Tamoxifen is the drug of choice in the treatment of breast cancer. Recent reports show an increased incidence of endometrial carcinoma in patients taking tamoxifen. In this article, we report a case of malignant mixed mullerian tumor after tamoxifen use. Copyright Â© 2006 by Razi Institute for Drug Research (RIDR)

Eftekhar, Z.

Izadi-Mood, N.

Rahimi-Moghaddam, P.

Yarandi, F.

English

Tamoxifen is the drug of choice in the treatment of breast cancer.
Recent reports show an increased incidence of endometrial carcinoma in
patients taking tamoxifen. In this article, we report a case of
malignant mixed mullerian tumor after tamoxifen use

Eftekhar, Zahra

Yarandi, Fariba

Izadi-Mood, Narges

Rahimi-Moghaddam, Parvaneh

University of Toronto Research Repository

Case Report - Malignant Mixed Mullerian Tumor of the Uterus Associated
with Tamoxifen Therapy in a Patient with a History of Breast Cancer

eprints Iran University of Medical Sciences

     IJPT  |  January 2006  |  vol. 5  |  no. 1  | 81-82 CASE REPORT Malignant Mixed Mullerian Tumor of the Uterus Associated with Tamoxifen Therapy in a Patient with a History of Breast Cancer ZAHRA EFTEKHAR, FARIBA YARANDI, NARGES IZADI-MOOD, PARVANEH RAHIMI-MOGHADDAM For author affiliations, see end of text. Received June 16, 2005; Revised May 29, 2006; Accepted June 3, 2006 This paper is available online at http://ijpt.iums.ac.ir ABSTRACT Tamoxifen is the drug of choice in the treatment of breast cancer. Recent reports show an increased inci-dence of endometrial carcinoma in patients taking tamoxifen. In this article, we report a case of malignant mixed mullerian tumor after tamoxifen use. Keywords: Tamoxifen, Breast cancer, Endometrial cancer, Case report Tamoxifen therapy is known to increase the risk of endometrial carcinoma. Most of these malignancies are endometrial adenocarcinma, but occurrence of endome-trial sarcoma has been reported as well [‎1-‎6]. Here, we report a woman who developed a malignant mixed mul-lerian tumor after use of tamoxifen for 5 years. CASE REPORT A 72-year-old woman, gravida 6, para 6, live child 4, was admitted to our gynecologic clinic because of post-menopausal vaginal bleeding for two months. Her medical history showed a standard radical left mastect-omy after the diagnosis of left breast cancer at age 60. She received an oral dose of 200mg tamoxifen daily for 5 years. In physical exam, she had a big uterus approx-imately in size of uterus of a 16-weeks pregnant woman. Abdominal ultrasound image showed a big uterine mass (3 × 2.9 × 1.8 cm) in endometrial area in association with liquid accumulation in adnexae. CT scan showed no bone involvement. An endometrial biopsy was ob-tained which showed a mixture of carcinomatous and sarcomatous elements. In sarcomatous component, pleomorphic cells with atypical mitoses and bizarre tu-moral giant cells were observed (Fig 1). In the carcino-matous part, malignant epithelial cells were arranged in tubular structures or cords (Fig 2). The preliminary pa-thological diagnosis was malignant mixed mullerian tumor. We performed laparotomy with a pre-operative diagnosis of malignant uterine mass. A total abdominal hysterectomy and bilateral salpingo-ophorectomy and pelvic lymph node sampling were performed. In gross examination, there was a polypoid tumoral mass mea-suring 5 x 4 cm in diameter which occupied endometrial cavity. The tumor invaded full thickness of the myome-trium. In microscopic examination, tumor consisted of tumoral epithelial cells with foci of pleomorphic atypi-cal spindle cells. Omentum and liver were involved as well. The diagnosis of malignant mixed mullerian tumor was made. DISCUSSION Tamoxifen, a partial agonist of estrogen, has been widely used in the treatment of breast cancer. In the recent yeas, the occurrence of uterine malignancy in patients receiving tamoxifen has been identified. These malignancies have been reported as adenocarcinoma