三苯氧胺治疗乳腺癌诱发子宫内膜增生过长一例

三苯氧胺治疗乳腺癌诱发子宫内膜增生过长一例裘乾金患者５０岁。于１９９３年６月１４日因患左侧乳腺癌在某院行乳腺癌根治术，于同年８月１３日行双侧卵巢切除去势。术后采用环磷酰胺、氨甲喋呤、顺铂联合化疗１疗程后，口服三苯氧胺，每次１０ｍｇ，每日２次，连续服用...     

三苯氧胺治疗乳腺癌：诱发子宫内膜癌

ＴＡＭ是治疗乳腺癌的有效药物，但是长期应用可以诱发子宫内膜癌。其作用机理与其雌激素样作用有关，ＴＡＭ的致宫内膜癌作用不容忽视，应引起临床医师重视并寻找预报措施。     

三苯氧胺治疗子宫内膜异位症的再评价

三苯氧胺（ＴＡＭ）基本的作用机制是与靶细胞雌激素受体结合，产生雌激素／抗雌激素效应。ＴＡＭ可能存在受体外作用部位。体内有八种ＴＡＭ代谢产物，均有生物学活性。ＴＡＭ的双重效应受体内有多种因素制约，其中以雌激素水平最重要。应用ＴＡＭ治疗子宫内膜异位症有许多优点，但对绝经期前后妇女可能诱发子宫内膜异位症，促进子宫内膜增生，导致子宫内膜癌及其他肿瘤。因此，选择ＴＡＭ治疗时应慎重，采取相应对策需予考虑。     

三苯氧胺对子宫内膜的影响

目的：观察乳腺癌患者服用三苯氧胺（TAM）后对子宫内膜的影响。方法：26例乳腺癌患者服用TAM（TAM组）后出现阴道异常出血或B超检查发现子宫内膜增厚而行宫腔镜检查及子宫内膜病理检查。另外以同时期无TAM服药史的非乳腺癌患者因绝经后阴道出血而行宫腔镜检查的78例作为对照组。结果：TAM组发生子宫内膜息肉和宫颈息肉共13例（50.0%）,而对照组为14例（17.9%),两组比较,差异有显著性（P＜0.05)。TAM组发生子宫内膜增生9例（34.6%),明显高于对照组的12例（15.4%,P＜0.05)。结论：乳腺癌患者长期服用TAM后子宫内膜病变增多,故对这些患者应进行B超监测子宫腔镜检查。     

释放左旋18甲基炔诺酮宫内节育器对三苯氧胺引起子宫内膜病变的治疗

目的　探讨释放左旋 18甲基炔诺酮宫内节育器 (LNG -IUD ,Mirena)对服用三苯氧胺的乳腺癌患者子宫内膜病变的疗效和不良反应。方法　对 2 7例绝经后乳腺癌患者 ,术后服用三苯氧胺 (1～ 10 8个月 )引起的子宫内膜增厚进行临床资料分析 ,经过宫腔镜及诊断性刮宫除外子宫内膜癌后 ,宫内放置Mirena ,每 1～3个月行阴道B超 1次 ,观察放置前后子宫内膜厚度的变化及不良反应。结果　 2 7例置Mirena患者 ,从放置前子宫内膜平均厚度 (1 30± 0 4 2 )cm ,到放置后 3、6及 12个月以上时 ,子宫内膜平均厚度分别为 (0 95± 0 2 9)cm、(0 93± 0 36 )cm及 (0 78± 0 2 2 )cm ,P值均 <0 0 1。不良反应主要为不规则阴道流血 ,但大多可自行停止。结论　释放左旋 18甲基炔诺酮宫内节育器对服用三苯氧胺绝经后乳腺癌患者增厚的子宫内膜具有治疗作用 ,不良反应轻微。左旋 18甲基炔诺酮可以保护服用三苯氧胺的绝经后乳腺癌患者的子宫内膜。     

