Le Bouëdec G, Auvray H, Curé H, de Latour M, Penault-Llorca F, Dauplat J
Service de chirurgie,centre régional de lutte contre le cancer Jean-Perrin, 58, rue Montalembert, B.P. 392, 63011 Clermont-Ferrand, France.
Rev Med Interne. 2001 Sep;22(9):881-5. doi: 10.1016/s0248-8663(01)00440-4.
Tamoxifen--a non steroidal triphenylethyl compound--in addition to having antiestrogenic properties may provoke weak estrogenic effects, the well known "paradoxical effects" on the female genital tractus. Concern has been raised about prolonged tamoxifen treatment and subsequent occurrence of endometrial adenocarcinoma; subsequent attention has been drawn through high risk histologic subtypes including poorly differentiated patterns and uterine sarcomas.
We report two cases of uterine sarcoma arising in postmenopausal women taking tamoxifen, 20 mg daily during 38 and 42 months, for breast carcinoma: one leiomyosarcoma and one endometrial stromal sarcoma; both cases were asymptomatic and detected by pelvic sonography.
Further studies will be required to establish if there is a relationship between long term tamoxifen exposure and highly aggressive types of cancer of the uterine corpus exhibiting adverse histologic features such as uterine sarcomas. There is no consensus regarding uterine surveillance of women receiving tamoxifen. We advocate an annual gynecologic examination plus imaging by means of transvaginal ultrasonography.
他莫昔芬——一种非甾体类三苯乙基化合物——除了具有抗雌激素特性外，还可能引发微弱的雌激素效应，即对女性生殖道产生众所周知的“矛盾效应”。人们对长期服用他莫昔芬及随后发生子宫内膜腺癌的情况表示担忧；随后，包括低分化模式和子宫肉瘤在内的高风险组织学亚型引起了关注。
我们报告了两例绝经后女性服用他莫昔芬（每日20毫克，持续38个月和42个月）治疗乳腺癌后发生子宫肉瘤的病例：一例平滑肌肉瘤和一例子宫内膜间质肉瘤；两例均无症状，通过盆腔超声检查发现。
需要进一步研究以确定长期接触他莫昔芬与子宫体部具有不良组织学特征（如子宫肉瘤）的高度侵袭性癌症类型之间是否存在关联。对于接受他莫昔芬治疗的女性进行子宫监测尚无共识。我们主张每年进行一次妇科检查，并通过经阴道超声进行影像学检查。
