title: Villous papyraceous: an unusual cause of tamoxifen-induced postmenopausal bleeding.
abstract: OBJECTIVE
  We describe an unusual histological finding in a woman with postmenopausal bleeding who was being treated with tamoxifen for breast cancer.
  
  
  METHODS
  This patient presented with a history of postmenopausal bleeding, 4 years after her last period. Pelvic ultrasound showed a thickened cystic endometrium and bulky uterus. A diagnostic endometrial aspiration biopsy by Pipelle was performed; at this time, urinary beta-human chorionic gonadotropin was negative.
  
  
  RESULTS
  Histology showed villous papyraceous (sclerosed and mummified chorionic villi) in a background of scanty atrophic endometrium.
  
  
  CONCLUSIONS
  Tamoxifen has dual estrogenic and antiestrogenic effects; the estrogenic effects have been associated with ovulation induction in premenopausal women. This effect, however, has not been documented in postmenopausal women. We conclude that the presence of chorionic villi is, in this instance, likely to be a tamoxifen-mediated effect.
authors.affiliation: Department of Gynaecology, Royal Cornwall Hospital, Truro, UK.
authors.forename: A
authors.initials: A
authors.lastname: Oladipo
authors.forename: J
authors.initials: J
authors.lastname: Mathew
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D001707:Biopsy, Needle; D006063:Chorionic Gonadotropin / Q000097:blood; D002824:Chorionic Villi / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D013629:Tamoxifen / Q000009:adverse effects*; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D018931:Antineoplastic Agents, Hormonal; D006063:Chorionic Gonadotropin; D013629:Tamoxifen