Endometrial müllerian carcinosarcoma after cessation of tamoxifen therapy for breast cancer

Abstract

The aim of this report is to draw the attention of clinicians to the possible occurrence of endometrial cancers of rare histological type among women currently undergoing or having in the past undergone tamoxifen therapy, in particular for breast cancer. We report a case of heterologous mixed malignant müller tumor occurring in an 80-year-old woman. At 69, she had been diagnosed with breast cancer and received tamoxifen for a total of 55 months over a 6-year period. In the 5th year after cessation of tamoxifen therapy, an endometrial carcinosarcoma was diagnosed. Although the association between tamoxifen use and endometrial cancer is recognized, only a few reports of occurrence long after cessation of therapy exist. We believe ours is the second for this particular histological type. Tamoxifen may have played a role in the occurrence of this tumor although it is also known that this type of tumor may arise de novo in elderly women. The etiologic hypothesis obtained from this case description will now be tested in a formal epidemiological investigation which hopefully will provide more definitive evidence.

Uterine carcinosarcomas in patients receiving tamoxifen. A report of 19 cases

“…In recent years, there have been several reports of uterine carcinosarcoma developing in patients taking tamoxifen (2–7) . These reports have highlighted a possible association between tamoxifen and the development of carcinosarcoma, and the cases we report provide support for such an association.…”

“…It is possible that in some of the patients who had been taking tamoxifen for a relatively short period, the development of uterine carcinosarcoma was merely coincidental. The duration of tamoxifen therapy in the previously reported cases of uterine carcinosarcoma has ranged from 3 to 9 years (2–7) .…”

“…In recent years, there have been occasional reports of uterine carcinosarcoma arising in patients taking tamoxifen for breast cancer (2–7) . The aim of this report is to describe the clinical and pathological findings in 19 patients (two of these have been previously reported (5) ) who developed uterine carcinosarcoma while taking tamoxifen.…”

Selective Estrogen Receptor Modulators

“…Women with previous alterations would be, they suggested, more sensitive to the carcinogenetic effects of tamoxifen, an indication favoring the concept that lesions would represent a risk factor (Berlière et al 1998). However, contrary to what was observed by other researchers (Sasco et al 1995;Magriples et al 1993), the adenocarcinomas diagnosed during the study were well differentiated (Berlière et al 1998). It was then postulated that, as observed for endometrial tumors associated with estrogen replacement therapy, tamoxifen would induce a high proportion of highly differentiated tumors with a better prognosis.…”

Endometrial mesodermal mixed tumor occurring after tamoxifen treatment: Report on a new case and review of the literature

“…Another point of particular note in the report is the long delay after cessation of tamoxifen therapy [6]. This has previously been pointed out in another case report on a mullerian carcinosarcoma of the endometrium [24] and could represent a specific feature of this type of tumor. With our patient, we also had to face the difficulty of distinguishing relapsing breast cancer from relapsing endometrial cancer on the basis of the cytological examination of malignant ascites.…”