Bilateral ovarian endometriomas after laparoscopic hysterectomy following adjuvant tamoxifen therapy for breast cancer: A case report

Satoshi Nishiyama, Sotaro Hayashi, Naoki Abe, Sachino Kira, Miho Oda, Lifa Lee, Yoko To, Maki Goto, Hiroshi Tsujioka
Case reports in women's health · 2022 · vol. 36 , pp. e00442 · doi:10.1016/j.crwh.2022.e00442 · PMID:36051432 · PMC9424343 · W4292245857
case-report OA: gold CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This report details a 50-year-old woman who developed bilateral ovarian endometriomas after hysterectomy while on tamoxifen therapy for breast cancer.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 48-year-old premenopausal woman who underwent total laparoscopic hysterectomy with ovarian conservation for symptomatic uterine fibroids and had no macroscopic endometriosis seen on laparoscopy. Two years later she developed breast cancer, received tamoxifen (20 mg/day) as adjuvant endocrine therapy, and after no pelvic masses were detected at baseline, developed sudden lower abdominal pain with imaging evidence of bilateral ovarian cysts; laparoscopy and histopathology confirmed benign bilateral ovarian endometriotic cysts with chocolate-like cyst contents. The paper’s limitation is that it is an individual case without ability to establish causality, though it notes prior reports and a cited trial reporting higher incidence of endometriosis among tamoxifen users, with uncertainty about progression. This paper is centrally about endometriosis—specifically the development of bilateral ovarian endometriomas during tamoxifen therapy following a hysterectomy.

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Abstract

Tamoxifen, a selective estrogen receptor modulator, is widely used as adjunctive therapy for women with breast cancer. However, tamoxifen has an agonistic effect on the endometrium and may be associated with endometrial proliferation, hyperplasia, polyp formation and carcinoma. The case report describes a 50-year-old woman who developed bilateral ovarian endometriomas while taking tamoxifen for breast cancer after total laparoscopic hysterectomy. She had undergone total laparoscopic hysterectomy for multiple uterine fibroids with no ovarian pathology at age 48 years, had been diagnosed with breast cancer and had commenced tamoxifen as post-mastectomy adjuvant therapy. One year after starting tamoxifen, she developed bilateral ovarian swelling accompanied by acute abdominal pain. At laparoscopic bilateral salpingo-oophorectomy, endometriomas were visible on both ovaries. Pathological examination confirmed endometriotic cysts with no evidence of malignancy. Postoperatively, anastrozole (an aromatase inhibiter) was substituted for tamoxifen as adjuvant therapy for her breast cancer.

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