Original Article
Carcinosarcoma, endometrial intraepithelial carcinoma and endometriosis after tamoxifen therapy in breast cancer

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Abstract

The fourth case of heterologous mesodermal tumour of the uterine corpus, that developed 7 years following tamoxifen therapy for breast cancer in a postmenopausal woman with no previous pelvic irradiation, is presented with coincidental endometriosis and endometrial intraepithelial carcinoma. This coincidence after tamoxifen treatment appears to be an indication for the possible carcinogenic potency of tamoxifen.

Introduction

With an incidence of 1.5% of all malignant diseases of the uterus, mullerian mixed tumour is a rarity amongst the malignancies of the female genital tract. Primary locations may be the endometrium, the cervix and the ovary [1]. Many studies have been published on the carcinogenic potency of tamoxifen. In animal experiments, indications were found for a raised liver toxicity with secondary development of hepatocarcinomas. Development of endometrial hyperplasia, endometriosis, endometrial polyps and endometrial adenocarcinomas has been described 2, 3.

Section snippets

Case report

A 73-year-old patient was admitted to hospital with the putative diagnosis of an adnexal tumour. Seven years before, her right breast had been removed with axillary lymphnodectomy because of a breast carcinoma in tumour stage pT 2, pN 1biii, G2, M0, ER:+++, PR:++. An adjuvant tamoxifen therapy was started with 40 mg/day over 31 months. The patient was then switched to 30 mg tamoxifen per day. The gynecological investigation showed a tumour extending to the navel, which could not be delimited

Discussion

To our knowledge, three cases of heterologous mullerian mixed tumour under tamoxifen therapy have been reported. In this case, the simultaneous occurrence of endometriosis, endometrial intraepithelial carcinoma (EIC) and mullerian mixed tumour after tamoxifen treatment over many years is described. This coincidence has not been reported up to now, while the development of endometriosis under tamoxifen administration has already been mentioned 2, 3.

Tamoxifen is a synthetic nonsteroid triphenyl

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