Colacurci N, De Seta L, De Franciscis P, Mele D, Fortunato N, Cassese S
Institute of Obstetrics and Gynaecology, Second University of Naples School of Medicine, Italy.
Panminerva Med. 2000 Mar;42(1):45-7.
To evaluate the effects on the endometrium of a long term treatment with Tamoxifen in postmenopausal patients, asymptomatic for gynecologic disorders, surgically treated for breast cancer.
Outpatient menopausal clinic and endoscopic unit.
45 patients (Group I) were treated with 20 mg of Tamoxifen daily for a mean of 23.4 months. Seven patients (Group II) represented the control group and did not receive Tamoxifen. A transvaginal ultrasonography and a hysteroscopic guided biopsy were performed in all patients.
Sagittal sonograms showed abnormal endometrial thickening (range 8-32 mm, mean 13 mm) in 17 patients (35.4%) of Group I and in 1 patient of Group II. Pathology on endometrial tissue sampling obtained at the time of hysteroscopy showed hyperplastic endometrial polyps in 3 patients (6.25%), endometrial hyperplasia in 16 patients (33.4%), while 1 patient had an endometrial polyp cancer on a background of hyperplasia and 1 had a superficial endometrial cancer (4.1%). Out of the 7 patients of Group II, one had an endometrial polyp, while 6 had no relevant endometrial abnormalities.
Our study confirms that Tamoxifen treatment is associated with an increased incidence of proliferative and neoplastic endometrial changes. No obvious correlation was found between the length of Tamoxifen exposure time and occurrence of endometrial pathologies. It is mandatory to undertake twice per year gynecological evaluations for patients treated with Tamoxifen to promptly identify and correctly manage endometrial changes.
评估他莫昔芬长期治疗对无症状妇科疾病、因乳腺癌接受手术治疗的绝经后患者子宫内膜的影响。
门诊绝经诊所和内镜科室。
45例患者（第一组）每日接受20mg他莫昔芬治疗，平均治疗23.4个月。7例患者（第二组）作为对照组，未接受他莫昔芬治疗。所有患者均接受经阴道超声检查和宫腔镜引导下活检。
矢状位超声检查显示，第一组17例患者（35.4%）子宫内膜增厚异常（范围8 - 32mm，平均13mm），第二组1例患者出现这种情况。宫腔镜检查时获取的子宫内膜组织样本病理检查显示，3例患者（6.25%）有增生性子宫内膜息肉，16例患者（33.4%）有子宫内膜增生，1例患者在增生背景下患有子宫内膜息肉癌，1例患有浅表性子宫内膜癌（4.1%）。第二组的7例患者中，1例有子宫内膜息肉，6例无相关子宫内膜异常。
我们的研究证实，他莫昔芬治疗与子宫内膜增生性和肿瘤性变化的发生率增加有关。未发现他莫昔芬暴露时间长短与子宫内膜病变发生之间存在明显相关性。对于接受他莫昔芬治疗的患者，每年必须进行两次妇科评估，以便及时识别并正确处理子宫内膜变化。
