%PDF-1.2
%
1 0 obj
<<
/CreationDate (D:20050926093605+02'00')
/ModDate (D:20050926093605+02'00')
/Producer (Acrobat Distiller 5.0.5 \(Macintosh\))
/Title (ONCO.2)
/Creator (QuarkXPress\(tm\) 4.1)
>>
endobj
2 0 obj
<<
/Type /Metadata
/Subtype /XML
/Length 937
>>
stream
ONCO.2
endstream
endobj
4 0 obj
<<
/Length 4676
>>
stream
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 0 k
/GS1 gs
26.77 691.61 490.35 -634.96 re
f
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.77 719.95 m
517.12 719.95 l
S
26.77 788 490.35 -56 re
f
26.77 48 24.01 -17.01 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
10 0 0 10 26.7705 33.1601 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(38)Tj
ET
0 0 0 0 k
26.77 57.65 490.35 -1 re
f
26.77 788 490.35 -56 re
f
26.77 152.27 490.35 -95.62 re
f
BT
5.4 0 0 5.4 26.7705 115.3335 Tm
0 0 0 1 k
(1)Tj
9 0 0 9 31.7205 112.3635 Tm
(Servicio de Ginecologa y Obstetricia. Complejo Hospitalario. Hospital General. Segovia)Tj
5.4 0 0 5.4 26.7705 104.58 Tm
(2)Tj
9 0 0 9 31.7205 101.61 Tm
(Servicio de Obstetricia y Ginecologa. Hospital Universitario Santa Cristina. Madrid)Tj
5.4 0 0 5.4 26.7705 93.8267 Tm
(3)Tj
9 0 0 9 31.7205 90.8566 Tm
(Servicio de Anatoma Patolgica. Hospital Universitario Santa Cristina. Madrid)Tj
-0.55 -2.3896 TD
(Recibido: 27.05.05)Tj
0 -1.1948 TD
(Aceptado: 06.07.05)Tj
ET
0 0 0 0 k
26.77 691.61 490.35 -33.61 re
f
BT
12 0 0 12 26.7705 683.4002 Tm
0 0 0 1 k
-0.0001 Tc
(Notas Clnicas)Tj
ET
0 0 0 0 k
26.77 653.99 490.35 -129.63 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
16 0 0 16 26.7705 606.6949 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
[(Sar)17.7(comas de ter)17.7(o despus de tratamiento con tamoxifeno por cncer)]TJ
0 -1.125 TD
(de mama)Tj
10 0 0 10 57.5179 562.887 Tm
(J. I. Bermejo Aycart)Tj
6 0 0 6 144.9715 566.187 Tm
0 Tc
(1)Tj
10 0 0 10 147.9715 562.887 Tm
-0.0001 Tc
(, S. Iniesta Prez)Tj
6 0 0 6 218.7748 566.187 Tm
0 Tc
(2)Tj
10 0 0 10 221.7748 562.887 Tm
-0.0001 Tc
0.0001 Tw
[(, T.)-250.1(Redondo Martn)]TJ
6 0 0 6 309.8217 566.187 Tm
0 Tc
0 Tw
(2)Tj
10 0 0 10 312.8217 562.887 Tm
-0.0001 Tc
(, I. Gallego Villaescusa)Tj
6 0 0 6 409.7528 566.187 Tm
0 Tc
(3)Tj
10 0 0 10 412.7529 562.887 Tm
-0.0001 Tc
(, M. C. Garca Andrade)Tj
6 0 0 6 514.1177 566.187 Tm
0 Tc
(3)Tj
ET
0 0 0 0 k
26.77 510.19 490.35 -345.17 re
f
BT
14 0 0 14 26.7705 486.6153 Tm
0 0 0 1 k
-0.0002 Tc
(Resumen)Tj
13 0 0 13 37.5138 458.6153 Tm
-0.0001 Tc
0.0155 Tw
[( Pr)17.7(opsito:)]TJ
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 105.9591 458.6153 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0.0154 Tw
(Descripcin de dos casos de sarcomas en mujeres que recibieron tamoxifeno despus del tra-)Tj
-7.199 -1.2727 TD
0 Tw
[(tamiento quirr)17.8(gico de cncer de mama.)]TJ
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
13 0 0 13 37.5138 430.6153 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0.0085 Tw
( Material y mtodos:)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 160.8949 430.6153 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0.0085 Tw
