be sa advised. Patients taking this drug should be warned not ta exceed the dosage recommended by their physician. Taxie ef· fects and fatalities have occurred following over~ doses of propoxyphene alone and in combinat1on with other central·nervous·system depressants. The majority of these patients have had previous histor~es of emotional disturbances or suicidai ideation or at· tempts as weil as histories of misuse of tranquilizers, alcohol, or other CN.S.·active drugs. Caution should be exercised in prescribing unnecessarily large amounts of propoxyphene for such patients. Drug___!kQendence-Propoxyphene can produce drug dependence characterized by psychic depen· denee and, less frequently, physical dependence and tolerance Propoxyphene w1ll only partially suppress the withdrawal syndrome in individuals phys1callyde· pendent on morphine or ether narcotics. The abuse liability of propoxyphene is qualitatively s1milar to th at of codeine although quantitatively less, and propoxy· phene should be prescribed with the same degree of caution appropria te ta the use of codeine. Usage m Ambulatoty Patients- Propoxyphene may impair the mental and/or phys1cal abilities required for the performance of potent1ally hazardous tasks, such as driving a car or operating machinery. The patient should be cautioned accordingly. Usage in Pregnancy-Safe use in pregnancy has not been established relative ta poss1ble adverse effects on fe tai development. Instances of withdrawal symp· toms in the neonate have been reported following usage dur~ng pregnancy Therefore, propoxyphene should not be used in pregnant women unless, in the judgment of the physician, the potential benefits out· weigh the possible hazards. !J.?.i!ge in Children-Propoxyphene 1s not recom· mended for use in children, because documented clinical experience has been insuffic1ent ta establ1sh safety and a sui table dosage regi men in the pediatrie age group. Prec•utloM: Confusion, anxiety, and tremors have been reported in a few patients rece1v1ng propoxy~ phene concomitantly with orphenadrine The central· nervous·system de pressant effect of propoxyphene may be addit1ve with that of other CN.S. depres· sants, including alcohol. Adverse Re•ctlons: The most frequent adverse re· actions are dizziness, sedation, nausea, and vomiting. These effects seem to be more prominent in ambula· tory than in nonambulatory pat1ents, and sorne of these adverse reactions may be alleviated if the patient lies dawn. Other adverse reactions include constipation, abdom1nal pain, skin rashes, lightheadedness, head· ache, weakness, euphoria, dysphoria, and mi nor visual disturbances. The chron1c ingestion of propoxyphene in doses exceed1ng BOO mg per day has caused taxie psy· choses and convulsions. Cases of liver dysfunction have been reported. Admlnlstr•tlon •nd Dos•ge: A narcotic prescription 11 not required. These products are g1ven orally. The usual dose is 100 mg propoxyphene napsylateand 650 mg aceta· minophen every four hours as needed for pa1n [OB17'l'7A)
adriamycin, 108 mg intravenously every three weeks, was given, and diethylstilbestrol therapy was continued. The patient's condition deteriorated, gastrointestinal bleeding developed, and death ensued. At autopsy the liver weighed 1,200 gm and was smooth but had prominent hemangiomatous foci. Sections showed a scattered reddish-brown hemangiomatous pattern (figure 1). Metastases were found in adrenal glands, bones, and periaortic and periportallymph nodes. Discussion ln peliosis hepatis the cystic spaces in the liver are filled with amorphous material and RBCs (figure 2). The spaces vary in size and shape and have no walls. The margins are formed by liver cell plates and may communicate with hepatic sinusoids or sublobular veins. The marginal hepatic cell plates usually are normal in appearance. lrregular vascular scars may represent healed foci. Sorne investigators believe peliosis originates from foci of liver cell necrosis resulting from toxic damage or congestion,l-3 while others favor a hormonal etiology. 4 The disorder has been described in patients with advanced pulmonary tuberculosis, pyelonephritis, and carcinoma of the stomach, rectum, or kidney. lt also has been seen in patients with a plastic anemia treated for long periods with androgenic anabolic steroids. Administration of steroid corn-
