Florid Polypoid Endometriosis Exacerbated by Tamoxifen Therapy in Breast Cancer

Cheng-Kun Chang, Pu Chen, Fur‐Jiang Leu, Mary Ann Lou
In: Obstetrics & Gynecology · 2003 · vol. 102(Supplement) , pp. 1127–1130 · doi:10.1097/00006250-200311001-00002 · W4256208477
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This case describes a premenopausal woman whose tamoxifen therapy for breast cancer coincided with and potentially exacerbated florid polypoid endometriosis.

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This case report describes a premenopausal woman with breast cancer who developed irregular vaginal bleeding and a large cul-de-sac mass after five years of tamoxifen therapy. Surgical pathology revealed florid polypoid endometriosis involving the rectal segment and peritoneal surface, accompanied by elevated serum CA 125 levels. The authors propose that the estrogenic effects of tamoxifen exacerbated the growth of these endometriotic implants in a hypoestrogenic state. They suggest considering alternative adjuvant hormonal therapies for breast cancer patients with preexisting endometriosis to avoid similar exacerbations. This paper is centrally about endometriosis — specifically the exacerbation of florid polypoid lesions by tamoxifen therapy in a breast cancer patient.

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Abstract

BACKGROUND We report an unusual case where tamoxifen may have exacerbated the growth of multiple polypoid endometriotic implants. CASE A premenopausal woman with right breast intraductal carcinoma underwent modified radical mastectomy and received six courses of chemotherapy, followed by continuous oral tamoxifen. Irregular vaginal bleeding was noted 5 years after the mastectomy and transvaginal ultrasound detected a 6-cm cul-de-sac mass. The serum CA 125 level was 138.86 U/mL. Surgical pathology showed florid polypoid endometriosis over the resected rectal segment and endometriotic implants over multiple biopsy sites of the peritoneal surface. CONCLUSION The estrogenic effects of tamoxifen may have induced florid endometriosis in this hypoestrogenic woman. If breast cancer patients have preexisting endometriosis, adjuvant hormonal therapy other than tamoxifen should be considered.
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Background

We report an unusual case where tamoxifen may have exacerbated the growth of multiple polypoid endometriotic implants. CASE A premenopausal woman with right breast intraductal carcinoma underwent modified radical mastectomy and received six courses of chemotherapy, followed by continuous oral tamoxifen. Irregular vaginal bleeding was noted 5 years after the mastectomy and transvaginal ultrasound detected a 6-cm cul-de-sac mass. The serum CA 125 level was 138.86 U/mL. Surgical pathology showed florid polypoid endometriosis over the resected rectal segment and endometriotic implants over multiple biopsy sites of the peritoneal surface.

Conclusion

The estrogenic effects of tamoxifen may have induced florid endometriosis in this hypoestrogenic woman. If breast cancer patients have preexisting endometriosis, adjuvant hormonal therapy other than tamoxifen should be considered.

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Condition tags

endometriosis

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