Tamoxifen-associated polypoid endometriosis mimicking an ovarian neoplasm

Abstract

Tamoxifen has been widely used for adjuvant treatment of breast cancer, but several gynecological side effects have been noted, including endometrial hyperplasia, polyp and carcinoma. Polypoid endometriosis is one of the extremely rare benign complications associated with tamoxifen therapy. A 66-year-old postmenopausal woman, who had received left partial mastectomy due to breast cancer (about 4 years ago) and was taking tamoxifen treatment, had an ovarian cyst on ultrasonography. Pelvic magnetic resonance imaging suggested tamoxifen-associated endometrial and ovarian changes, especially a 4.1×3.4-cm-sized, well-defined, multicystic mass in the right ovary. She received hysterectomy with bilateral salpingo-oophorectomy. Microscopically, the right paratubal mass showed endometrial glands and stroma, and immunohistochemical staining for CD10 confirmed the endometrial nature of the stroma. Three cases of polypoid endometriosis have been reported in the Korean literature, but in none of the cases, polypoid endometriosis was associated with tamoxifen use. Herein, we report the first case of polypoid endometriosis associated with tamoxifen treatment in Korea.

A case of cyclic hemoperitoneum in a hemodialysis patient: Encapsulated peritoneal sclerosis complicated by endometriosis and fungal peritonitis

“…9,12 Decreased cytotoxic activity of natural killer cells has been blamed in the pathogenesis of endometriosis 11,13 ; decreased phagocytic activity of macrophages and disturbances in cellular and humoral immunity may also disrupt the removal of endometrial tissue from the peritoneum, with increased cytokine production namely, TGF- But tamoxifen treatment may also result and associate with accelerated endometriosis. 1,15 However, in our case, hemoperitoneum and the biopsy signs of endometriosis have appeared before the initiation of tamoxifen treatment. In our case, tamoxifen treatment has been continued for 4 months after EPS diagnosis.…”

“…Its use has been reported to be associated with reduced mortality in adult patients with EPS. But tamoxifen treatment may also result and associate with accelerated endometriosis 1,15 . However, in our case, hemoperitoneum and the biopsy signs of endometriosis have appeared before the initiation of tamoxifen treatment.…”

Polypoid endometriosis mimicking invasive cancer in an obese, postmenopausal tamoxifen user

“…Only one of the Parker cases featured a patient using tamoxifen; in this case the polypoid endometriosis was incidentally discovered and limited to the uterus and ovaries ( Parker et al, 2004 ). Additionally, our literature review revealed 9 cases of severe postmenopausal endometriosis with associated tamoxifen use ( Choi et al, 2015 , Chang et al, 2003 , Laird et al, 2004 , Schlessinger and Silverberg, 1999 , Naufel et al, 2014 ). Most presentations of tamoxifen effect were in the form of an isolated pelvic or adnexal mass, typically measuring 4-10 cm ( Choi et al, 2015 , Chang et al, 2003 , Laird et al, 2004 , Schlessinger and Silverberg, 1999 , Naufel et al, 2014 ).…”

“…It is an estrogen receptor antagonist in the breast, but an estrogen receptor agonist in the endometrium. As a result, tamoxifen can increase the risk of endometrial cancer, and users are monitored closely for abnormal uterine and postmenopausal bleeding ( Choi et al, 2015 ). Several factors from the patient's medical history, to include infertility are suggestive of a previous history of endometriosis.…”

“…There are few reported cases of endometriosis mimicking cancer and even fewer with an association to tamoxifen use ( Choi et al, 2015 , Parker et al, 2004 , Chang et al, 2003 , Laird et al, 2004 , Schlessinger and Silverberg, 1999 , Naufel et al, 2014 , Matsuura et al, 2009 ). This case represents an unusually aggressive presentation of endometriosis in a postmenopausal woman from our literature review.…”