pounds has various effects on the liver parenchyma.s Androgenic anabolic steroids are known to be closely associated with hepatocellular carcinoma, and peliosis has been seen in four patients receiving anabolic steroids.6.7 The mechanism ofhepatocellular injury is not known. 17-Alkylated anabolic steroids cause an increase in serum transaminase values and sulfobromophthalein (BSP) retention and cholestasis. Bagheri and Boyers have emphasized that peliosis may be more serious than previously reported, since severe liver injury, hepatorenal failure, hemorrhagic shock, and death occurred in their patients with peliosis associated with androgenic anabolic steroid therapy. ln the past severa! years there has been a marked increase in the frequency of benign hepatic adenomas, particularly in women taking oral contraceptives. Such tumors also have been seen in postmenopausal women receiving hormone replacement therapy. The terminology for hepatic tumors associated with oral
Anjaneya R. Puppala Dr Puppala was in the department of medicine, Veterans Administration Hospital, North Chicago, Illinois, and the Chicago Medical School. He is now at Richardson Medical Center, Richardson, Texas. Jae A. Ro Dr Ro is in the department of pathology, Veterans Administration Hospital, North Chicago, Illinois, and the Chicago Medical School.
Addit1onal Information ava1lable to the profess1on on request from Eli Lilly and Company, IndianapoliS, lnd1ana 46206 El1 Lilly and Company, lnc Carol ina, Puerto Rico 00630 acl03113
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
contraceptive use is confused, with apparently similar changes being described as adenomas, hamartomas, and focal nodular hyperplasia. The focal proliferation of hepatocytes with blood-fùled cysts resembles peliosis hepatis. ln one case, postmortem radiologie studies showed that the cysts were supplied by a hepatic artery and tended to expand and eventually rupture.9 True liver cell adenomas have a partial or complete capsule and no central scarring. Of ali the cases of hepatic tumors associated with oral contraceptive use, only nine have proved to be nodular hyperplasia or hamartoma. 10·11 Liver scan and angiography are valuable in differentiai diagnosis of adenomas and peliosis. Liver biopsy is contraindicated because of the risk of hemorrhage. Compared with the estrogen content of oral contraceptives, the amounts of estrogens used in treatment of prostatic carcinoma are massive. Diethylstilbestrol in large doses produces various toxic effects. In a study by Kontturi and Sotaniemi, 12 24 patients with histologically proved carcinoma of the prostate were treated with castration and diethylstilbestrol, 500 mg/ day for tendays. SGOT and biliru bin levels and BSP retention increased. Kletschke13 described four patients in whom marked jaundice developed with diethylstilbestrol therapy but disappeared when therapy was discontinued. Cholestasis
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
and occasional necrosis also have been noted. Estrogens mainly affect protein synthesis in rough endoplasrnic reticulum, whereas 17-alkylated anabolic steroids affect the smooth endoplasmic reticulum and drug-metabolizing enzymes. Summary In the two cases presented here, peliosis hepatis occurred after prolonged admini
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Possible association between peliosis hepatis and diethylstilbestrol Anjaneya R. Puppala MB & Jae A. Ro MD To cite this article: Anjaneya R. Puppala MB & Jae A. Ro MD (1979) Possible association between peliosis hepatis and diethylstilbestrol, Postgraduate Medicine, 65:5, 277-281, DOI: 10.1080/00325481.1979.11715157 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715157
Published online: 07 Jul 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [University of Newcastle, Australia]
Date: 22 March 2017, At: 04:26
CASE REPORT
Possible association between peliosis hepatisand d iethylsti 1bestrol Report of two cases
POSTGRADUATE MEDICINE invites submission ofbrief case reports, especially those related to ambulatory medical care. Illustrations and references should be included only when essential.
