Korean J Obstet Gynecol KJOG Korean Journal of Obstetrics & Gynecology 2233-5188 2233-5196 Korean Society of Obstetrics and Gynecology 10.5468/KJOG.2011.54.12.836 Case Report A giant endometrial polyp with tamoxifen therapy in postmenopausal woman Moon Soo Hyeon MD 1 Lee Seong Eui MD 1 Jung In Kook MD 1 Jeong Ju Eun MD 1 Park Won Young MD 2 Yi Woo Hee MD 3 Suh Dong Soo MD 1 Yoon Man Soo MD 1 Kim Ki Hyung MD 1 Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Korea. Department of Pathology, Pusan National University School of Medicine, Busan, Korea. Department of Obstetrics and Gynecology, Busan St. Mary's Medical Center, Busan, Korea. Corresponding author: Ki Hyung Kim, MD. Department of Obstetrics and Gynecology, Pusan National University School of Medicine, 305 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel : +82-51-240-7288, Fax: +82-51-248-2384, ghkim@pusan.ac.kr 12 2011 15 12 2011 54 12 836 840 27 07 2011 08 09 2011 Copyright © 2011. Korean Society of Obstetrics and Gynecology 2011

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Tamoxifen is a synthetic non-steroid anti-estrogen that has been used effectively for several years in the adjuvant treatment of breast cancer. But, the drug has been associated with development of endometrial poylp, hyperplasia and adenocarcinoma possibly mediated through its agonistic estrogen properties during the menopausal period in which estrogens are at a low level. Endometrial polyp has been described as the most common endometrial pathology in association with postmenopausal tamoxifen treatment. We present the case of woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for 5 years after breast cancer surgery.

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Transvaginal ultrasonographic image of an endometrial polyp in 58-year-old patient with breast cancer treated with tamoxifen. The Swiss-cheese appearance of the polyp is evident.

Pelvic magnetic resonance imaging findings. (A) Axial T2-weighted image shows a 6 cm sized endometrial mass with multiple hyperintense cystic lesions (arrowhead) and hypointense fibrous stroma (arrow). (B) Sagittal T2-weighted image shows a hypointense fibrovascular stalk (arrow) within hyperintense cystic mass (arrowheads) that is limited to endometrial cavity. (C) Sagittal gadolinium enhanced T1-weighted image shows an enhancing fibrovascular stalk (arrow) within the endometrial mass. (D) Diffusion-weighted image at b=800 s/mm2 shows a hypointense mass (*) and (E) apparent diffusion coefficient map shows a hyperintense mass (*), which is suggestive of benign endometrial lesion such as endometrial polyp.

Gross finding. A giant endometrial polyp which developed after prolonged tamoxifen treatment. Extirpated polyp measuring 7.5 × 5.5 × 2.6 cm.

Microscopic findings. (A) Tumor is consisted of cystically dilated endometrial glands with fibrotic stroma (H&E, ×100). (B) Cystic glands are lined by flattened epithelium (H&E, ×200). Estrogen receptor (ER) and progesterone receptor (PR) immunohistochemical staining (C, D). Both receptors are positive for stromal cells and epithelial cells (×200). (E) Immunohistochemically weak staining for Ki-67; 1-2% (×400). (F) Bcl-2 positive for dilated endometrial glans and stroma in endometrial polyp (×100).