Endometrial polyps

Uterine Fibroids Adenomyosis Endometrial polyps Gynecologic cancers Alteration of endometrium, changes in uterine contractility Alteration of endometrium, changes in uterine contractility Alteration of endometrium Various dysplastic alterations of endometrium, uterus, cervix... 

The estrogenicity of tamoxifen at several levels brings both advantages and inconveniences. Among the former we have already mentioned bone quality and vaginal proliferation. However, the inconveniences, especially endometrial polyps and cancer and thrombotic events, are important enough to avoid the... 

It has been demonstrated that At is embryotoxic in pregnant mice, and there also exists a dose-related occurrence of associated fetal malformations (29, 30). Long-term studies in female rats that had received 0.5 /tCi g At systemically indicated a significant incidence of radiation-induced mammary carcinomata (39/45 44%) and endometrial polyps (43/55 76.4%) at 14 months after treatment. No thyroid tumors were found (50). Detailed macroscopic radiation dosimetric studies related to the biodistribution of At in animal models have been reported (29, 33, 39). 

Effects on reproductive organs and reproductive function have been observed in animals following oral exposure to PBBs. An increased incidence of uterine endometrial polyps was observed in rats, 2 years after they were administered a single gavage of 1,000 mg/kg dose FireMaster FF-1 (Kimbrough et al. 

Several sources have suggested that raloxifene can on occasion either cause uterine endometrial polyps or cause pre-existent polyps to enlarge considerably (30). 

Maia H Jr, Maltez A, Oliveira M, Almeida M, Coutinho EM. Growth of an endometrial polyp in a postmenopausal patient using raloxifene. Gynaecol Endosc 2000 9 117-21. 

Endometrial polyps ( basilomas ) can become malignant (82,83), perhaps because they lack progesterone receptors and are exposed to unopposed estrogen (84). 

A Japanese study of DNA extracted from endometrial polyps in women treated with tamoxifen showed a threefold increase in K-ras mutations compared with the incidence in cases of spontaneous endometrial hyperplasia. These findings could support the hypothesis that the endometrial polyps will prove an early indicator for the development of endometrial carcinoma in such patients (86). 

Uterine fibroids and endometrial polyps (sometimes with bleeding) have been reported in menopausal women who had taken tamoxifen for periods of months or years (SEDA-16, 466) (92,93). In view of this, the question of whether tamoxifen increases the risk of endometrial cancer has been widely discussed. The authors of a 1993 review of the outcome of six major trials tended strongly to the conclusion that tamoxifen can cause both endometrial hyperplasia and endometrial cancer proportional to the total dose (94) the figures pointed to an overall incidence of endometrial cancer of 0.5 % in tamoxifen users and 0.1% in controls. Another major review up to 1992 concluded that in the world literature there were 70 cases of uterine malignancies with tamoxifen, including 61 cases of adenocarcinoma of the endometrium and four cases of uterine sarcoma (95). 

When assessing the risk of endometrial malignancy in women with breast cancer taking tamoxifen, it is worth taking into account evidence that patients with breast cancer may at the outset have some endometrial pathology. In women with breast cancer scheduled for tamoxifen there were endometrial polyps in 9.3%, endometrial cysts in 16%, and synechiae in 12% at the outset. Tamoxifen significantly increased the incidence of these benign endometrial lesions, usually after less than 1 year of treatment. There were no cases of endometrial carcinoma in 34 patients who had taken tamoxifen for 12-24 months, and only one in 78 patients who had taken it for 5-72 months (103). 

Cohen I, Azaria R, Bernheim J, Shapira J, Beyth Y. Risk factors of endometrial polyps resected from postmenopausal patients with breast carcinoma treated with tamoxifen. Cancer 2001 92(5) 1151-5. 

Cohen I, Bernheim J, Azaria R, Tepper R, Sharony R, Beyth Y. Malignant endometrial polyps in postmenopausal breast cancer tamoxifen-treated patients. Gynecol Oncol 1999 75(1) 136-41. 

Biron-Shental T, Tepper R, Fishman A, Shapira J, Cohen I. Recurrent endometrial polyps in postmenopausal breast cancer patients on tamoxifen. Gynecol Oncol 2003 90 382-6. 

Hachisuga T, Miyakawa T, Tsujioka H, Horiuchi S, Emoto M, Kawarabayashi T. K-ras mutation in tamoxifen-related endometrial polyps. Cancer 2003 98 1890-7. 

