Korean J Obstet Gynecol.  2011 Dec;54(12):836-840. 10.5468/KJOG.2011.54.12.836.

A giant endometrial polyp with tamoxifen therapy in postmenopausal woman

• Moon SH
• Lee SE
• Jung IK
• Jeong JE
• Park WY
• Yi WH
• Suh DS
• Yoon MS
• Kim KH

• KMID: 1443953
• DOI: http://doi.org/10.5468/KJOG.2011.54.12.836

Abstract

Tamoxifen is a synthetic non-steroid anti-estrogen that has been used effectively for several years in the adjuvant treatment of breast cancer. But, the drug has been associated with development of endometrial poylp, hyperplasia and adenocarcinoma possibly mediated through its agonistic estrogen properties during the menopausal period in which estrogens are at a low level. Endometrial polyp has been described as the most common endometrial pathology in association with postmenopausal tamoxifen treatment. We present the case of woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for 5 years after breast cancer surgery.

Keyword

Tamoxifen; Polyp; Breast neoplasm

MeSH Terms

Adenocarcinoma
Breast Neoplasms
Estrogens
Female
Humans
Hyperplasia
Polyps
Tamoxifen
Estrogens
Tamoxifen

Figure

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  Fig. 1 Transvaginal ultrasonographic image of an endometrial polyp in 58-year-old patient with breast cancer treated with tamoxifen. The Swiss-cheese appearance of the polyp is evident.

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  Fig. 2 Pelvic magnetic resonance imaging findings. (A) Axial T2-weighted image shows a 6 cm sized endometrial mass with multiple hyperintense cystic lesions (arrowhead) and hypointense fibrous stroma (arrow). (B) Sagittal T2-weighted image shows a hypointense fibrovascular stalk (arrow) within hyperintense cystic mass (arrowheads) that is limited to endometrial cavity. (C) Sagittal gadolinium enhanced T1-weighted image shows an enhancing fibrovascular stalk (arrow) within the endometrial mass. (D) Diffusion-weighted image at b=800 s/mm2 shows a hypointense mass (*) and (E) apparent diffusion coefficient map shows a hyperintense mass (*), which is suggestive of benign endometrial lesion such as endometrial polyp.

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  Fig. 3 Gross finding. A giant endometrial polyp which developed after prolonged tamoxifen treatment. Extirpated polyp measuring 7.5 × 5.5 × 2.6 cm.

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  Fig. 4 Microscopic findings. (A) Tumor is consisted of cystically dilated endometrial glands with fibrotic stroma (H&E, ×100). (B) Cystic glands are lined by flattened epithelium (H&E, ×200). Estrogen receptor (ER) and progesterone receptor (PR) immunohistochemical staining (C, D). Both receptors are positive for stromal cells and epithelial cells (×200). (E) Immunohistochemically weak staining for Ki-67; 1-2% (×400). (F) Bcl-2 positive for dilated endometrial glans and stroma in endometrial polyp (×100).

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