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Endometrial polyps in postmenopausal patients receiving tamoxifen
M A Nuovo1, G J Nuovo, R M McCaffrey
1Department of Pathology, Montefiore Hospital Medical Center, Bronx, New York.
Summary
Tamoxifen, a breast cancer drug, can cause significant endometrial polyp growth and hyperplasia in postmenopausal women. These changes, including atypical cells, mimic malignancy, highlighting the need for careful monitoring.
Area of Science:
- Gynecologic Oncology
- Endocrinology
- Oncology
Background:
- Endometrial polyps are common gynecologic lesions.
- Tamoxifen is a selective estrogen receptor modulator used in breast cancer treatment.
- Hormonally active agents can influence endometrial tissue.
Observation:
- Three postmenopausal patients receiving tamoxifen for metastatic breast carcinoma presented with vaginal bleeding and uterine enlargement.
- Large endometrial polyps (up to 9 cm) were detected.
- Histologic examination revealed extensive cystic glandular hyperplasia.
Findings:
- One polyp showed atypical epithelial proliferation and predecidualization, testing positive for carcinoembryonic antigen.
- The atypical proliferation suggested a borderline neoplastic process.
- These findings demonstrate marked proliferative changes in endometrial polyps induced by tamoxifen.
Implications:
- Tamoxifen can induce significant, potentially concerning changes in endometrial polyps in postmenopausal women.
- Vaginal bleeding and uterine enlargement in patients on tamoxifen warrant thorough investigation for endometrial pathology.
- Close monitoring of the endometrium is crucial for patients on hormonally active chemotherapeutic agents.