Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
권호 표지

A Case of Tamoxifen-Associated Rapid Growing and Multiple Endometrial Polyps

타목시펜 사용과 연관되어 빠르게 진행하는 다발성 자궁내막폴립 1예

  • Lee, Hee-Jun (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Kim, Hoon (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Ku, Seung-Yup (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Han, Won-Shik (Department of Surgery, Seoul National University College of Medicine) ;
  • Kim, Seok-Hyun (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Choi, Young-Min (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Kim, Jung-Gu (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Moon, Shin-Yong (Department of Obstetrics and Gynecology, Seoul National University College of Medicine)
  • 이희준 (서울대학교 의과대학 산부인과학교실) ;
  • 김훈 (서울대학교 의과대학 산부인과학교실) ;
  • 구승엽 (서울대학교 의과대학 산부인과학교실) ;
  • 한원식 (서울대학교 의과대학 외과학교실) ;
  • 김석현 (서울대학교 의과대학 산부인과학교실) ;
  • 최영민 (서울대학교 의과대학 산부인과학교실) ;
  • 김정구 (서울대학교 의과대학 산부인과학교실) ;
  • 문신용 (서울대학교 의과대학 산부인과학교실)
  • Received : 2010.02.12
  • Accepted : 2010.04.29
  • Published : 2010.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

The antiestrogen tamoxifen is currently the most commonly used adjuvant treatment of breast cancer with antiestrogenic effect on mammary tissue. However, it is also associated with endometrial abnormalities, including hyperplasia, polyps, carcinoma, mostly interpreted as evidence of estrogenic effect on the endometrium. Previously, tamoxifen-associated polyp in breast cancer has been reported in the literature. Most studies had a long follow-up period and tamoxifen-associated polyp developed more than 1 year after tamoxifen treatment. In this case, we report an unusual case of rapid growing and multiple endometrial polyps that were developed only after 3 months' tamoxifen treatment in a postmenopausal breast cancer patient who received quadrant mastectomy with a brief review of literature.

