Villous papyraceous: an unusual cause of tamoxifen-induced postmenopausal bleeding.
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.
Oladipo
A
A
Department of Gynaecology, Royal Cornwall Hospital, Truro, UK.
Mathew
J
J
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
D018931:Antineoplastic Agents, Hormonal; D006063:Chorionic Gonadotropin; D013629:Tamoxifen