三苯氧胺对绝经后子宫及性激素的影响

目的选择手术确诊的绝经后乳腺癌患者１７例,前瞻性观察服用三苯氧胺后子宫及性激素的变化。方法采用妇科检查、盆腔Ｂ超检查、血激素测定以及病理检查观察随访。结果服药后发生子宫肌瘤３例（其中１例并发子宫内膜单纯增生）,子宫内膜息肉１例。血清促卵泡激素明显降低,血清睾酮明显升高。结论三苯氧胺可引起子宫内膜增生性病变,促进子宫肌瘤的发生、发展,建议对服用三苯氧胺的患者应进行定期随访,以便及早发现和及时处理妇科并发症     

三苯氧胺的妇科作用

雌激素拮挤剂三苯氧胺被广泛使用于乳腺癌的辅助治疗，在欧洲和美国的几项研究已显示其在增加生存，减少复发中的作用。然而该药作用具有组织特异性，对子宫内膜，肌层和阴道发挥雌激素样作用。在安慰剂对照试验中已肯定该增加子宫体危险性。由于其广泛使用，因此有必要复习其妇科作用。     

三苯氧胺短期治疗子宫内膜癌对孕激素受体及性激素水平的影响

三苯氧胺短期治疗子宫内膜癌对孕激素受体及性激素水平的影响孙红，张惜阴近年来，在妇科肿瘤领域中，子宫内膜癌的发病卒在世界各国均有不同程度的增加，大量的资料表明：雌激素有促使子宫内膜癌发生的潜在可能［１～３］，由此，人们发现抗雌激素药物三苯氧胺可治疗子宫...     

长期应用三苯氧胺的妇科并发症

三苯氧胺为一治疗、预防乳腺癌的较为安全有效的药物，近年也用于治疗妇科恶性肿瘤及某些良性疾患。但长期应用可使子宫内膜增生及子宫内膜癌发病率增加，并可能与卵巢囊肿、子宫内膜异位症发病有关。     

三苯氧胺致卵巢囊肿一例

患者 37岁 ,因发现下腹部包块 5个月 ,于 1996年 3月2 7日入院。 5个月前出现一次下腹隐痛 ,妇科检查发现右侧附件区有一鸭卵大包块 ,Ｂ超检查提示为附件囊肿 ,未予治疗。近 2个月来下腹有坠胀感。患者孕 1产 1。既往月经规律 ,无痛经史 ,末次月经 1996年 3月 18日。入院检查 :一般情况好 ,心肺正常 ,腹软 ,肝脾无肿大。妇科检查 :子宫前位、稍大、质中 ,其后方扪及一约妊娠 4个月大小包块 ,囊性 ,压痛不明显 ,活动度差。初步诊断为卵巢巧克力囊肿。于 1996年 4月 1日行剖腹探查术。术中见子宫稍大 ,质硬。右侧卵巢 2 0ｃｍ× 16ｃｍ× 12ｃ…     

Saline infusion sonography and office hysteroscopy to assess endometrial morbidity associated with tamoxifen intake

OBJECTIVE: The objective of this study was to compare office feasibility, patient acceptance, and diagnostic accuracy of hysteroscopy (HYS) and saline infusion sonography (SIS) in breast cancer patients taking tamoxifen. METHODS: Sixty-six asymptomatic postmenopausal women on tamoxifen for breast cancer underwent SIS, followed by outpatient HYS with endometrial biopsy. In all women an endometrial stripe over 4 mm was previously measured by transvaginal ultrasonography (TU). Histologic reports were matched with sonographic and hysteroscopic findings. After SIS and HYS, patients were asked to rate pelvic pain experienced during the two procedures on a 10 cm Visual Analog Scale (VAS). RESULTS: SIS and HYS were not accomplished in 26 (39.3%) and 4 (6.0%) patients, respectively, due to cervical stenosis or patient intolerance. No adverse event was recorded after 40 SIS and 62 hysteroscopic procedures. Pathologic assessment reported 15 polyps (22.7%), 7 hyperplasias (10.5%), and 2 submucous myomas (3.0%). Sensitivity, specificity, and negative and positive predictive values of SIS in distinguishing between normal and abnormal endometrium were 85.7, 83.3, 93.7, and 66.0%, respectively, whereas HYS provided corresponding values of 100, 94.1, 97.8, and 100%, respectively. No significant difference was found between SIS and HYS in the subjective perception of pelvic pain (VAS scores 3.02 +/- 2.8 and 3.82 +/- 2.7, respectively). CONCLUSIONS: Office hysteroscopy is a safe and conclusive diagnostic tool for endometrial investigation in menopausal women on tamoxifen. It exposes the patients to the same pelvic discomfort as SIS, but has a better feasibility rate and diagnostic accuracy.     

