Atypical endometriosis and other benigne diseases in a perimenopausal patient taking Tamoxifen for breast cancer

Gabriele Rosenow, Matthias David, Sylvia Mechsner, IS Magalov, T. Papadopoulos, AD Ebert
In: Geburtshilfe und Frauenheilkunde · 2008 · vol. 68(S 01) · doi:10.1055/s-0028-1089328 · W2333048009
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This case report describes atypical endometriosis in a perimenopausal patient with breast cancer taking tamoxifen, highlighting the drug's estrogen agonist role and recommending a switch to an aromatase inhibitor.

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This case report describes a 54-year-old perimenopausal woman with invasive lobular breast cancer who developed atypical endometriosis and other benign gynecological conditions while receiving tamoxifen therapy. Laparoscopic evaluation revealed extensive, vascularized endometriotic lesions on the bladder peritoneum, pelvic wall, and Douglas pouch, alongside uterine myomas and ovarian cysts, all exhibiting strong estrogen and progesterone receptor expression. The authors note that these findings support the hypothesis that tamoxifen acts as an estrogen agonist in postmenopausal women, potentially driving the development of such lesions. Relevance to endometriosis: Centrally about the condition — specifically examining tamoxifen-induced atypical endometriosis in a perimenopausal patient.

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Abstract

For woman taking tamoxifen, recent data strongly support the estrogen agonist role of tamoxifen as a causal factor for the increased risk of endometriosis, but also of leiomyomas, endometrial polyps, and endometrial hyperplasia. Case Report: A 54-year-old perimenopausal woman on tamoxifen (20mg/d), gravida 0, with a surgically treated invasive-lobular breast cancer with extensive carcinoma lobulare in situ (pT2 (m) pN0 (snl) pL0 G2 pTis (LCLIS) R0 M0 Ki–67 1%, ER+, PR+, Her–2 neu negative) was referred for evaluation of a pelvic mass. The ultrasonographic examination did show a regular endometrium, 1 uterine myoma (approx. 3 cm Ø), a right-sided sactosalpinx, ovarian cyst on the right resp. on the left-side without any criteria of malignancy. The CA 125 level was normal. With the exception of P, the endocrine status did show no signs of an ovarian insufficience. During laparoscopy a uterine subserous myoma, a right-sighted sactosalpinx, bilateral ovarian cysts, and a extended polypous, vascularized endometriosis of the bladder peritoneum, the pelvic wall and of the Douglas pouch were found. Complete pelvic deperitonealization, bilateral adnexectomy, but also the enucleation of the myoma was performed. The removed myoma did not show atypia or significant mitotic activity. The endometriotic lesions did present a strong expression of the Estrogen Receptor (ER), the Progesteron Receptor (PR), and the proliferation marker MIB–1. In addition, there was a strong (+++) CD34 expression, but no HER–2-neu expression. A switch to the aromatase inhibitor letrozol was recommended. Conclusion: The possibility of tamoxifen-induced or tamoxifen-driven endometriosis in peri- or postmenopausal patients with breast cancer should be considered.
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Subscribe to RSS DOI: 10.1055/s-0028-1089328 Atypical endometriosis and other benigne diseases in a perimenopausal patient taking Tamoxifen for breast cancer For woman taking tamoxifen, recent data strongly support the estrogen agonist role of tamoxifen as a causal factor for the increased risk of endometriosis, but also of leiomyomas, endometrial polyps, and endometrial hyperplasia. Case Report: A 54-year-old perimenopausal woman on tamoxifen (20mg/d), gravida 0, with a surgically treated invasive-lobular breast cancer with extensive carcinoma lobulare in situ (pT2 (m) pN0 (snl) pL0 G2 pTis (LCLIS) R0 M0 Ki–67 1%, ER+, PR+, Her–2 neu negative) was referred for evaluation of a pelvic mass. The ultrasonographic examination did show a regular endometrium, 1 uterine myoma (approx. 3 cm Ø), a right-sided sactosalpinx, ovarian cyst on the right resp. on the left-side without any criteria of malignancy. The CA 125 level was normal. With the exception of P, the endocrine status did show no signs of an ovarian insufficience. During laparoscopy a uterine subserous myoma, a right-sighted sactosalpinx, bilateral ovarian cysts, and a extended polypous, vascularized endometriosis of the bladder peritoneum, the pelvic wall and of the Douglas pouch were found. Complete pelvic deperitonealization, bilateral adnexectomy, but also the enucleation of the myoma was performed. The removed myoma did not show atypia or significant mitotic activity. The endometriotic lesions did present a strong expression of the Estrogen Receptor (ER), the Progesteron Receptor (PR), and the proliferation marker MIB–1. In addition, there was a strong (+++) CD34 expression, but no HER–2-neu expression. A switch to the aromatase inhibitor letrozol was recommended. Conclusion: The possibility of tamoxifen-induced or tamoxifen-driven endometriosis in peri- or postmenopausal patients with breast cancer should be considered. Tamoxifen - Breast Cancer - Endometriosis - uterus myomatosus

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