20 July 2008 Case of the Week #125
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We thank Dr. Mowafak Hamodat, Eastern Health of Newfoundland and Labrador, St. Johns, Canada for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.
Case of the Week #125
A 62 year old woman presented to her gynecologist with postmenopausal bleeding. Seven endometrial biopsies were taken, all showing negative results, although one was suggestive of an endometrial polyp. Physical examination showed uterine prolapse with cystocele, for which the patient requested a hysterectomy. Past medical history included well controlled hypertension, DVT and a mastectomy 12 years previous, for which she received Tamoxifen for a few years. A hysterectomy was performed. These sections are from an endometrial polyp.
What is your diagnosis?
Metastatic lobular carcinoma in an endometrial polyp.
Immunostains were confirmatory for a breast metastasis (ER, PR, GCDFP-15). Metastases to the cervix (image #1; #2) were also identified, with a similar morphology and staining pattern. The mastectomy was apparently performed for lobular breast carcinoma, although no reports or slides were available.
Tamoxifen is an estrogen antagonist widely used for treatment or prevention of breast carcinoma. It may cause endometrial proliferative abnormalities, including endometrial polyps (Obstet Gynecol 1992;79:111). Since metastatic breast carcinoma to tamoxifen-associated polyps has been reported, usually involving lobular carcinoma (Ann Diagn Pathol 2005;9:166, Mod Path 2003;16:395, Gynecol Oncol 2005;97:946, Obstet Gynecol 2003;102:1149, Acta Obstet Gynecol Scand 1993;72:585), careful histologic evaluation of the endometrium is crucial in these patients.
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