DNA-content in endometrial carcinoma of tamoxifen-treated breast cancer patients

DNA measurements and histopathologic evaluation were performed in 17 patients treated with adjuvant tamoxifen for early breast cancer and who developed endometrial carcinoma during or after the tamoxifen therapy. The tumors were exclusively characterized by euploid DNA content except for two cases, one mixed mesodermal sarcoma, a highly malignant and rare tumor, and one adenocarcinoma. Although the use of adjuvant tamoxifen therapy most likely enhances the risk of developing endometrial carcinoma, the beneficial effects of adjuvant breast cancer treatment is of well-known clinical importance. The hazards of giving long-term tamoxifen seem to be low since the endometrial tumors were associated with low-grade malignancy and euploid DNA pattern.     

Subsequent endometrial carcinoma with adjuvant tamoxifen treatment in Japanese breast cancer patients

Abstract. Nishimura N, Hachisuga T, Saito T, Kawarabayashi T. Subsequent endometrial carcinoma with adjuvant tamoxifen treatment in Japanese breast cancer patients.
This study aimed to detail the clinicopathologic features of endometrial carcinomas that developed in Japanese patients receiving adjuvant tamoxifen treatment for breast cancer patients. Ten endometrial carcinomas in tamoxifen-treated breast cancer patients were collected from two medical centers. The endometrial carcinomas included two stage Ia, four stage Ib, two stage Ic and two stage IIIc. Three tumors were Grade 1, six were Grade 2, and one was Grade 3. The tumor was limited to the endometrium in two cases. Myometrial invasion was limited to the inner half of the myometrium in five cases and involved the outer half in three. A mild degree of lymphovascular space invasion was identified in five cases. Deep cervical invasion was recognized in one case. The cell types comprised nine endometrioid adenocarcinomas and one serous carcinoma. Five of eight postmenopausal endometrial carcinomas were associated with polypoid endometrial lesions composed of cystically dilated atrophic and proliferative glands widely separated by fibrotic stroma. Two patients with retroperitoneal lymph node metastases died of endometrial cancer. One patient developed a contralateral breast cancer during tamoxifen treatment. No patient died of breast cancer. We did not demonstrate a higher frequency of either high-grade tumors or unfavorable histologic subtypes in tamoxifen-treated Japanese breast cancer patients.     

Failure of megestrol acetate to reverse tamoxifen induced endometrial neoplasia: two case reports

Abstract. Rose PG, Brandewie EV, Abdul-Karim FW. Failure of megestrol acetate to reverse tamoxifen induced endometrial neoplasia: two case reports.
Tamoxifen's agonist effect on the endometrium has been associated with an increased incidence of endometrial carcinoma. It has been suggested that this agonist effect may be averted by the concomitant use of a progestational agent. We report two patients with breast cancer receiving tamoxifen who developed endometrial carcinoma and atypical endometrial hyperplasia, respectively. In one patient, this occurred despite the use of concomitant megestrol acetate. In the other patient, tamoxifen-associated endometrial hyperplasia persisted and progressed despite cessation of tamoxifen and initiation of megestrol acetate therapy. These cases may have implications for strategies to avert tamoxifen induced endometrial neoplasia.     