Anjaneya R. Puppala, MB JaeA.Ro,MD
Peliosis hepatis is characterized by cystic spaces in the Jiver which are filled with blood and do not have distinct walls. It has been associated with various diseases and with administration of androgenic anabolic steroids. In the two cases reported here, peliosis occurred with Jong-term administration of diethylstilbestrol for prostatic carcinoma. Case 1 In 1973 a 74-year-old man was seen at Veterans Administration Hospital, North Chicago, Illinois, because of acute urinary retention of four da ys' duration. Results of physical examination were normal. Urinalysis showed a 2+ reaction for protein, occult blood, an increased number of leukocytes, and bacteria. Other laboratory results were as follows: hemoglobin 13.3 gm/ 100 I:Til, hematocrit 38.8%, WBCs 6,500jcu mm, and acid phosphatase 32.5 lU/liter. BUN, glucose, and liver enzyme values were normal. Intravenous pyelography showed a poorly functioning right kidney, and cystoscopy showed bladder neck obstruction. Retropubic prostatectomy, wedge resection of the bladder neck, and bilateral vasectomy
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
Figure 1. Section of li ver showing hemangiomatous foci.
were do ne with use of spinal anesthesia, and infiltrating adenocarcinoma of the prostate was confirmed histologically. No metastases were found. Diethylstilbestrol, 1 mg1 day orally, was prescribed. In 1975 the patient experienced progressive weakness and pain radia ting dawn the right leg. He also had urinary and fecal incontinence. On physical examination, the liver was enlarged to 2 cm below the right costal margin and smooth. The alkaline phosphatase value was 234 1Ut liter, SGOT 21 1U j liter, and total bilirubin
0.6 mg/ 100 ml. X-ray films showed spinal cord compression. Liver scan was normal, but bane scan showed metastases in the left shoulder, ribs, vertebrae, pelvis, and femurs. Warfarin sodium was given for deep vein thrombophlebitis, and diethylstilbestrol therapy was continued. The patient's condition deteriorated, and he died. At autopsy the liver was large ( 1.600 gm), smooth. and covered with dark-reddish and blackish a reas. Sections showed distinct dark-reddish hemangiomatous foci. continued
277
CASE REPORT CONTINUED
Figure 2. Photomicrographs ofliver showing cys tic space fi lied with blood. Space has no wall and is lined with hepatocytes showing extensive fa tt y changes. (Top x 100. bottom x450)
278
Case 2 ln 1974 a62-year-old man wasseenat Veterans Administration Hospital because of urinary frequency and urgency of three years' duration. He had !ost 40 lb during the previous four months and had had low-back pain for four weeks. On physical examination,left supraclavicular lymph nodes were palpable and the prostate was enlarged. Laboratory findings were as follows: hemoglobin 11.6gm(IOO ml, hematocrit 35.6%, WBCs 5,500/cu mm, and alkaline phosphatase 189 lU (liter. Results of urinalysis and li ver enzyme tests were normal. Bone scan showed increased uptake consistent with metastases of skull, shoulders, ribs, left iliac crest, sacroiliac joints, and femurs. Needle biopsy of the prostate confirmed adenocarcinoma, and transurethral resection was performed. Biopsy ofaleftsupraclavicular lymph node showed metastasis. Diethylstilbestrol, 1 mg/ day orally, was prescribed. ln 1975 the patient feil and sustained a subtrochanteric fracture of the left femur. Laboratory findings were as follows: hemoglobin 9 gm( 100 ml, hematocrit 28.2%, alkaline phosphatase 19 lU (liter, albumin 2.9 gm;' 100 ml, SGOT20 lU /liter, SGPT 16 1U /liter, and total bilirubin 0.3 mg; lOO ml. The fracture was treated with open reduction and internai fixation. Bone marrow showed myelophthisic anemia and metastasis. Fluorouracil, 1,000 mg intravenously weekly for two months, followed by continued
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
Darvocet-NIIIl 50
and
@
Darvocet-NIIIl100 propoxyphene napsylate with acetaminophen
CASE AEPOATCONTINUED
