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Regression of tamoxifen-stimulated massive uterine fibroid after conversion to anastrozole

A 93-year-old woman was referred to the rapid access oncology clinic with a large pelvic mass and increasing frequency of micturition. During the past 16 years she had been attending the gynaecology department for changes of a shelf pessary. During 2001, her uterus was found to be slightly enlarged. An ultrasound scan suggested multiple uterine fibroids. She had been diagnosed as having a localised cancer of the left breast 5 years earlier. Because of her age, this had been treated with Tamoxifen alone (20 mg daily) continuously since that time. This treatment had kept the local tumour under control but had not eradicated it. There was no evidence of metastasis. On examination, she had no evidence of anaemia, jaundice or lymphadenopathy. Abdominal palpation revealed a large non-tender 24-week size mass consistent with a large uterine fibroid. On vaginal examination, the mass was in continuity with the cervix. An ultrasound scan confirmed that the mass was uterine in origin with features of fibroids and no ascites, urinary retention or hydronephrosis. A chest X-ray was normal. It was concluded that the mass was probably a large leiomyoma and that its growth might have been promoted by Tamoxifen. She declined laparotomy. The Tamoxifen was stopped and Anastrozole (1 mg daily) was commenced. The woman was reviewed in the clinic 5 weeks later when she reported a great improvement in her symptoms and there was an obvious reduction in the size of the mass to that of an 18-week size pregnancy. Nine weeks after discontinuation, the woman had no pressure symptoms and the mass was 12 – 14 weeks in size and freely mobile.