(Se describen dos casos de dos mujeres de 74 y 53 aos que recibieron tratamien-)Tj
-12.1931 -1.2727 TD
0.0817 Tw
[(to con 20 mg diarios de tamoxifeno despus del tratamiento quirr)17.8(gico de un cncer de mama. Cuatro y dos)]TJ
T*
0.0754 Tw
(aos despus de iniciar el tratamiento, desarrollaron un tumor Mlleriano mixto maligno heterlogo \(Estadio)Tj
T*
-0.0001 Tc
0 Tw
(III\) y un sarcoma del estroma endometrial \(Estadio I\).)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
13 0 0 13 37.5138 374.6153 Tm
0 0 0 1 k
/GS1 gs
-0.0002 Tc
0.0365 Tw
( Discusin:)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 106.7079 374.6153 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0.0365 Tw
[(Los carcinosarcomas y otros sarcomas uterinos son raros, y ocurren en menos del 4% de los)]TJ
-7.267 -1.2727 TD
0 Tc
0.0545 Tw
[(tumores uterinos. En la mayora de los estudios se refieren tasas altas de estos tumores en mujeres postmeno-)]TJ
T*
0.0159 Tw
(pusicas, con cncer de mama, tratadas con tamoxifeno, en comparacin a las no tratadas, especialmente aque-)Tj
T*
0 Tw
[(llas expuestas a lar)17.8(gos periodos de tratamiento.)]TJ
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
11 0 0 11 37.5138 304.6153 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0.0001 Tw
(Palabras clave:)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 37.5138 290.6153 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
[(Sarcoma uterino. T)69.8(amoxifeno. Cncer de mama.)]TJ
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
11 0 0 11 37.5238 262.6153 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(Oncologa, 2005; 28 \(7\):338-342)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.77 133.69 m
131.7 133.69 l
S
Q
endstream
endobj
5 0 obj
<<
/ProcSet [/PDF /Text ]
/Font <<
/F1 6 0 R
/F2 7 0 R
>>
/ExtGState <<
/GS1 8 0 R
>>
>>
endobj
10 0 obj
<<
/FunctionType 0
/Domain [0 1]
/Range [0 1]
/BitsPerSample 8
/Size [256]
/Length 271
/Filter /FlateDecode
>>
stream
H
!"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~
endstream
endobj
12 0 obj
<<
/Length 7907
>>
stream
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 0 k
/GS1 gs
26.73 691.61 490.35 -634.96 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 26.7332 436.9843 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
[(Intr)17.7(oduccin)]TJ
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 37.4765 410.9843 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0.006 Tw
(El tamoxifeno es el tratamiento antiestrognico de)Tj
-0.9767 -1.1818 TD
0.1086 Tw
(eleccin en pacientes postmenopusicas con cncer)Tj
T*
0.007 Tc
0.118 Tw
(de mama y receptores estrognicos positivos. Uno)Tj
T*
-0.0001 Tc
0.0574 Tw
(de sus efectos adversos ms destacable es su accin)Tj
T*
0.0164 Tc
0.1086 Tw
(proliferativa sobre el endometrio, desde hiperpla-)Tj
T*
0.0239 Tc
0.1011 Tw
[(sias, plipos, carcinomas y sarcomas; llegando a)]TJ
T*
0 Tc
0.11 Tw
[(identificarse hasta en el 36% de los casos tratados)]TJ
6.6 0 0 6.6 255.7029 336.6143 Tm
0 Tw
(1)Tj