Houghton JP, Ioffe OB, Silverberg SG, McGrady B, McCluggage WG. Metastatic breast lobular carcinoma involving tamoxifen-associated endometrial polyps report of two cases and review of tamoxifen-associated polypoid uterine lesions. Mod Pathol 2003 16 395-8. 

Nuovo MA, Nuovo GJ, McCaffrey RM, Levine RU, Barron B, Winkler B. Endometrial polyps in postmenopausal patients receiving tamoxifen. Int J Gynecol Pathol 1989 8(2) 125—31. 

In fact, the most widely recognized adverse effects of tamoxifen are those related to the stimulatory effects on the endometrium. These effects include proliferation of the endometrium (Dijkhuizen et al., 1996 Hann et al., 1997 Lahti et al., 1993), formation of endometrial polyps (Cohen et al., 1997 Hann et al., 1997 Kedar et al., 1994a Lahti et al., 1993), hyperplasia (Cohen, 1997 Lahti et al, 1993), and cancer (Fisher et al, 1994 Rutqvist et al., 1995 Stearns and Gelmann, 1998 Wilking et al, 1997). Other reproductive side effects of tamoxifen are worsening of endometriosis (Buckley, 1990 Hajjar et al, 1993 Ismail and Maulik, 1997), adenomyosis (Cohen etal, 1997), and proliferation of benign uterine tumors (Cohen, 1997 Kang et al, 1996). 

Uterine fibroids and endometrial polyps (sometimes with bleeding) have been reported in menopausal women who had taken tamoxifen for periods of months or years (SEDA-16, 466) (62,63). In view of this, the question of whether tamoxifen increases the risk of... 

Tanioxircn hits seen extensive use in treating primary breast cancers that arc ER dependent, For premenopausal women with metastatic disease, tamoxifen is an alternative and adjuvant with oophorectomy, ovarian irradiation, and mastectomy. Tamoxifen u.se. however, is not problem free. Tamoxifen increases the incidence of endometrial polyps. hyperplasia, and carcinoma and uterine sarcomas. The risk of endometrial cancer resulting from tamoxifen is. however. much lower than the "modest but highly significant reductions in morbidity and mortality of breast cancer." Becau.se of the increased risk of endometrial cancer with tamoxifen therapy, tamoxifen. should be u.sed to prevent breast cancer only in women at high ri.sk. Women without a family history of breast cancer or other risks should not use tamoxifen in this manner. 

MHRA, Drug Safety Update I (2), 5 (from internet) (2007) Notelovitz M, MedGenMed 9( I), 2 Endometrial polyps... 

It has been proposed that studying CDIO expression could help to distinguish invasive endometrial cancer from adenocarcinomas that colonize adenomyosis. " Since CDIO expression is characteristic of endometrial stroma and not myometrial smooth muscle, the theory goes that CDIO expression surrounding adenocarcinoma in the myometrium would support adenomyosis over invasive carcinoma. Unfortunately, there are at least two problems with this idea. It turns out that many invasive adenocarcinomas are surrounded by a rim of tissue that expresses CDIO, such that the appearance mimics the endometrial stroma that one expects in adenomyosis. A less common problem involves metaplastic stroma. In occasional endometrial cancers, endometrial stroma supporting endometrial cancer undergoes metaplasia to a smooth muscle or fibroblastic phenotype, similar to the stroma that is characteristic of endometrial polyps. This metaplastic stroma frequently expresses CDIO only weakly or focally. Therefore, absent CDIO staining does not entirely exclude the presence of endometrial stroma and adenomyosis. 

Euscher ED, Malpica A, Deavers MT, et al. Differential expression of WT-l in serous carcinomas in the peritoneum with or without associated serous carcinoma in endometrial polyps. Am J Surg Pathol. 2005 29 1074-1078. 

Grasel RP, Outwater EK et al (2000) Endometrial polyps MR imaging features and distinction from endometrial carcinoma. Radiology 214 47-52... 

Fig. 5.22. Leiomyoma, diffuse adenomyosis and endometrial polyp on MRI. T2-weighted sagittal image of a patient depicts di se adenomyosis (arrowheads) with symmetrical broadening of the junctional zone. An endometrial polyp exhibiting similar high signal intensity as the endometrium can be clearly identified within the uterine cavity (short arrow). A fibroid is present in the fundus (long arrow)...

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