Endometrial carcinoma in postmenopausal patients using hormone replacement therapy: a report on four cases

Abstract

Objective To report the occurrence of endometrial carcinoma in polyps in postmenopausal patients using hormone replacement therapy (HRT). Setting A private hospital with facilities for carrying out hysteroscopy. Subjects Four postmenopausal patients who developed endometrial carcinoma while using HRT. Interventions Hysteroscopy with biopsy, immunohistochemical investigation for oestradiol, progesterone receptors and p53 overexpression. Results All four cases of carcinoma were associated with endometrial polyps. The cancerous cells were positive for oestrogen receptors, negative for progesterone receptors and showed p53 overexpression in all cases. Conclusions The lack of detectable progesterone receptors in endometrial carcinomas arising in polyps in HRT patients indicates an unopposed action of oestrogens, which may accelerate the carcinomatous changes in polyps through a p53 pathway.

Hysteroscopic findings in postmenopausal patients using tibolone

“…The high incidence of endometrial polyps in tibolone users which was seen in the present study confirms previous observations carried out with hysteroscopy; these revealed that the presence of uterine intracavitary lesions accounts for a large number of the bleeding episodes reported during tibolone treatment 5,6 . The higher incidence of endometrial polyps in menopausal patients using HRT has also been observed in previous studies 8,10 …”

“…Ginsburg & Prelevic 5 have also reported the occurrence of endometrial carcinomas in tibolone users with bleeding, and in one patient the carcinoma occurred in association with a cervical polyp. The presence of endometrial carcinomas associated with uterine polyps has also been observed in postmenopausal patients who had been using other forms of HRT 10 …”