Jeon Se Jeong, Lee Jae Il, Lee Maria, Kim Hee Seung, Kim Jae Weon, Park Noh Hyun, Song Yong Sang
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Obstet Gynecol Sci. 2017 Jan;60(1):26-31. doi: 10.5468/ogs.2017.60.1.26. Epub 2017 Jan 19.
To describe the endometrial pathologic lesions in premenopausal breast cancer patients with a history of tamoxifen (TMX) use.
We retrospectively reviewed the medical records of 120 premenopausal breast cancer patients with a history of TMX use that had undergone a gynecological examination.
Among 120 patients, 44.2% (n=53) were asymptomatic with an endometrial thickness ≥5 mm, as assessed by transvaginal ultrasonography. Of the patients that reported abnormal uterine bleeding, 5% (n=6) had an endometrial thickness <5 mm and 20% (n=24) had an endometrial thickness ≥5 mm by transvaginal ultrasonography. The final group of patients were asymptomatic, but showed an abnormal endometrial lesion, such as an endometrial polyp, by transvaginal ultrasonography (30.8%, n=37). Of the 56 benign lesions that were histologically reviewed, 50 (41.7%) were endometrial polyps, 3 (2.5%) were submucosal myomas, 2 (1.7%) were endometrial hyperplasias, and 1 (0.8%) was chronic endometritis. There were 64 (53.3%) other non-pathologic conditions, including secreting, proliferative, and atrophic endometrium, or in some cases, there was insufficient material for diagnosis. In our data, only one case was reported as a complex hyperplasia without atypia arising from an endometrial polyp, and one patient was diagnosed with endometrioid adenocarcinoma.
For premenopausal breast cancer patients with a history of TMX use, the majority of the patients were asymptomatic, and endometrial polyps were the most common endometrial pathology observed. Therefore, we believe that endometrial assessment before starting TMX treatment, and regular endometrial screening throughout TMX treatment, are reasonable suggestions for premenopausal breast cancer patients.
描述有他莫昔芬（TMX）使用史的绝经前乳腺癌患者的子宫内膜病理病变情况。
我们回顾性分析了120例有TMX使用史且接受过妇科检查的绝经前乳腺癌患者的病历。
120例患者中，经阴道超声检查显示，44.2%（n = 53）无症状但子宫内膜厚度≥5mm。在报告有异常子宫出血的患者中，经阴道超声检查发现5%（n = 6）的患者子宫内膜厚度<5mm，20%（n = 24）的患者子宫内膜厚度≥5mm。最后一组患者无症状，但经阴道超声检查显示有异常子宫内膜病变，如子宫内膜息肉（30.8%，n = 37）。在组织学检查的56例良性病变中，50例（41.7%）为子宫内膜息肉，3例（2.5%）为黏膜下肌瘤，2例（1.7%）为子宫内膜增生，1例（0.8%）为慢性子宫内膜炎。还有64例（53.3%）为其他非病理情况，包括分泌期、增殖期和萎缩期子宫内膜，或在某些情况下，诊断材料不足。在我们的数据中，仅报告1例由子宫内膜息肉引起的不伴非典型性的复杂性增生，1例患者被诊断为子宫内膜样腺癌。
对于有TMX使用史的绝经前乳腺癌患者，大多数患者无症状，子宫内膜息肉是观察到的最常见的子宫内膜病理情况。因此，我们认为在开始TMX治疗前进行子宫内膜评估，以及在整个TMX治疗过程中定期进行子宫内膜筛查，对绝经前乳腺癌患者来说是合理的建议。
