DOI: 10.1097/MPA.0b013e318255adec
,
,
PMID: 23254914
Issn Print: 0885-3177
Publication Date: 2013/01/01
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Estrogen receptors are present at the level of specialized organs—ovaries, uterus, mammary gland—as well as at the level of other organs, the pancreas among them. If their role in the first case is well established, the role of estrogen receptors in other cases is less known.
It is interesting to underline the presence of estrogen receptors at the level of fibrotic tissues in patients with retroperitoneal fibrosis, a serious invalidating affection, and the favorable reaction to tamoxifen in many cases. A possible relationship was suggested between estrogen receptors, the fibrosis process, and that of atherosclerosis, mainly at the level of the aorta.1,2
A case of retroperitoneal fibrosis treated with tamoxifen for 3 years, with favorable evolution under observation follow-up, developed pancreatic neoplasia within 2 years since interruption of the treatment. We want to discuss the possible relationship of this treatment and the estrogen receptors, but at a pancreatic level.
The pancreas has estrogen receptors; they have also been found in the tumor tissue in pancreatic carcinoma.3,4 Moreover, the treatment with modulators of estrogen receptors was used in treating pancreatic carcinoma.5
A 74-year-old female patient with diabetes mellitus (under oral antidiabetics for 10 years), hypertension (15 years), and a long history of urinary tract infections was hospitalized when given a diagnosis of extensive retroperitoneal fibrosis with extrinsic obstruction of the right ureter and subsequent hydronephrosis. Aortic atheromatosis with calcifications in the inferior part of the aorta was also found.
Treatment with tamoxifen was administered for 3 years, with favorable evolution.
In 2007, the ultrasound examination showed endometrial hyperplasia and a 2-cm cyst in the left ovary.
In June 2007, hysterectomy was performed, including bilateral ovarectomy and periaortic tissue resection.
A histopathological examination showed uterine fibromatosis. Endometrial proliferation or neoplastic transformations were excluded. By histochemical methods, the presence of estrogen receptors at the level of the uterus was detected (Fig. 1). At histochemical examination, the periaortic fibrous tissue showed the presence of estrogen and progesterone receptors.
Treatment with tamoxifen was discontinued.
One year after the last tomography, pancreatic cancer was detected, which imposed surgical intervention. The pathological examination showed presence of estrogen receptors in the tumoral tissue. These receptors were also present in the pancreatic tissue nonaffected by the tumoral process.
We do not know how long it takes for a neoplastic process to develop in organisms. Can we bring into discussion whether the treatment with tamoxifen might have exerted a time prophylactic effects on the occurrence of pancreatic cancer by modulation of estrogen receptors? The question is whether there are any connections between fibrosis pathologic processes and neoplastic processes and what is the role of estrogen receptors in the 2 processes.