유방암의 치료는 수술, 항암치료 및 방사선 치료 등의 주 치료법이 있으며, 유방암 환자에서 주 치료 후 보조적 치료 수단으로 호르몬 치료가 사용된다. 이 호르몬 치료에는 타목시펜이 가장 보편적으로 사용되며, 타목시펜은 체내에서 항에스트로겐 효과를 보여 유방암 치료에 도움을 주며 유방암의 재발방지에도 효과가 있다고 알려져 있다. 그러나 타목시펜의 부작용 또한 여러 가지가 있으며 문헌에 보고된 것으로는 자궁내막폴립, 자궁내막증식증, 자궁내막암 등이 있다고 알려져 있다. 본원에서도 유방암으로 수술 치료를 시행 받은 후 보조적 치료로서 호르몬 제제인 타목시펜을 사용하여 왔으며 이러한 환자들은 모두 외과와 협진하여 산부인과 외래로 추적 관찰하고 있다. 최근에 본원산부인과 외래로 추적 관찰 중인 타목시펜 사용 환자 중에서, 호르몬 치료 시작 3개월 후의 단기간 내에 빠르게 진행하는 다발성의 자궁내막폴립의 1예가 발견되었으며, 이는 타목시펜의 부작용으로 발생한 것으로 사료된다. 이에 저자는 유방암 수술 후 보조적 치료로 타목시펜을 사용한 환자들 중 우연히 발견된 빠르게 진행하는 다발성의 자궁내막폴립의 1예를 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Dibi RP, Zettler CG, Pessini SA, Ayub AV, de Almeida SB, da Silveira GP. Tamoxifen use and endometrial lesions: hysteroscopic, histological, and immunohistochemical findings in postmenopausal women with breast cancer. Menopause 2009; 16: 293-300. https://doi.org/10.1097/gme.0b013e31818af10a
  2. Al-Brahim N, Elavathil LJ. Metastatic breast lobular carcinoma to tamoxifen-associated endometrial polyp: case report and literature review. Ann Diagn Pathol 2005; 9: 166-8. https://doi.org/10.1016/j.anndiagpath.2005.03.003
  3. Maugeri G, Nardo LG, Campione C, Nardo F. Endometrial lesions after tamoxifen therapy in breast cancer women. Breast J 2001; 7: 240-4. https://doi.org/10.1046/j.1524-4741.2001.20038.x
  4. Mourits MJ, De Vries EG, Willemse PH, Ten Hoor KA, Hollema H, Van der Zee AG. Tamoxifen treatment and gynecologic side effects: a review. Obstet Gynecol 2001; 97: 855-66. https://doi.org/10.1016/S0029-7844(00)01196-0
  5. Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol 2004; 94: 256-66. https://doi.org/10.1016/j.ygyno.2004.03.048
  6. Mourits MJ, Ten Hoor KA, van der Zee AG, Willemse PH, de Vries EG, Hollema H. The effects of tamoxifen on proliferation and steroid receptor expression in postmenopausal endometrium. J Clin Pathol 2002; 55: 514-9. https://doi.org/10.1136/jcp.55.7.514
  7. Goncalves MA, Goncalves WJ, Matias MM, Nazario AC, de Lima GR, Baracat EC. Hysteroscopic evaluation of the endometrium of post-menopausal patients with breast cancer before and after tamoxifen use. Int J Gynaecol Obstet 1999; 66: 273-9. https://doi.org/10.1016/S0020-7292(99)00079-X
  8. Cohen I, Azaria R, Bernheim J, Shapira J, Beyth Y. Risk factors of endometrial polyps resected from postmenopausal patients with breast carcinoma treated with tamoxifen. Cancer 2001; 92: 1151-5. https://doi.org/10.1002/1097-0142(20010901)92:5<1151::AID-CNCR1433>3.0.CO;2-Y
  9. Gregoriou O, Konidaris S, Vrachnis N, Bakalianou K, Salakos N, Papadias K, et al. Clinical parameters linked with malignancy in endometrial polyps. Climacteric 2009; 12: 454-8. https://doi.org/10.1080/13697130902912605
  10. Antunes A Jr, Costa-Paiva L, Arthuso M, Costa JV, Pinto-Neto AM. Endometrial polyps in pre- and postmenopausal women: factors associated with malignancy. Maturitas 2007; 57: 415 -21. https://doi.org/10.1016/j.maturitas.2007.04.010
  11. Cohen I, Bernheim J, Azaria R, Tepper R, Sharony R, Beyth Y. Malignant endometrial polyps in postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol 1999; 75: 136-41.
  12. Qureshi A, Bukhari F, Pervez S. Spectrum of tamoxifen associated endometrial pathology in breast cancer patients. J Pak Med Assoc 2009; 59: 249-50.
  13. Markovitch O, Tepper R, Fishman A, Shapira J, Aviram R, Cohen I. The value of transvaginal ultrasonography in the prediction of endometrial pathologies in asymptomatic postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol 2004; 95: 456-62. https://doi.org/10.1016/j.ygyno.2004.06.053
  14. ACOG committee opinion. No. 336: Tamoxifen and uterine cancer. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Obstet Gynecol 2006; 107: 1475-8. https://doi.org/10.1097/00006250-200606000-00057
  15. Lin MC, Gosink BB, Wolf SI, Feldesman MR, Stuenkel CA, Braly PS, et al. Endometrial thickness after menopause: effect of hormone replacement. Radiology 1991; 180: 427-32. https://doi.org/10.1148/radiology.180.2.1829843
  16. Neven P, Vernaeve H. Guidelines for monitoring patients taking tamoxifen treatment. Drug Saf 2000; 22: 1-11. https://doi.org/10.2165/00002018-200022010-00001
  17. Le Donne M, Lentini M, De Meo L, Benedetto V, Mesiti M. Uterine pathologies in patients undergoing tamoxifen therapy for breast cancer: ultrasonographic, hysteroscopic and histological findings. Eur J Gynaecol Oncol 2005; 26: 623-6.
  18. Tepper R, Beyth Y, Altaras MM, Zalel Y, Shapira J, Cordoba M, et al. Value of sonohysterography in asymptomatic postmenopausal tamoxifen-treated patients. Gynecol Oncol 1997; 64: 386-91. https://doi.org/10.1006/gyno.1996.4568
  19. Senkus-Konefka E, Konefka T, Jassem J. The effects of tamoxifen on the female genital tract. Cancer Treat Rev 2004; 30: 291-301. https://doi.org/10.1016/j.ctrv.2003.09.004