Endometrial hyperplasia in an oophorectomized woman receiving tamoxifen therapy: case report

Article Abstract:

A 54-year-old woman who had had her breast removed 18 years previously because of breast cancer had her ovaries removed nine years after that, because the cancer appeared to have spread to neighboring lymph nodes under her arm. Since many tumors of the breast are stimulated by estrogen, the patient began tamoxifen therapy, an anti-estrogen drug used to block the uptake of estrogen. The patient was admitted to the hospital during this admission to perform a hysterectomy for the treatment of uterine bleeding. The patient's estrogen level at the time of admission was 42 pmol per liter (normal postmenopause level is less than 250 pmol per liter). After hysterectomy the uterine tissue was examined microscopically. The uterine lining was found to be hyperplastic, showing abnormal proliferative-type endometrium as if the cells were continuing to be stimulated by estrogen. Although tamoxifen initially acts to stimulate estrogen, estrogen antagonism eventually follows. The effects of long-term tamoxifen therapy are not known. It is thought that tamoxifen may increase ovarian stimulation directly. However, this patient had her ovaries removed and there was no evidence that any ovarian tissue had been left behind. In addition, the low estrogen level measured at hospital admission indicates that estrogen was not coming from another outside source. It is hypothesized that tamoxifen exerts its effect on the uterus via the estrogen receptors. The cumulative low-grade estrogen-like effect may have hyperstimulated the endometrial lining over time. This theory is also supported by reports of endometrial cancer occurring in patients with breast cancer. The long-term effects of tamoxifen therapy need to be investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Renal endometriosis treated with a gonadotrophin releasing hormone agonist. Case report

Article Abstract:

Endometriosis is a condition in which endometrial tissue, which normally lines the uterus, is located in abnormal sites throughout the body. One such site is the kidney; such cases of renal endometriosis are very rare. The case report is presented of a patient with a three-year history of blood in the urine (hematuria) of undetermined origin (cause). A biopsy of the patient's kidney revealed abnormal tissue and led to the diagnosis of renal endometriosis; no other areas of endometriosis were observed during subsequent exploratory surgery. Treatment with a progestogen (a female hormone) led to symptom improvement, but not full relief. Several months after surgery, hematuria returned, and small foci (regions) of endometriosis were identified within the pelvis. The patient was then treated with a gonadotrophin releasing hormone agonist (GnRH), a drug that simulates (mimics) the effects of hormones that stimulate the ovaries. This treatment led to the gradual disappearance of symptoms, which returned when GnRH was stopped after 11 months. After reinstitution of treatment, the patient again improved. The drug did not appear to cause any major side effects with the exception of amenorrhea (absence of menstruation). A discussion is presented of the histopathologic (abnormal tissue findings) and clinical symptoms associated with renal endometriosis. The results show that GnRH, a drug not commonly prescribed for treating endometriosis, is effective in some cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Diagnosis, Physiological aspects, Drug therapy, Gonadotropin releasing hormone, Gonadorelin, Kidney diseases

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Tamoxifen and endometriosis: case report

Article Abstract:

Tamoxifen is an anti-estrogen agent used in the treatment of estrogen-dependent types of breast cancer. Blocking the uptake of estrogen makes less estrogen available for the tumor. However, when estrogen production in the body is high, tamoxifen acts like an antagonist. When estrogen levels are low (such as during menopause), it does the opposite and increases estrogen production. A 44-year-old woman with a history of breast cancer was taking tamoxifen (20 milligrams a day) for three years. A hysterectomy and ovary removal was performed to treat abnormal bleeding between menstrual periods and bleeding during sex. Microscopic analysis of the cells lining the inside of the uterus and of the cells of the ovaries revealed hyperplasia, abnormal cell growth similar to that found with estrogen overstimulation. The cells were not atypical or cancerous. In women with endometriosis, cells normally lining the inside of the uterus dislodge, grow and begin to function in other areas of the body, including the ovary itself. Various studies have been published demonstrating the stimulatory effect of tamoxifen on the endometrial lining of the uterus. This case study may be the first report of hyperplasia of abnormally placed endometrial tissue in the ovaries. Had the ovaries of this patient not been removed, she may have suffered severe pain from hyperplasia of the endometrotic tissue in the ovaries. (Consumer Summary produced by Reliance Medical Information, Inc.)

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