{"paper_id":"ddfb3646-a3f7-42a7-a257-3851afc731ae","body_text":"Letrozole for the Treatment of Thoracic Endometriosis: A Case Report [15J]\n- Tara Hardiman Chadwick\n- Kevin Audlin\nINTRODUCTION:\nThoracic endometriosis syndrome describes ectopic endometrial tissue within the thoracic cavity causing significant morbidity including cyclic chest pain, pneumothorax, hemothorax, and hemoptysis. Thoracic endometriosis is a rare condition usually requiring multiple interventions and hormonal suppression of the endometrial implants. Given the overexpression of aromatase P450 within endometrial tissue, off label use of aromatase inhibitors has been proposed as a mechanism for hormonal suppression with successful treatment of symptoms in cases of pelvic endometriosis.\nMETHODS:\nA case report of a 48 year old with recurrent thoracic endometriosis following hysterectomy with bilateral salpingo-oophorectomy. Her disease was significant, resulting in pneumothorax requiring bleb resection and pleurodesis, as well as subsequent hemothorax requiring chest tube placement. She was maintained on Lupron therapy after surgical sterilization with recurrent hemothorax again requiring thoracentesis. She was subsequently switched to Letrozole with resolution of symptoms and no further episodes of hemothorax. The patient consented to publication of a case report.\nRESULTS:\nAfter 21 months of Letrozole treatment, the patient has remained asymptomatic without recurrence of hemothorax. Following surgical sterilization, the main source of estrogen is peripheral conversion of androgens to estrogen through the aromatization process. Thus, aromatase inhibitors can be used to eliminate this pathway for estrogen synthesis that can stimulate endometriosis.\nCONCLUSION:\nWhile aromatase inhibitors have been demonstrated to reduce the pain associated with pelvic endometriosis, this case report demonstrates its potential efficacy in treating thoracic endometriosis as well. Additional research is needed to determine the potential for aromatase inhibitors to become a mainstay in the treatment of thoracic endometriosis.","source_license":"CC0","license_restricted":false}