Uterine sarcoma in patients receiving tamoxifen therapy: two cases.

Introduction. - Tamoxifen - a non steroidal triphenylethyl compound - in ad dition to having antiestrogenic properties may provoke weak estrogenic effe cts, the well known "paradoxical effects" on the female genital tractus, Co ncern has been raised about prolonged tamoxifen treatment and subsequent oc currence of endometrial adenocarcinoma; subsequent attention has been drawn through high risk histologic subtypes including poorly differentiated patt erns and uterine sarcomas. Exegesis. - We report two cases of uterine sarcoma arising in postmenopausa l women taking tamoxifen, 20 mg daily during 38 and 42 months, for breast c arcinoma: one leiomyosarcoma and one endometrial stromal sarcoma; both case s were asymptomatic and detected by pelvic sonography. Conclusion. - Further studies will be required to establish if there is a r elationship between long term tamoxifen exposure and highly aggressive type s of cancer of the uterine corpus exhibiting adverse histologic features su ch as uterine sarcomas. There is no consensus regarding uterine surveillanc e of women receiving tamoxifen. We advocate an annual gynecologic examinati on plus imaging by means of transvaginal ultrasonography. (C) 2001 Editions scientifiques et medicales Elsevier SAS.