Korean J Obstet Gynecol.  2011 Dec;54(12):836-840. 10.5468/KJOG.2011.54.12.836.

A giant endometrial polyp with tamoxifen therapy in postmenopausal woman

Affiliations
  • 1Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea. ghkim@pusan.ac.kr
  • 2Department of Pathology, Pusan National University School of Medicine, Busan, Korea.
  • 3Department of Obstetrics and Gynecology, Busan St. Mary's Medical Center, Busan, Korea.

Abstract

Tamoxifen is a synthetic non-steroid anti-estrogen that has been used effectively for several years in the adjuvant treatment of breast cancer. But, the drug has been associated with development of endometrial poylp, hyperplasia and adenocarcinoma possibly mediated through its agonistic estrogen properties during the menopausal period in which estrogens are at a low level. Endometrial polyp has been described as the most common endometrial pathology in association with postmenopausal tamoxifen treatment. We present the case of woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for 5 years after breast cancer surgery.

Keyword

Tamoxifen; Polyp; Breast neoplasm

MeSH Terms

Adenocarcinoma
Breast Neoplasms
Estrogens
Female
Humans
Hyperplasia
Polyps
Tamoxifen
Estrogens
Tamoxifen

Figure

  • Fig. 1 Transvaginal ultrasonographic image of an endometrial polyp in 58-year-old patient with breast cancer treated with tamoxifen. The Swiss-cheese appearance of the polyp is evident.

  • Fig. 2 Pelvic magnetic resonance imaging findings. (A) Axial T2-weighted image shows a 6 cm sized endometrial mass with multiple hyperintense cystic lesions (arrowhead) and hypointense fibrous stroma (arrow). (B) Sagittal T2-weighted image shows a hypointense fibrovascular stalk (arrow) within hyperintense cystic mass (arrowheads) that is limited to endometrial cavity. (C) Sagittal gadolinium enhanced T1-weighted image shows an enhancing fibrovascular stalk (arrow) within the endometrial mass. (D) Diffusion-weighted image at b=800 s/mm2 shows a hypointense mass (*) and (E) apparent diffusion coefficient map shows a hyperintense mass (*), which is suggestive of benign endometrial lesion such as endometrial polyp.

  • Fig. 3 Gross finding. A giant endometrial polyp which developed after prolonged tamoxifen treatment. Extirpated polyp measuring 7.5 × 5.5 × 2.6 cm.

  • Fig. 4 Microscopic findings. (A) Tumor is consisted of cystically dilated endometrial glands with fibrotic stroma (H&E, ×100). (B) Cystic glands are lined by flattened epithelium (H&E, ×200). Estrogen receptor (ER) and progesterone receptor (PR) immunohistochemical staining (C, D). Both receptors are positive for stromal cells and epithelial cells (×200). (E) Immunohistochemically weak staining for Ki-67; 1-2% (×400). (F) Bcl-2 positive for dilated endometrial glans and stroma in endometrial polyp (×100).


Reference

1. Bergman L, Beelen ML, Gallee MP, Hollema H, Benraadt J, van Leeuwen FE. Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Comprehensive Cancer Centres' ALERT Group. Assessment of Liver and Endometrial cancer Risk following Tamoxifen. Lancet. 2000. 356:881–887.
2. Erdemoglu E, Güney M, Keskin B, Mungan T. Tamoxifen and giant endometrial polyp. Eur J Gynaecol Oncol. 2008. 29:198–199.
3. Killackey MA, Hakes TB, Pierce VK. Endometrial adenocarcinoma in breast cancer patients receiving antiestrogens. Cancer Treat Rep. 1985. 69:237–238.
4. Lee KE, Ko YB, Noh HT, Suh KS. Endometrial pathologies in tamoxifen-treated breast cancer patients. Korean J Obstet Gynecol. 2008. 51:757–765.
5. Cohen I, Azaria R, Shapira J, Yigael D, Tepper R. Significance of secondary ultrasonographic endometrial thickening in postmenopausal tamoxifen-treated women. Cancer. 2002. 94:3101–3106.
6. Cohen I, Altaras MM, Shapira J, Tepper R, Rosen DJ, Cordoba M, et al. Time-dependent effect of tamoxifen therapy on endometrial pathology in asymptomatic postmenopausal breast cancer patients. Int J Gynecol Pathol. 1996. 15:152–157.
7. Bonadona V, Mignotte H, Chauvin F, Lesur A, Mauriac L, Granon C, et al. Tamoxifen and endometrial cancer: the results from a multicenter case controlled study. Bull Cancer. 1996. 83:507–508.
8. Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM. Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst. 1994. 86:527–537.
9. McGurgan P, Taylor LJ, Duffy SR, O'Donovan PJ. Does tamoxifen therapy affect the hormone receptor expression and cell proliferation indices of endometrial polyps? An immunohistochemical comparison of endometrial polyps from postmenopausal women exposed and not exposed to tamoxifen. Maturitas. 2006. 54:252–259.
10. Choe BH, Choi EK, Kim YT, Kim JW, Park BW. Cases with endometrial polyp and endocervical polyp associated with tamoxifen use. Korean J Obstet Gynecol. 2000. 43:725–730.
11. Franchi M, Ghezzi F, Donadello N, Zanaboni F, Beretta P, Bolis P. Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease. Obstet Gynecol. 1999. 93:1004–1008.
12. Neven P, De Muylder X, Van Belle Y, Vanderick G, De Muylder E. Tamoxifen and the uterus and endometrium. Lancet. 1989. 1:375.
13. Mourits MJ, Van der Zee AG, Willemse PH, Ten Hoor KA, Hollema H, De Vries EG. Discrepancy between ultrasonography and hysteroscopy and histology of endometrium in postmenopausal breast cancer patients using tamoxifen. Gynecol Oncol. 1999. 73:21–26.
Full Text Links
  • KJOG
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr