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Re: tamoxifen/ultrasoundFrom: Terrence.Jones@ncal.kaiperm.orgTue Mar 26 17:03:52 1996
Art, Thanks for the reply. Sono-hysterogram seems an innovative method for documenting a sub-endometrial location to this lesion. However, this has already been shown as such by hysteroscopy. My concern is of a "myometrial" neoplastic lesion which appears to be enlarging. There is evidence to suggest that tamoxifen SUPPRESSES benign leiomyomata (Howe, Endocrinology 11/95 vol 136: 4996-5003) as well as benign metastasizing leiomyomata, (Coppleson, Gynecol Oncol 1992, pg 832 {Text}). The article by Dilts (AJOG 1/92 vol 166: 167-8), describing increased myoma growth while on Tamoxifen, is presumed secondary to PREMENOPAUSAL ovarian stimulation. Despite the reassuring outcome in the 5 pts presented by Goldstein, there is some concern based on a case report by Bocklage et al (Gynecol Oncol {Journal this time, not Textbook} 1/96 vol 44: 104-9), describing a pt with an adenomyoma which subsequently developed into an adenomyosarcoma after initiating tamoxifen therapy. I worry that sampling error, secondary to heterogeneity, might create a false sense of reassurance, and was hoping someone had more experience with such findings. Thanx, TJ. KSF. --------------------------( Enclosure 1 follows )---------------------------- Date: Tuesday, 26 March 1996 9:14am --------------------------( Enclosure 1 follows )---------------------------- From: evsono@pipeline.com (acf) --------------------------( Enclosure 1 follows )---------------------------- Subject: Re: tamoxifen/ultrasound Sender: ob-gyn-l@listserv.bcm.tmc.edu To: terrence.jones@ncal.kaiperm.org Errors-to: gklein@bcm.tmc.edu Reply-To: ob-gyn-l@listserv.bcm.tmc.edu Precedence: bulk Originator: ob-gyn-l@listserv.bcm.tmc.edu X-Listserver-Version: 6.0 -- UNIX ListServer by Anastasios Kotsikonas X-Comment: List for the discussion of obstetrics and gynecology hi! sounds like a good indication for a "sono-hysterogram!" following Steve Goldstein's lead, we have instilled sterile saline into the uterine cavity to further evaluate these tamoxifen-induced findings. this procedure is very well-tolerated and requires no pre-medication or anesthesia. incidentally, our most common finding has been polyp. certainly worth a try and definitely before resorting to uterine biopsy. art fougner, md forest hills, ny evsono@nyc.pipeline.com
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