J Gynecol Oncol.  2010 Dec;21(4):269-272. 10.3802/jgo.2010.21.4.269.

Endometrial mullerian adenosarcoma after toremifene treatment in breast cancer patients: a case report

• Chung YW
• Bae HS
• Han SI
• Song JY
• Kim IS
• Kang JS

• KMID: 2173552
• DOI: http://doi.org/10.3802/jgo.2010.21.4.269

Abstract

Toremifene is an anti-estrogen which has been shown to be effective in the treatment of breast cancer, and is thought to be a less uterotrophic agent than tamoxifen. The risk assessment concerning endometrial cancer has been inconclusive because of its rare use up to the mid-1990s. We report a case of an adenosarcoma, which is a very rare type of uterine malignancy, after toremifene treatment for 5 years in a breast cancer patient. After 1 year of toremifene use, the patient had a benign Mullerian adenofibroma. After an additional 4 years of toremifene treatment, the endometrial polypoid lesion was transformed into a Mullerian adenosarcoma. Although toremifene is a promising anti-estrogenic agent in the treatment of breast cancer patients, clinicians should not neglect the possibility of a uterine malignancy.

Keyword

Toremifene; Tamoxifen; Mullerian adenosarcoma; Mullerian adenofibroma; Breast cancer

MeSH Terms

Adenofibroma
Adenosarcoma
Breast
Breast Neoplasms
Endometrial Neoplasms
Female
Humans
Risk Assessment
Tamoxifen
Toremifene
Tamoxifen
Toremifene

Figure

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  Fig. 1 Sonography. (A) The endometrial cavity was dilated to 2×3.5 cm. The lesion was diagnosed as Mullerian adenofibroma. (B) A 4×3.8 cm-sized heterogeneous mass in the endometrial cavity that was diagnosed as Mullerian adenosarcoma.

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  Fig. 2 The MRI finding for the same lesion as described in Fig. 1B. A heterogeneous lesion (arrow) thought to be endometrial cancer in the endometrial cavity with a high signal intensity on a T1-weighted image.

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  Fig. 3 Microscopic finding. (A) The first biopsy of an endometrial polypoid lesion was composed of irregularly shaped glandular structures and loose fibromatous stroma (H&E, ×40). (B) The second biopsy of the endometrial mass was composed of glandular or cystic structures with stromal proliferation with a collar pattern and an intraluminal polypoid growth pattern (H&E, ×40). (C) Immunohistochemical (IHC) staining for CD10 shows positive stromal cells around epithelial structures (IHC, ×100). (D) Immunohistochemical staining for smooth muscle actin shows a positive reaction in most of the stromal cells (IHC, ×100).

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