الفهرس 
Anatomy of the Female Genital System
Submucosal LeiomyomaOnly 14 pages are availabe for public view
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Abstract
ormonal therapy (Tamoxifen) is an effective adjuvant therapy in treating breast cancer, but it is associated with increased endometrial cancer risk.
It has a pro-estrogenic effect on the endometrium and is associated with a number of pathologies.
The gynecologic side effects of Tamoxifen are diverse and reflect the complexity of its mechanism of action, with agonistic and antagonistic effects on various tissues, depending on the ambient estradiol concentration and hence menopausal status of the patient.
The most worrisome gynecologic side effect was a two- to three-fold increased risk of endometrial cancer in postmenopausal women.
Despite its side effects, the benefits of Tamoxifen in controlling breast cancer or prevention of its relapse are still without debate.
Up to one-half of breast cancer patients who are treated with Tamoxifen may develop an endometrial lesion within 6-36 months. Therefore, any patient who develops bleeding while taking Tamoxifen requires evaluation.
The present study has shown that long term use of Tamoxifen as adjuvant therapy for carcinoma breast is associated with endometrial pathology. Endometrial thickness is increased in such patients and is related to the duration of Tamoxifen use.
There is a significant risk of premalignant and malignant lesions of endometrium in patients on long term Tamoxifen. All patients on long term Tamoxifen should be annually screened for endometrial pathology.
We evaluated whether there is a correlation between Tamoxifen therapy and endometrial benign and malignant conditions and correlate the findings by TVUS by pathology.
The study group comprised 50 patients with breast cancer who were treated with Tamoxifen for a period ranging from 3months to 5 years, by TVUS endometrial thickness measurement was ranging from (3 to 30 mm) the mean is 10.22mm and standard deviation ± 5.76 mm, all patients were candidate for endometrial biopsy regarding their TVUS findings and gynecological examination.
In our study, 22 patients (44%), their transvaginal ultrasound showed no definite abnormality could be, thickness ranging from 3-8 mm, from these 4 patients (8%) were with endometrial thickness 3-5mm (cut off of normal postmenopausal female 5mm) and 18 patients (36 %) were with endometrial thickness 5-8 mm. By follow up in all these patients during study, all of them preserved their sonographic appearance and had no abnormality by histopathology.
Total 28 patients (56%) with period of Tamoxifen range from 7 months up to 5 years, their transvaginal ultrasound showed different types of pathologies in the form of:
1- 4 patients (8%) detected with uni or bilateral adnexal cysts either simple or complicated in their follow up with normal sonographic appearance of myometrium, no focal lesions detected and smooth regular endometrium with thickness ranging from 5 - 7.7 mm.
2- 24 patients (46%) had normal sonographic appearance of myometrium and adnexa but, their endometrium show different measures of endometrial thickness ranged from 8-30 mm, after D&C and histopathology results showed different types of pathology in endometrium.
Prevalence of their histopathology results were:- Endometrial hyperplasia (14%), Endometrial polyp (14%), Adenomyosis (10%), Endometrial atrophy (6%) and Endometrial carcinoma (4) %.
We detected that, endometrial carcinoma patients were having a thickened inhomogenous echogenic endometrium ranged in our study from 25 – 30mm with ill-defined border, in some cases lost endometrial – myometrial interface. This sonographic findings are considered suspicious criteria of malignancy.
Endometrium hyperplasia patients were having regular smooth echogenic endometrium, some of them showed regular border, homogenous endometrium with endometrial thickness ranged in our study from 16-19 mm.
Endometrial polyp patients had thickened homogenous endometrium ranged in our study from 10-17 mm with preservation of subendometrial halo and presence of multiple variable sized cysts, some patients had surrounding fluid secretions ± vascular pedicle.
Endometrial atrophy had thinned homogenous echogenic endometrium 3 and 4 mm, preserving subendometrial halo with one case detected with internal hypoechoic cystic variable areas endometrial thickness 14.7mm.
Adenomyosis patients had mild increase in endometrial thickness ranged in our study from 8.6-11 mm with multiple cystic spaces also noted in myometrium (heterogeneous) with irregular endometrial border.
So TVUS is a necessary screening tool for detection of endometrial abnormalities in breast cancer patients under hormonal therapy.