Kalampokas T, Sofoudis C, Anastasopoulos C, Boutas I, Melloy S, Kondi-Pafiti A, Kalampokas E, Botsis D, Salakos N
Department of Obstetrics and Gynecology University of Athens, Aretaieion Hospital, Athens, Greece.
Eur J Gynaecol Oncol. 2013;34(4):325-8.
The objective of this study was to evaluate the effect oftamoxifen on the endometrium of45 postmenopausal women with breast cancer, as evidenced by hysteroscopic, ultrasound, histological methods, and by immunohistochemical investigation of the expression of Bcl-2 and Ki67.
Forty-five postmenopausal women with breast cancer (ER and/or PgR positive) undergoing tamoxifen therapy for six to 48 months, were selected from the files of the 2nd Department of Obstetrics and Gynecology, University of Athens Aretaieion Hospital, among a total of 120 patients treated from 2004-2009.
The ultrasound findings during the follow-up period revealed 18 cases of thickened endometrium, 14 cases of suspected polyps, one case with accumulation of endometrial fluid, and 12 cases of heterogeneous endometrial echo texture. The patients had undergone hysteroscopy because of thickened endometrium (18/45 patients), postmenopausal bleeding (14/45 patients), and polyps (13/45 patients). The endometrial tissue samples were examined in the Pathology Department of Aretaieion Hospital and showed in 23 cases with adenomatous endometrial polyps, 15 cases with endometrial cystic atrophy, two cases with adenomatous hyperplasia, and five cases with mucosal endometrial adhesions. Immunohistochemical investigation of Bcl-2 and KJ67 expression was undertaken on paraffin blocks and showed elevated expression in the cases with endometrial polyps and hyperplasia, in contrast to atrophic endometria.
Long-term tamoxifen therapy of postmenopausal women with breast cancer is associated with uterine pathology. Ultrasonography alone is useful in asymptomatic patients selecting cases with increased endometrial thickness for further investigation. Hysteroscopy is an accurate method for diagnosing endometrial disease because it provides a direct view of the uterine cavity, reveals focal lesions, and enables targeted biopsies to be performed at the same time. Pathological findings show elevated expression of Ki67 and Bcl-2 in hyperplastic endometria and adenomatous polyps, consistent with an elevated glandular cell proliferation due to tamoxifen effect.
本研究的目的是通过宫腔镜检查、超声检查、组织学方法以及对Bcl-2和Ki67表达的免疫组化研究，评估他莫昔芬对45例绝经后乳腺癌患者子宫内膜的影响。
从雅典大学阿雷塔伊翁医院妇产科第二科室2004年至2009年治疗的120例患者档案中，选取45例接受他莫昔芬治疗6至48个月的绝经后乳腺癌患者（雌激素受体和/或孕激素受体阳性）。
随访期间的超声检查结果显示，18例子宫内膜增厚，14例疑似息肉，1例子宫内膜积液，12例子宫内膜回声质地不均。患者因子宫内膜增厚（18/45例患者）、绝经后出血（14/45例患者）和息肉（13/45例患者）接受了宫腔镜检查。阿雷塔伊翁医院病理科对子宫内膜组织样本进行了检查，结果显示23例为腺瘤性子宫内膜息肉，15例为子宫内膜囊性萎缩，2例为腺瘤样增生，5例为子宫内膜黏膜粘连。对石蜡块进行了Bcl-2和Ki67表达的免疫组化研究，结果显示与萎缩性子宫内膜相比，子宫内膜息肉和增生病例中的表达升高。
绝经后乳腺癌患者长期使用他莫昔芬治疗与子宫病变有关。单独的超声检查对无症状患者有用，可以筛选出子宫内膜厚度增加的病例进行进一步检查。宫腔镜检查是诊断子宫内膜疾病的准确方法，因为它可以直接观察子宫腔，发现局灶性病变，并能同时进行靶向活检。病理结果显示增生性子宫内膜和腺瘤性息肉中Ki67和Bcl-2表达升高，这与他莫昔芬作用导致腺细胞增殖增加一致。
