Advertisement

Unusual ultrasonographic appearance of the uterus in patients receiving tamoxifen

      Abstract

      Tamoxifen is widely used as adjunctive therapy for patients with breast cancer and has been suggested as protection against the development of breast cancer in women at risk on the basis of heredity. It is a nonsteroidal estrogen antagonist, but like all antagonists it has some agonistic properties. Its administration should result in atrophic changes in the endometrium, but paradoxically some reports have found hyperplasia and even carcinomas developing prospectively in patients on tamoxifen therapy. Increasingly, endovaginal ultrasonography is being used for endometrial assessment in a wide variety of patients. This report is the first description of an unusual ultrasonographic finding in the uteri of some patients receiving tamoxifen. Initially believed to be endometrial in location, when viewed after fluid instillation (sonohysterogram) the heterogenous bizarre ultrasonographic appearance was actually found to represent small subendometrial sonolucencies in the proximal myometrium. Because none of these patients were clinically bleeding and all had inactive endometria on biopsy, it seems prudent not to overinterpret ultrasonography findings in patients receiving tamoxifen who have not had fluid-enhanced assessment. (AM J OBSTET GYNECOL 1994;170:447-51.)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Furr BJA
        • Jordan VC
        The pharmacology and clinical use of tamoxifen.
        Pharmacol Ther. 1984; 25: 127-135
        • Grenman SE
        • Roberts JA
        • England BG
        • et al.
        In vitro growth regulation of endometrial carcinoma cells by tamoxifen and medroxyprogesterone acetate.
        Gynecol Oncol. 1988; 30: 239-250
        • Gottardia MM
        • Robinson SP
        • Satyaswaroop PG
        • et al.
        Contrasting actions of tamoxifen on endometrial and breast tumor growth in the athymic mouse.
        Cancer Res. 1988; 48: 812-815
        • Hardell L
        Tamoxifen as risk factor for carcinoma of corpus uteri [Letter].
        Lancet. 1988; 2: 563
        • Hardell L
        Pelvic irradiation and tamoxifen as risk factors for carcinoma of corpus uteri [Letter].
        Lancet. 1988; 2: 1432
        • Jordan VC
        Tamoxifen and endometrial cancer [Letter].
        Lancet. 1989; 2: 117-120
        • Stewart HJ
        • Knight GM
        Tamoxifen and the uterus and endometrium [Letter].
        Lancet. 1989; 1: 375-376
        • Neven P
        • De Muyleder X
        • Van Belle Y
        • et al.
        Tamoxifen and the uterus and endometrium [Letter].
        Lancet. 1989; 1: 375
        • Mathew A
        • Chabon AB
        • Kabakow B
        • et al.
        Endometrial carcinoma in five patients with breast cancer on tamoxifen therapy.
        N Y J Med. 1990; 90: 207-208
        • Atlanta G
        • Pozzi M
        • Vincenzoni C
        • et al.
        Four case reports presenting new acquisitions on the association between breast and endometrial carcinoma.
        Gynecol Oncol. 1990; 37: 378-380
        • Fornander T
        • Cedermark B
        • Mattsson A
        • et al.
        Adjuvant tamoxifen in early breast cancer: occurrence of new primary cancers.
        Lancet. 1989; 1: 117-120
        • Neven P
        • De Muylder X
        • Van Belle Y
        • et al.
        Hysteroscopic follow-up during tamoxifen treatment.
        Eur J Obstet Reprod Biol. 1990; 35: 235-238
        • Gal D
        • Kopel S
        • Bashevkin M
        • et al.
        Oncogenic potential of tamoxifen on endometria of postmenopausal women with breast cancer - preliminary report.
        Gynecol Oncol. 1991; 42: 120-123
        • Gusberg SB
        Tamoxifen for breast cancer: associated endometrial cancer [Editorial].
        Cancer. 1990; 65: 1463-1464
        • Timor-Tritsch IE
        • Rottem S
        Transvaginal sonography.
        in: 2nd ed. Elsevier, New York1991: 80-81
        • Nasri MN
        • Shephard JH
        • Setchell ME
        • et al.
        The role of vaginal scan in measurement of endometrial thickness in postmenopausal women.
        Br J Obstet Gynaecol. 1991; 98: 470-475
        • Osmers R
        • Volksen M
        • Schauer A
        Vaginosonography for early detection of endometrial carcinoma?.
        Lancet. 1990; 335: 1569-1571
        • Goldstein SR
        • Nachtigall M
        • Snyder JR
        • Nachtigall L.
        Endometrial assessment by vaginal ultrasonography before endometrial sampling in patients with postmenopausal bleeding.
        AM J OBSTET GYNECOL. 1990; 163: 119-123
        • Goldstein SR.
        Incorporating endovaginal ultrasonography into the overall gynecologic examination.
        AM J OBSTET GYNECOL. 1990; 162: 625-632
        • Burke P
        • Fasciano F
        • Frigerio A
        • et al.
        Studio ectomografico dell utero post-menopausale in pazienti tratte con tamoxifen.
        Minerva Ginecol. 1987; 39: 453-457