Description: Each tablet of Darvocet~N 50 conta1ns 50 mg propoxyphene napsylate and 325 mg aceta~ minophen. Each tablet of Darvocet~N 100 contains 100 mg propoxyphene napsylate and 650 mg acetammophen. lndlc•tlon: These products are indicated for the relief of mild ta moderate pain, either when pa1n is present alone or when it is accompanied by fever. Contr•lndlc•tlons: Hypersensitivity ta propoxy~ phene or to acetaminophen. W•rnlngs: CN S. Addit1ve Effects and Overdosag~ - Propoxyphene in combination with alcohol, tran~ quilizers, sedative-hypnotics, and ether central· nervous-system depressants has additive depressant effects, and the patient should be sa advised. Patients taking this drug should be warned not ta exceed the dosage recommended by their physician. Taxie ef· fects and fatalities have occurred following over~ doses of propoxyphene alone and in combinat1on with other central·nervous·system depressants. The majority of these patients have had previous histor~es of emotional disturbances or suicidai ideation or at· tempts as weil as histories of misuse of tranquilizers, alcohol, or other CN.S.·active drugs. Caution should be exercised in prescribing unnecessarily large amounts of propoxyphene for such patients. Drug___!kQendence-Propoxyphene can produce drug dependence characterized by psychic depen· denee and, less frequently, physical dependence and tolerance Propoxyphene w1ll only partially suppress the withdrawal syndrome in individuals phys1callyde· pendent on morphine or ether narcotics. The abuse liability of propoxyphene is qualitatively s1milar to th at of codeine although quantitatively less, and propoxy· phene should be prescribed with the same degree of caution appropria te ta the use of codeine. Usage m Ambulatoty Patients- Propoxyphene may impair the mental and/or phys1cal abilities required for the performance of potent1ally hazardous tasks, such as driving a car or operating machinery. The patient should be cautioned accordingly. Usage in Pregnancy-Safe use in pregnancy has not been established relative ta poss1ble adverse effects on fe tai development. Instances of withdrawal symp· toms in the neonate have been reported following usage dur~ng pregnancy Therefore, propoxyphene should not be used in pregnant women unless, in the judgment of the physician, the potential benefits out· weigh the possible hazards. !J.?.i!ge in Children-Propoxyphene 1s not recom· mended for use in children, because documented clinical experience has been insuffic1ent ta establ1sh safety and a sui table dosage regi men in the pediatrie age group. Prec•utloM: Confusion, anxiety, and tremors have been reported in a few patients rece1v1ng propoxy~ phene concomitantly with orphenadrine The central· nervous·system de pressant effect of propoxyphene may be addit1ve with that of other CN.S. depres· sants, including alcohol. Adverse Re•ctlons: The most frequent adverse re· actions are dizziness, sedation, nausea, and vomiting. These effects seem to be more prominent in ambula· tory than in nonambulatory pat1ents, and sorne of these adverse reactions may be alleviated if the patient lies dawn. Other adverse reactions include constipation, abdom1nal pain, skin rashes, lightheadedness, head· ache, weakness, euphoria, dysphoria, and mi nor visual disturbances. The chron1c ingestion of propoxyphene in doses exceed1ng BOO mg per day has caused taxie psy· choses and convulsions. Cases of liver dysfunction have been reported. Admlnlstr•tlon •nd Dos•ge: A narcotic prescription 11 not required. These products are g1ven orally. The usual dose is 100 mg propoxyphene napsylateand 650 mg aceta· minophen every four hours as needed for pa1n [OB17'l'7A)