11 0 0 11 26.7332 319.9843 Tm
0.014 Tw
(pero tratndose en su mayora de alteraciones benig-)Tj
T*
0.0207 Tc
0.1043 Tw
(nas del tero. Es por ello por lo que los ensayos)Tj
T*
0 Tc
0.0296 Tw
(prospectivos en este tipo de pacientes no desaconse-)Tj
T*
0.0374 Tw
(jan el uso del tamoxifeno como tratamiento coadyu-)Tj
T*
0.0061 Tc
0 Tw
(vante)Tj
6.6 0 0 6.6 50.8918 271.6143 Tm
(2-4)Tj
11 0 0 11 59.8097 267.9843 Tm
0.1189 Tw
(, aunque se investigan otras lneas carentes)Tj
-3.007 -1.1818 TD
0 Tc
0.0362 Tw
[(de estos efectos adversos como los inhibidores de la)]TJ
T*
-0.0001 Tc
0.0658 Tw
(aromatasa. Queremos presentar aqu 2 casos de sar-)Tj
T*
0 Tc
0.1022 Tw
(comas uterinos, en dos pacientes postmenopusicas)Tj
T*
0.0192 Tw
(tratadas con tamoxifeno por un cncer de mama, co-)Tj
T*
0.0142 Tc
0.1108 Tw
(mo una patologa aunque poco frecuente, amplia-)Tj
T*
0 Tc
0 Tw
(mente descrita en la bibliografa.)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 26.7332 150.9843 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(Casos clnicos)Tj
11 0 0 11 26.7332 124.9843 Tm
(Caso 1)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 37.4765 98.9843 Tm
0 0 0 1 k
/GS1 gs
-0.0025 Tc
0.048 Tw
(Paciente de 74 aos en 1997, que consulta por tu-)Tj
-0.9767 -1.1818 TD
0.0852 Tw
(moracin en mama izquierda de 4 cm y una adeno-)Tj
T*
0.004 Tc
0.1185 Tw
(pata palpable. Estudio radiolgico compatible con)Tj
T*
-0.0025 Tc
0.0831 Tw
(carcinoma. Es tratada mediante mastectoma radical)Tj
23.4616 34.2727 TD
0.022 Tw
(modificada tipo Madden previa biopsia intraoperato-)Tj
0 -1.1818 TD
0.0279 Tw
(ria positiva para carcinoma. Informe anatomopatol-)Tj
T*
-0.0016 Tc
0.1241 Tw
(gico: Carcinoma ductal infiltrante mucinoso \(coloi-)Tj
T*
-0.0025 Tc
0.0384 Tw
(de\) de 3.2 cm de eje mximo y una adenopata posi-)Tj
T*
0.0023 Tc
0.1202 Tw
(tiva de 22 ganglios axilares aislados. Recibe como)Tj
T*
0.0048 Tc
0.1177 Tw
(tratamiento complementario tamoxifeno a dosis de)Tj
T*
-0.0025 Tc
0.0224 Tw
(20 mg diarios. Se realizan controles de rastreo de tu-)Tj
T*
0.0024 Tc
0.1201 Tw
(mor que resultan negativos. As mismo se realizan)Tj
T*
-0.0023 Tc
0.1248 Tw
(ecografas ginecolgicas anuales que son normales.)Tj
T*
-0.0025 Tc
0.0779 Tw
(En Mayo de 2001 consulta por metrorragia postme-)Tj
T*
-0.0015 Tc
0.124 Tw
(nopusica. Se realiza una ecografa vaginal que re-)Tj
T*
0.0189 Tc
0.1036 Tw
(sulta ser compatible con plipo endometrial de)Tj
T*
0.0082 Tc
0.1143 Tw
(19*16 mm. Se realiza una Histeroscopia donde se)Tj
T*
-0.0025 Tc
0.0488 Tw
(aprecia una formacin excrecente en la cara anterior)Tj
T*
0.025 Tw
(de vagina que es biopsiada y a nivel intrauterino una)Tj
T*
0.0046 Tw
(formacin polipoidea con vasos anmalos, altamente)Tj
T*
0.064 Tw
(sospechosa que es igualmente biopsiada. El informe)Tj
T*
0.0943 Tw
(anatomopatolgico de la zona en vagina se informa)Tj
T*
0.0014 Tc
0.1211 Tw
(como carcinoma pobremente diferenciado y la for-)Tj
T*
-0.0025 Tc
0 Tw
(macin polipoidea como atipia celular no filiada.)Tj
0.9767 -1.1818 TD
0 Tc
0.1045 Tw
(Se realiza una histerectoma total con doble ane-)Tj
