Ovarian cysts in postmenopausal tamoxifen-treated breast cancer patients with endometrial thickening detected by transvaginal sonography

Objective: To investigate the frequency of ovarian cysts in tamoxifen-treated postmenopausal breast cancer patients with endometrial thickening detected by transvaginal sonography.

Methods: Medical records and transvaginal sonographies of 38 postmenopausal women treated for breast cancer with adjuvant tamoxifen therapy who had undergone endometrial sampling due to abnormal endometrial thickness were reviewed retrospectively.

Results: During the study period five of 38 tamoxifen-treated postmenopausal patients (13.2%) had ovarian cysts. The mean tamoxifen treatment interval of the patients with an ovarian cyst was 22.4 +/- 18.4 months (p = 0.17). The mean endometrial thickness of the patients with an ovarian cyst was 12.6 +/- 5.9 mm (p = 0.17). Endometrial biopsy detected six cases of abnormal endometria, including endometrial carcinoma (n = 1), endometrial polyp (n = 1) and simple endometrial hyperplasia without atypia (n = 4). Three patients with ovarian cysts underwent laparatomy revealing simple cysts on histopathological examination. Two patients with ovarian cysts declined laparatomy and are currently under follow-up.

Conclusion: Ovarian cysts a common side-effect of tamoxifen treatment in postmenopausal tamoxifen-treated breast cancer patients. Transvaginal sonography should be performed to detect any concomitant endometrial pathology.

Tamoxifen; Endometrium; Postmenopause; Ovarian cyst

[1] Sunderland M. C., Osborne C. K.,:'Tamoxifen in premenopausal patients with metastatic breast cancer: a review". J. Clin. Oncol., 1991, 9, 1283.

[2] Gol<lhirsch A., Gelber R. D., Castiglione M. for the International Breast Cancer Study Group.: "Ad」vant therapy of breast cancer" Eur..T. Cancer, 1991, 27,399

[3] Spinelli G., Bordozzi N., Citernessi A., Fontonarosa M., Curiel P.: "Endometrial carcinoma in tamoxifen treated cancer patients". J. Chemother， 1991, 3. 267.

[4] ordan V. C.: "Long-term adjuvant tamoxifen therapy for breast cancer". Breast cancer Res. Treat.. 1990, 15, 125.

[5] Uziely B., Lewin A., Brufman, G., Dorembus D.,Mor-Yosef S.: 'The effect of tamoxifen on the endometrium". Breast Cancer Res. Treat., 1993, 26, 101.

[6] Hartgc P., Schiffman M. H., Hoover R., McGowan L., Lesher L., Norris H.J.: "A case-control study of epithelial ovarian cancer". Am. J. Obstet. Gynecol., 1989, 161, 10.

[7] Jolles C. J., Smotkin D., Ford K. L.,J ones K. P.: "Cystic ovanan necrosis complicating tamoxifen therapy in a premenopausal breast cancer woman: a case report"..I. Reprod. Med., 1990, 35, 299.

[8] Terada S., Uchide K., Suzuki N., Akasofu K.: "A follicular cyst during tamoxifen therapy in a premenopausal breast cancer woman". Gynecol. Obstet. Invest., 1993, 3, 62.

[9] Hung T. H., Pollak M.: "Insulin-like growth factor I gene expression in the uterus is stimulated by tamoxifen and inh伽ted by the pure antiestrogen TC! 1827780". Cancer Res., 1993, 53, 5589.

[10] Shushan A., Peretz T., Uziely B., Lewin A., Mor-Yosef S.: "Ovarian cysts in premenopausal and postmenopausal tamoxifentreated women with breast cancer". Am. J. Obstet. Gynecol., 1996, 174, 141.

[11] Fisher B., Constantino J. P., Redmondo C. K., Fisher E. R., Wickerham D. L., Cronin W. M.: "Endometrial cancer in tamoxifen treated breast cancer women: Findings from the national surgical breast and bowel project. (NSABP) B-14". J. Natl. Cancer Inst., 1994, 86, 527.

[12] McGonigle K. F., Vasilev S. A., Odom-Maryon T., Simpson J. F: "Ovarian histopathology in brest cancer patients receiving tamoxifen". Gynecol. Oncol., 1999, 73, 402.

[13] Mourits M. J., de Vries E. G., Willemse D. H., ten Hoor K. A., Hollema H., Sluitcr W. J. et al.: "Ovarian cysts in women receiving tamoxifen for breast cancer". Br. J. Cancer, 1999, 79. 1761.

[14] Lindahl B., Andolf E., lnguar C., Liedman R., Ranstam J., Willen R.: "Endometrial thickness and ovarian cysts as measured by ultrasound in asymptomatic postmenopausal breast cancer patients on various adjuvant treatments including tamoxifen". Anticancer Res., 1997, 17, 3821.

[15] Cohen I.,F iger A.,Te pper R.,S hapira J.,A ltaras M. M.,Y igael D., Beyth Y.: "Ovarian hyperstimulation and cystic formation in premenopausal tamoxifen exposure: Comparison between tamoxifentreated and non-treated breast cancer patients". Gynecol. Oncol., 1999, 72, 202.

[16] Gorodeski G. I.. Beery R., Lunenfeld B., Geiger A.: "Tamoxifen increases plasma estrogen-binding equivalent、and has an estradiol agonistic effect on histologically normal premenopausal and postmenopusal endometrium‘’ Fertil. Steril., 1992, 57, 320.