Abstract
Background: Although tamoxifen has well documented oestrogen-like effects in the endometrium and ectocervical squamous epithelium, its effects on the endocervix are poorly documented. Case report: We report a case of an 88 year-old woman who presented with postmenopausal bleeding after receiving tamoxifen for 16 months following a diagnosis of Grade 2 invasive and in situ carcinoma of breast. Endometrial biopsy was performed revealing either atypical hyperplasia or adenocarcinoma. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and lymph gland sampling. Histopathological examination of the uterus showed an endometrioid carcinoma (FIGO Grade 2) at the endometrium. In addition, there was extensive florid endocervical microglandular hyperplasia. Conclusion: Endocervical microglandular hyperplasia is usually seen in woman of reproductive age, particularly in association with pregnancy and contraceptive use. It is unusual in postmenopausal woman and its presence in this 88 year-old tamoxifentreated patient implicates tamoxifen as a course of endocervical microglandular hyperplasia in this instance.
Highlights
ConclusionEndocervical microglandular hyperplasia is usually seen in woman of reproductive age, in association with pregnancy and contraceptive use
The non-steroidal triphenylethylene derivative tamoxifen has been widely used in the management of established breast cancer [1]
Microscopic examination showed a FIGO grade 2 adenocarcinoma of the endometrium with significant myometrial invasion confined to the inner half of the uterine wall
Summary
Published reports regarding the short-term pathological effects of tamoxifen on the endometrium are difficult to evaluate critically because of an unfortunate lack of attention to pathological detail and lack of understanding of the pathological terminology [16]. Tamoxifen may cause florid endocervical hyperplasia in older postmenopausal women, a finding which may lead to diagnostic difficulties when seen in association with endometrial carcinoma [15]
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