-0.9767 -1.1818 TD
0.0058 Tc
0.1192 Tw
(xectoma, manguito vaginal y linfadenectoma. In-)Tj
T*
0 Tc
0.0586 Tw
(forme anatomopatolgico: Lavado peritoneal positi-)Tj
T*
0.0783 Tw
[(vo para clulas malignas. T)34.9(umor intracavitario de 6)]TJ
T*
0.0079 Tc
0.1171 Tw
[(cm, T)34.9(u)0(mor Mlleriano Mixto Maligno Heterlogo)]TJ
T*
0 Tc
0.081 Tw
(con extensa permeacin vascular linftica. Metsta-)Tj
T*
0.0038 Tc
0.1212 Tw
(sis mltiples en miometrio, trompa y ovarios \(Fig.)Tj
T*
0 Tc
0.0574 Tw
(1\) y metstasis ganglionares. La formacin de vagi-)Tj
T*
0.0141 Tw
(na es de un carcinoma pobremente diferenciado pro-)Tj
T*
0.0032 Tc
0.1218 Tw
(bablemente metstasis del tumor Mlleriano mixto)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.74 719.95 m
517.08 719.95 l
S
0 0 0 0 k
26.73 788 490.35 -56 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
10 0 0 10 382.1097 734.168 Tm
0 0 0 1 k
/GS1 gs
0 Tc
-0.0001 Tw
(Oncologa, 2005; 28 \(7\):338-342)Tj
ET
0 0 0 0 k
493.07 48 24.01 -17.01 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
10 0 0 10 507.0804 33.1601 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(39)Tj
ET
0 0 0 0 k
26.73 691.61 490.35 -239.61 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 26.7332 682.0326 Tm
0 0 0 1 k
/GS1 gs
-0.0002 Tc
0 Tw
(Summary)Tj
13 0 0 13 37.4765 654.0326 Tm
0.0073 Tc
0.1176 Tw
( Purpose:)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 101.706 654.0326 Tm
0 0 0 1 k
/GS1 gs
0.0073 Tc
0.1176 Tw
[(Description of two cases of sarcoma in women who received tamoxifen after the sur)17.6(gical)]TJ
-6.8157 -1.2727 TD
0 Tc
0 Tw
[(treatment of breast cancer)54.9(.)]TJ
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
13 0 0 13 37.4765 626.0326 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0.0563 Tw
( Material and methods:)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 177.9121 626.0326 Tm
0 0 0 1 k
/GS1 gs
-0.0798 Tc
0 Tw
(We)Tj
1.3078 0 TD
( )Tj
0.3063 0 TD
0 Tc
0.0563 Tw
(report two cases of 74 and 53 years old women that received tamoxifen)Tj
-15.3577 -1.2727 TD
0.0073 Tc
0.1177 Tw
[(20 mg daily after the sur)17.8(gical treatment of breast cancer)54.9(. Four and two years after initiation of tamoxifen)]TJ
T*
0.0002 Tc
0.1248 Tw
(treatment, they developed an heterologous malignant mixed Mllerian tumor \(stage III\) and an endometrial)Tj
T*
-0.0001 Tc
0 Tw
[(stromal sarcoma \(stage I\), respectively)64.9(.)]TJ
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
13 0 0 13 37.4765 570.0326 Tm
0 0 0 1 k
/GS1 gs
-0.0002 Tc
0.1175 Tw
( Discussion:)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 113.6703 570.0326 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0.1175 Tw
[(: Carcinosarcomas and other uterine sarcomas are rare, accounting for fewer than 4% of)]TJ
-7.9034 -1.2727 TD
0 Tc
0.058 Tw
[(uterine tumors. Most studies reported on a higher rate of these sarcomas among postmenopausal women with)]TJ
T*
0.0803 Tw
(breast cancer treated with tamoxifen when compared with non-treated patients, especially those exposed to a)Tj
