Endometrial Adenofibroma in a Patient Receiving Toremifene: A Case Report

INTRODUCTION

Adenofibroma is a rare benign Müllerian mixed tumor composed of epithelial and mesenchymal cells. This tumor may occasionally be associated with toremifene therapy which is used as an adjuvant drug for breast cancer.

CASE PRESENTATION

We describe a case of a 55-year-old woman with adenofibroma of the endometrium. This patient was receiving toremifene after surgery and neoadjuvant chemotherapy for breast cancer. She underwent a total abdominal hysterectomy and bilateral salpingectomy. There was no evidence of tumor residual or recurrence at 32 months of MRI follow-up.

CONCLUSION

In conclusion, we report a rare case of endometrial adenofibroma in a patient receiving toremifene. It must be borne in mind that long-term toremifene therapy may increase the frequency of endometrial neoplasms.

Nephrogenic adenofibroma in a young child

Nephrogenic adenofibroma is a benign renal tumor in children and young adults described by Hennigar and Beckwith in 1992. Seven cases have been described, and we report the first case in an 11-month-old child, in good health, revealed by a macroscopic hematuria. Nephrogenic adenofibroma is an unusual tumor, which was difficult to distinguish from nephroblastoma and mesoblastic nephroma. Beckwith makes a distinction between this principal differential diagnosis in child renal tumors based upon morphologic and immunohistochemical patterns. In our observation, the diagnosis remained difficult and needed several reviews of our case. Beckwith proposed the final diagnosis: nephrogenic adenofibroma with stromal predominance. The prognosis is excellent and no treatment is indicated. A FISH analysis of the tumor cells found a trisomy 11. Trisomy 11 has been reported in mesoblastic nephroma as the most frequent chromosomal abnormality. This finding in tumor cells provides an argument for excluding the diagnosis of nephroblastoma but can not clarify the difference between nephrogenic adenofibroma and mesoblastic nephroma.

Ovarian endometrioid adenocarcinoma coexistent with benign and borderline endometrioid adenofibroma: a case report

A well-differentiated endometrioid adenocarcinoma coexistent with benign and borderline-malignant endometrioid adenofibroma was found in the ovary of a 64-year-old woman. She had vaginal bleeding caused by simple hyperplasia of the endometrium due to high levels of sex steroid hormones. A FIGO stage Ia solid ovarian tumor was identified. It was composed of irregularly shaped endometriotic glands with benign and borderline malignant cytologic features embedded in abundant fibromatous stroma. Well-differentiated malignant epithelium was adjacent to these areas, but fibromatous stroma was not predominant. She was treated by surgery and three cycles of chemotherapy. This paper describes this unusual tumor and reviews the literature.

Feline mammary carcinomas as a model for human breast cancer. II. Comparison of in vivo and in vitro adriamycin sensitivity

Feline mammary carcinomas were tested for their in vitro and in vivo sensitivity to Adriamycin. In vitro, twenty randomly chosen tumor islands were studied to test the effect of concentrations of the drug ranging from 0.25-2.00 micrograms/ml. In vivo, parts of primary tumors left in situ after surgical biopsy were used to assess the response to five i.v. injections of 30 mg/m2 Adriamycin. When comparing the in vitro and in vivo response, the best sensitivity (100%) was obtained using 2.00 micrograms/ml Adriamycin and the best specificity (75%) using 1.00 microgram/ml Adriamycin, both in vitro. Tumors recurring after treatment showed acquired resistance in vitro.

Tamoxifen responders selection by computerized contact thermography in benign breast disease

Initial thermic breast values recorded by contact thermography in 29 premenopausal patients with benign breast disease were compared to those recorded 4 and 24 hours after a single 20 mg tamoxifen oral administration. Programmes worked out by the thermographic Prometheus computerized system processed the thermic values. The data obtained were analyzed and compared to the clinical effects resulting from 2 or 3 tamoxifen therapeutic cycles subsequently administered to these patients. The results obtained so far are indicative of the possibility to differentiate by thermographic means the responders from non-responders to subsequent tamoxifen-therapy for breast benign disease.

Combined tamoxifen-lynestrenol treatment in benign breast disease

In order to avoid secondary induction of estrogens caused by tamoxifen treatment, tamoxifen was associated with the progestative lynestrenol in 48 menstrual women with benign breast disease (adenoma or fibroadenoma, cystic, simple or complex dysplasia). In one variant tamoxifen dosage was 20 mg (2 tablets) daily taken orally from day 5 to day 25 of the menstrual cycle, associated with 10 mg (2 tablets) of lynestrenol daily, only during the last 15 days. In another variant the above mentioned drugs were given concomitantly from day 10 to 15 of the cycle (according to cycle length) for 10 days. The average duration of the treatment was 4 cycles. The results are analysed according to surface percentage reduction of the main and associated lesions within the same case. In all cases of simple dysplasia, in 78% of the cases with complex dysplasia and in 54% of the adenomas, the lesions decreased to less than half their initial size, and in some instances the lesions disappeared altogether and the breasts became normally soft. Breast pain was improved or disappeared altogether in 96% of the cases. Despite its positive results the associated treatment used should be applied only in certain cases, especially those diagnozed as complex dysplasia and only in those medical units that have adequate diagnosis and treatment follow-up facilities.