as well as uterine sarcoma. In women not taking tamox-ifen, fewer cases of uterine malignancies have been ob-served when compared with those taking the drug. Tamoxifen is a complex drug with both agonist and antagonist effects on estrogen receptors. This mixture agonist and antagonist properties may explain both effi-cacy and toxicity of tamoxifen. Toxic effects of tamox-ifen are observable throughout the entire urogenital tract including vaginal epithelium, cervix, uterine corpus, endometrium an ovaries. Tamoxifen has a proliferative effect on endometrial stromal cells and this effect is intensified by higher doses of drug as well as a longer time of its use [‎7-‎8]. Overall, benefits of tamoxifen in the treatment and prevention of breast cancer is much higher than its risk for uterine malignancies. It should be kept in mind that 1735-2657/06/51-81-82 IRANIAN JOURNAL OF PHARMACOLOGY & THERAPEUTICS Copyright © 2006 by Razi Institute for Drug Research (RIDR) IJPT 5:81-82, 2006 82 |  IJPT  |  January 2006  |  vol. 5  |  no. 1  Eftekhar et al.  high-risk patient for endometrial cancer should be iden-tified before tamoxifen therapy. Also, in patients re-ceiving tamoxifen, regular uterine sonography in con-junction with endometrial biopsies would be appropriate for early diagnosis of endometrial malignancies. REFERENCES 1. Bocklage T, Lee KR, Belinson JL. Uterine mullerian adenosar-coma following adenomyoma in a woman on tamoxifen therapy. Gynecol Oncol. 1992;44:104-9. 2. Clarke MR. Uterine malignant mixed mullerian tumor in a pa-tient on long-term tamoxifen therapy for breast cancer. Gynecol Oncol. 1993;51:411-5. 3. Carvalho FM, Carvalho JP, Motta EV, Souen J.Mullerian adeno-sarcoma of the uterus with sarcomatous overgrowth following tamoxifen treatment for breast cancer. Rev Hosp Clin Fac Med Sao Paulo. 2000;55:17-20. 4. Arici DS, Aker H, Yildiz E, Tasyurt A. Mullerian adenosaraco-ma of the uterus associated with tamoxifen therapy. Arch Gyne-col Obstet. 2000;264:105-7. 5. Maluf FC, Sabbatini P, Schwartz L, Xia J, Aghajanian C. Endo-metrial stromal sarcoma: objective response to letrozole. Gyne-col Oncol. 2001;82:384-8. 6. Saga Y, Ohwada M, Kohno T, Takayashiki N, Suzuki M. High-grade endometrial stromal sarcoma after treatment with tamox-ifen in a patient treated for breast cancer. Int J Gynecol Cancer. 2003;13:690-2. 7. Dallenbach-Hellweg G, Schmidt D, Hellberg P, Bourne T, Kreuzwieser E, Doren M, Rydh W, Rudenstam G, Granberg S. The endometrium in breast cancer patients on tamoxifen. Arch Gynecol Obstet. 2000;263:170-7. 8. Deligdisch L, Kalir T, Cohen CJ, de Latour M, Le Bouedec G, Penault-Llorca F. Endometrial histopathology in 700 patients treated with tamoxifen for breast cancer. Gynecol Oncol. 2000;78:181-6. CURRENT AUTHOR ADDRESSES Zahra Eftekhar, Department of Gynecologic Oncology, Mirza-Koochak-Khan Hospital, Tehran University of Medical Sciences. Nejatollahi St. Karim Khan Zand Ave. Tehran, Iran. Phone: +98 (21) 6693 9320, Fax: +98 (21) 6693 7321 E-mail: par127@mail.usask.ca (Corresponding Author). Fariba Yarandi, Department of Gynecologic Oncology, Iran Universi-ty of Medical Sciences, Mirza-Koochak-Khan Hospital, Tehran University of Medical Sciences. Narges Izadi-Mood, Department of Pathology, Mirza-Koochak-Khan Hospital, Tehran University of Medical Sciences. Parvaneh Rahimi-Moghaddam, Razi Institute for Drug Research, Iran University of Medical Sciences, Tehran, Iran. Fig 1. Sarcomatous component of malignant mixed mullerian tumor. Fig 2. Carcinomatous element of malignant mixed mullerian tumor. 

Malignant mixed mullerian tumor of the uterus associated with tamoxifen therapy in a patient with a history of breast cancer

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Malignant mixed mullerian tumor of the uterus associated with tamoxifen therapy in a patient with a history of breast cancer

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