Le Bouëdec G, de Latour M, Dauplat J
Centre Jean Perrin, Clermont-Ferrand.
Presse Med. 1995 Nov 25;24(36):1694-6.
Tamoxifen, a non-steroid anti-oestrogen derivative of diethylstilboestrol, is the main drug used for hormone therapy for hormone-dependent breast cancer. This ambivalent drug has both antagonist and agonist effects. While tamoxifen blocks tumour growth it can also have an undesirable agonist effect on the genital tract. The uterus is a target organ for this paradoxical action due to proestrogenic stimulation of the endometrium and the myometrium. We observed eleven cases of uterine fibromyoma during treatment with tamoxifen which required hysterectomy due to increased tumour volume. The pathology report on the surgical specimens did not show any evidence of malignancy. Differential diagnosis is based on sarcomatous degeneration of the fibromyoma and presence of intra-myomatous metastases from the breast. Hysterectomy is indicated in menopaused patients with a symptomatic fibromyomatous uterus before starting long-term anti-oestrogen therapy for hormone-dependent breast cancer.
他莫昔芬是己烯雌酚的一种非甾体抗雌激素衍生物，是用于激素依赖性乳腺癌激素治疗的主要药物。这种具有双重作用的药物兼具拮抗剂和激动剂效应。他莫昔芬在阻断肿瘤生长的同时，也可能对生殖道产生不良的激动剂效应。由于子宫内膜和子宫肌层受到雌激素的刺激，子宫是这种矛盾作用的靶器官。我们在他莫昔芬治疗期间观察到11例子宫纤维瘤病例，这些病例因肿瘤体积增大而需要进行子宫切除术。手术标本的病理报告未显示任何恶性证据。鉴别诊断基于纤维瘤的肉瘤样变性以及乳腺肌层内转移灶的存在。对于患有症状性纤维瘤子宫的绝经后患者，在开始对激素依赖性乳腺癌进行长期抗雌激素治疗之前，应进行子宫切除术。
