Torsion of a Functional Ovarian Cyst in a Premenopausal Patient Receiving Tamoxifen

Abstract

We report a case of torsion of an ovarian follicular cyst that developed during treatment with tamoxifen for breast cancer. A 40-year-old Japanese woman was admitted complaining of acute lower abdominal pain. Eight months earlier, she had undergone a partial mastectomy and local irradiation for ductal carcinoma of her left breast, estrogen receptor-positive stage I (T_1a N_1b M₀). The administration of tamoxifen, 20 mg/day, and doxifluridine, 600 mg/day, were started immediately postoperatively. Pelvic examination after admission revealed the left ovarian cyst and enlarged uterus. Transvaginal ultrasonography and computed tomography revealed a multilocular cystic mass in the pelvic cavity. The pathological diagnosis of the tumor after total hysterectomy and bilateral salpingo-oophorectomy was a typical follicular cyst with torsion and uterine leiomyoma. This ovarian cyst was believed to have developed during tamoxifen administration.

Tumorigenic Effects of Tamoxifen on the Female Genital Tract

“…In all of the other patients, ovarian cysts disappeared within three months after the cessation of therapy. We have also reported the torsion of an ovarian functional cyst in a premenopausal breast cancer patient who was treated surgically (Nasu et al 1999). …”

“…In breast cancer patients, ovarian cyst formation during prolonged tamoxifen treatment (Cohen et al 1994a; Barbieri et al 1993; Kedar et al 1994; Shulman et al 1994; Nasu et al 1999) and in series of tamoxifen-treated breast cancer patients (Cohen et al 1996; Shushan et al 1996a) has been reported. Ovarian cysts also have been described in a breast cancer prevention study (Powles et al 1994).…”

“…Although torsion of a cystic ovary during tamoxifen treatment has been described (Barbieri et al 1993; Nasu et al 1999), surgical intervention is rarely required, and functional asymptomatic monolocular cysts in these patients should be followed conservatively (Mourits et al 2001). The discontinuation of tamoxifen usually leads to the gradual reduction and disappearance of these lesions (Cohen et al 1994a).…”

“…However, it has become clear in the past decade that prolonged use of this agent is associated with significant gynecological complications (Table 1). The potential adverse effects of the drug include the development of endometrial cancer (Killackey et al 1985; Fisher et al 1994; Clarke et al 1998; Bernstein et al 1999), endometrial polyps (Corley et al 1992; Lahti et al 1993; Kedar et al 1994), adenomyomatous polyp (Nasu et al 1997), adenomyosis (Cohen et al 1995), leiomyoma (Dilts et al 1992; Leo et al 1994; Kang et al 1996), cervical polyps, and ovarian cysts (Sawka et al 1986; Cohen et al 1994a; Barbieri et al 1993; Shushan et al 1996a; Terada et al 1993; Nasu et al 1999). Of these diseases, tamoxifen-associated endometrial pathologies have been evaluated exclusively.…”