To the Editor.—The article by Ameriks et al, "Hepatic Cell Adenomas, Spontaneous Liver Rupture, and Oral Contraceptives" (Arch Surg 110:548, 1975), summarizes the recent reports of hepatic tumors and their possible association with oral contraceptives. However, we believe it necessary to point out several inconsistencies requiring clarification.
First, the title is misleading as it implies that all of their patients had "hepatic cell adenomas" complicated by spontaneous liver rupture; in fact, only half of their cases (cases 4, 6, 7, and 8) had this complication.
Second, we disagree that histopathologic differentiation of focal nodular hyperplasia (FNH) from liver cell adenoma is often impossible. By definition, liver cell adenomas lack a substructure and FNH characteristically shows a central stellate scar with proliferating intranodular and internodular bile ductules.1,2 That the authors do not appreciate these histopathologic criteria is evidenced by several of their remarks: (1) "both adenomas and FNH may