Short-term tamoxifen treatment in benign breast diseases

Fifty woman patients with adenoma or fibroadenoma, cystic, simple or complex dysplasias were treated with tamoxifen in daily doses of 20 mg. (2 tbs.) for 10 or 20 days during one or two menstrual cycles (in most cases 2 successive treatments) and uninterrupted for 30 or 90 days in menopaused women. A response was recorded in the main and associated lesions as well as in several similar lesions in the same case, and therefore, the results are analysed according to the lesion surface reduction in percentage. The different responses recorded can explain why the classification into responders and non-responders is difficult to make sometimes. 64% of the cases responded to the treatment. The results are most relevant if lesions are summed up and considered by type of lesion. Subjective symptoms disappeared or improved in 97% for mastodynia and 100% for dysmenorrhoea with a general decrease in menstrual bleeding. Short-term treatment of two tamoxifen cycles can be a means to select the responsive cases. They may be a preliminary stage before further endocrine treatment or before further surgery. This medicating pattern can solve some cases otherwise fit for surgery only.

[The treatment of benign pathological conditions of the breasts with progesterone and progestogens. The results according to the type of breast condition (260 case records) (author's transl)]

This work reports the clinical results which were obtained after treating 260 women who had pathological conditions of the breasts using a combination of a progestogen which was given by a generalised route (orally or by injection) and progesterone which was applied locally so that its effect would be percutaneous on the breasts. These results were evaluated according to the effectiveness of the treatment according to the different symptoms or groups of clinical symptoms and radiological findings which had been noted at the time of the first examination. A better therapeutic effect was found in cases of early lesions where oedema was the dominant factor (mastodynia) and glandular hyperplasia (diffuse polyadenomatosis). On the other hand, longstanding lesions (sclerocystic mastopathia) where sclerosis was marked showed a much more variable result of treatment with progestogens. Therefore its seems that benign conditions of the breasts should be treated early and particularly in the stage of mastodynia if development into irreversible sclerotic conditions is to be avoided. It also has to be carried on for a long time, especially if there are other risk factors for cancer which are associated with conditions in the breast. The prophylactic role of this treatment in regard to cancer of the breast is discussed.

Inhibitory effect of mepitiostane on the growth of mammary tumor of a rat

Mepitiostane (2alpha,3alpha-epithio-5alpha-androstan-17beta-yl 1-methoxycyclopentyl ether) is an orally active anti-estrogenic and anabolic-androgenic steroid compound. Mepitiostane administered orally suppressed the growth of transplanted estrogen-dependent mammary tumor in rats. This result was compared with the oral administration of fluoxymesterone, which is widely used orally for treatment of advanced breast cancer. Experimental result showed that Mepitiostane has a more dominant antitumor activity than fluoxymesterone. Therefore, this new compound may be useful for clinical treatment of breast cancer.

Regression of "hormone-independent" DMBA-induced mammary carcinomas in response to GP 48989 and its effects on hormone receptors

GP 48 989 causes regression of DMBA-induced mammary carcinomas of spayed ("hormone-independent"), non spayed (approximately 5% "hormone-dependent") rats and of tumors which had become refractory to estradiol treatment. Since no binding to the cytoplasmic estradiol receptor after prolonged intramuscular treatment was found, the compound does not act as a classical anti-estrogen.

Pathological review of breast lesions analyzed for estrogen receptor protein

This report provides a detailed pathological review of 333 specimens analyzed for estrogen receptor protein (ERP) and correlates a series of morphological features with ERP results. Included were 147 primary breast carcinomas, 78 metastases, 27 fibroadenomas, and 81 nonneoplastic tissues, all from women. ERP in cytosols was assayed by incubation with [3H]estradiol in the presence and absence of "cold" estradiol followed by dextran-charcoal treatment. Results were summarized as positive (greater 60% inhibition by nontritiated estradiol, greater than 10 fmoles/mg protein), negative (less than 60% inhibition by nontritiated estradiol, less than 10 fmoles/mg protein), or intermediate borderline combinations. ERP in primary tumors ranged from 0.2 to 358 fmoles/mg protein (54.4% positive, 35.4% negative, 10.2% borderline). New findings are: (a) a high frequency of positive ERP in invasive lobular carcinoma (12 of 13, 92.3%) compared to typical ductal tumors (64 of 117, 54.7%); and (b) low frequency of positive ERP(5 of 21, 23.8%) in tumors with a prominent local lymphocyte reaction. Three ERP-positive noncarcinomatous specimens were fibroadenomas of high epithelial cellularity from patients under 30 years. No statistically significant relationship existed between ERP and any other morphological features that were examined.