adriamycin, 108 mg intravenously every three weeks, was given, and diethylstilbestrol therapy was continued. The patient's condition deteriorated, gastrointestinal bleeding developed, and death ensued. At autopsy the liver weighed 1,200 gm and was smooth but had prominent hemangiomatous foci. Sections showed a scattered reddish-brown hemangiomatous pattern (figure 1). Metastases were found in adrenal glands, bones, and periaortic and periportallymph nodes. Discussion ln peliosis hepatis the cystic spaces in the liver are filled with amorphous material and RBCs (figure 2). The spaces vary in size and shape and have no walls. The margins are formed by liver cell plates and may communicate with hepatic sinusoids or sublobular veins. The marginal hepatic cell plates usually are normal in appearance. lrregular vascular scars may represent healed foci. Sorne investigators believe peliosis originates from foci of liver cell necrosis resulting from toxic damage or congestion,l-3 while others favor a hormonal etiology. 4 The disorder has been described in patients with advanced pulmonary tuberculosis, pyelonephritis, and carcinoma of the stomach, rectum, or kidney. lt also has been seen in patients with a plastic anemia treated for long periods with androgenic anabolic steroids. Administration of steroid corn-
pounds has various effects on the liver parenchyma.s Androgenic anabolic steroids are known to be closely associated with hepatocellular carcinoma, and peliosis has been seen in four patients receiving anabolic steroids.6.7 The mechanism ofhepatocellular injury is not known. 17-Alkylated anabolic steroids cause an increase in serum transaminase values and sulfobromophthalein (BSP) retention and cholestasis. Bagheri and Boyers have emphasized that peliosis may be more serious than previously reported, since severe liver injury, hepatorenal failure, hemorrhagic shock, and death occurred in their patients with peliosis associated with androgenic anabolic steroid therapy. ln the past severa! years there has been a marked increase in the frequency of benign hepatic adenomas, particularly in women taking oral contraceptives. Such tumors also have been seen in postmenopausal women receiving hormone replacement therapy. The terminology for hepatic tumors associated with oral
Anjaneya R. Puppala Dr Puppala was in the department of medicine, Veterans Administration Hospital, North Chicago, Illinois, and the Chicago Medical School. He is now at Richardson Medical Center, Richardson, Texas. Jae A. Ro Dr Ro is in the department of pathology, Veterans Administration Hospital, North Chicago, Illinois, and the Chicago Medical School.
Addit1onal Information ava1lable to the profess1on on request from Eli Lilly and Company, IndianapoliS, lnd1ana 46206 El1 Lilly and Company, lnc Carol ina, Puerto Rico 00630 acl03113
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
contraceptive use is confused, with apparently similar changes being described as adenomas, hamartomas, and focal nodular hyperplasia. The focal proliferation of hepatocytes with blood-fùled cysts resembles peliosis hepatis. ln one case, postmortem radiologie studies showed that the cysts were supplied by a hepatic artery and tended to expand and eventually rupture.9 True liver cell adenomas have a partial or complete capsule and no central scarring. Of ali the cases of hepatic tumors associated with oral contraceptive use, only nine have proved to be nodular hyperplasia or hamartoma. 10·11 Liver scan and angiography are valuable in differentiai diagnosis of adenomas and peliosis. Liver biopsy is contraindicated because of the risk of hemorrhage. Compared with the estrogen content of oral contraceptives, the amounts of estrogens used in treatment of prostatic carcinoma are massive. Diethylstilbestrol in large doses produces various toxic effects. In a study by Kontturi and Sotaniemi, 12 24 patients with histologically proved carcinoma of the prostate were treated with castration and diethylstilbestrol, 500 mg/ day for tendays. SGOT and biliru bin levels and BSP retention increased. Kletschke13 described four patients in whom marked jaundice developed with diethylstilbestrol therapy but disappeared when therapy was discontinued. Cholestasis
VOL 65/NO 5/MAY 1979/POSTGRADUATE MEDICINE
and occasional necrosis also have been noted. Estrogens mainly affect protein synthesis in rough endoplasrnic reticulum, whereas 17-alkylated anabolic steroids affect the smooth endoplasmic reticulum and drug-metabolizing enzymes. Summary In the two cases presented here, peliosis hepatis occurred after prolonged admini