子宫内膜癌腹腔镜手术32例临床分析

目的探讨腹腔镜手术治疗子宫内膜癌的临床效果。方法回顾性分析北京大学人民医院2004年2月至2008年12月具有完整资料的子宫内膜癌腹腔镜手术32例患者,并与同期开腹手术32例比较,观察两组的围手术期指标和近期疗效。结果腹腔镜组术中出血量（345．31±276．60）ml,切除淋巴结数量（20．53±8．35）个,开腹组术中出血量（568．75±345．62）ml,切除淋巴结数量（30．41±11．17）个,差异均有统计学意义（P〈0．05）。两组手术时间比较,差异无统计学意义（P＝0．375）。腹腔镜组和开腹组肛门排气时间分别为（1．91±0．86）d和（2．91±1．67）d（P〈0．05）,平均住院时间分别为（17．22±6．19）d和（21．72±6．84）d（P=0．002）,差异均有统计学意义。腹腔镜组淋巴囊肿形成、切口愈合不良等术后并发症发生率明显低于开腹组（P〈0．05）。两组术后无瘤生存率（P=0．629）、总生存率（P=1．000）及复发率（P=0．629）差异均无统计学意义。结论腹腔镜手术术中出血量少、术后并发症少,近期疗效满意,是治疗早期子宫内膜癌较好的手术方式,但其远期治疗效果及长期预后需进一步研究。     

Uterine effects of tamoxifen: a prospective study

The purpose of the study was to evaluate tamoxifen-associated changes in the vagina and uterus in postmenopausal breast cancer patients. Between June 1994 and December 1998, 45 patients enrolled in a prospective study before commencing tamoxifen therapy. Patients with endometrial thickness >5 mm or neoplasia were excluded. Transvaginal ultrasonography, vaginal maturation indexes (VMI), and endometrial biopsy were performed at baseline and repeated at 6 months (n= 42), 1 year (n= 39), 2 years (n= 32), 3 years (n= 26), 4 years (n= 19), and 5 years (n= 15). For the 39 patients followed for 1 year, VMI (% parabasal/intermediate/superficial) was 21/71/8 at baseline compared with 1/90/9 at 1 year (P value = 0.0008/0.001/0.78). At baseline, mean endometrial thickness and uterine volume were 2.6 mm and 64 cm(3), respectively, compared with 5.8 mm and 84 cm(3) at 1 year (P= 0.0002, 0.002). At baseline, 80% of patients had atrophic endometrium and 9% proliferative endometrium compared with 61% and 26% at 1 year, respectively (P= 0.04). No cases of endometrial hyperplasia or adenocarcinoma were detected. Findings observed at 6 months persisted through 5 years of follow-up. Tamoxifen exerts a weak estrogenic effect on the vagina and uterus in highly prescreened postmenopausal women without preexisting endometrial pathology.     

子宫内膜癌85例临床分析

目的探讨子宫内膜癌的临床特点及处理原则。方法回顾性分析1996年9月～2005年9月间北京大学临床肿瘤学院妇科收治的85例子宫内膜癌患者的临床资料、诊治经过及随访结果。结果单纯因腹腔冲洗液细胞学检查阳性导致手术病理分期由Ⅰ期升至Ⅲa期者6例，随访2年．未见复发。而同期因肿瘤侵犯子宫浆膜面或附件所诊断的Ⅲa期10例患者中，术后复发3例，因例数较少，未行统计学分析。13例侵及脉管者4例复发，复发率为30．8％，明显高于未侵及脉管者（3／39，P=0．046）；复发心者中，68．8％于术后2年内发生。结论子宫内膜癌的复发与脉管浸润、手术病理分期及组织学分级有关；单纯因腹腔冲洗液阳性导致的111a期患者预后好于同期别的其他患者。