T*
0 Tw
(long term treatment.)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
11 0 0 11 37.4765 500.0326 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(Key words: )Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 94.2919 500.0326 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
[(Uterine sarcoma. T)69.8(a)0(moxifen. Breast cancer)54.9(.)]TJ
ET
Q
endstream
endobj
13 0 obj
<<
/ProcSet [/PDF /Text ]
/Font <<
/F1 6 0 R
/F2 7 0 R
>>
/ExtGState <<
/GS1 8 0 R
>>
>>
endobj
15 0 obj
<<
/Length 5628
>>
stream
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 0 k
/GS1 gs
26.77 691.61 490.35 -634.96 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 27.0402 449.9843 Tm
0 0 0 1 k
/GS1 gs
0.0068 Tc
0.1182 Tw
[(descrito \(Estadio III\). Realiza tratamiento comple-)]TJ
0 -1.1818 TD
0 Tc
0.1195 Tw
[(mentario con T)69.8(axol, que tolera mal, y radioterapia,)]TJ
T*
0 Tw
(falleciendo al ao de este proceso.)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
11 0 0 11 27.0402 397.9843 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(Caso 2)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 37.7835 371.9843 Tm
0 0 0 1 k
/GS1 gs
-0.005 Tc
0.0022 Tw
(Paciente de 53 aos en 1993 momento en el que se)Tj
-0.9767 -1.1818 TD
0.0016 Tw
(le realiza una biopsia diferida previa localizacin con)Tj
T*
0.1003 Tw
[(arpn en mama izquierda por presentar unas micro-)]TJ
T*
-0.0051 Tc
0.0705 Tw
[(calcificaciones sospechosas. Se informa como carci-)]TJ
T*
0.0002 Tc
0.1198 Tw
(noma ductal infiltrante G II con componente intra-)Tj
T*
0.0172 Tc
0.1028 Tw
(ductal slido. Se realiza mastectoma radical tipo)Tj
T*
-0.004 Tc
0.124 Tw
(Madden no objetivndose tumor residual y 21 gan-)Tj
T*
-0.005 Tc
0.0383 Tw
[(glios linfticos sin metstasis. No realiza tratamiento)]TJ
T*
0.0113 Tc
0.1087 Tw
(complementario. En 1996 tiene una recidiva local)Tj
T*
-0.005 Tc
0.0599 Tw
(sobre la cicatriz realizndose una exresis que es in-)Tj
T*
0.0133 Tw
(formada como recidiva local de carcinoma infiltrante)Tj
T*
0.0426 Tw
(de mama. Se indica tratamiento complementario con)Tj
T*
-0.0005 Tc
0.1205 Tw
(radioterapia y tamoxifeno 20 mg diarios. Dos aos)Tj
T*
0.0071 Tc
0.1129 Tw
(ms tarde, en una revisin rutinaria, se le practica)Tj
T*
-0.005 Tc
0.0915 Tw
(una ecografa vaginal en la que se describe un mio-)Tj
T*
0.0297 Tw
(ma de 7*8 cm no visto con anterioridad realizndose)Tj
T*
0.003 Tc
0.117 Tw
(una histerectoma total con doble anexectoma. In-)Tj
T*
-0.005 Tc
0.0292 Tw
(forme anatomopatolgico: Sarcoma del estroma en-)Tj
T*
0.0776 Tw
(dometrial de bajo grado de malignidad e hiperplasia)Tj
T*
0.0406 Tw
[(glandular qustica de endometrio. T)34.9(rompas y ovarios)]TJ
T*
-0.0051 Tc
0 Tw
(sin lesiones \(Estadio I\). \(Figs. 2-4\).)Tj
0.9767 -1.1818 TD
0 Tc
0.0362 Tw
(En Enero del 2002 la paciente presenta un cuadro)Tj
-0.9767 -1.1818 TD
0.0335 Tw
(de disnea con derrame pleural que resulta ser positi-)Tj
T*
0.0369 Tw
(vo para clulas tumorales, falleciendo a los seis me-)Tj
T*
-0.0001 Tc
0 Tw
(ses por mltiples metstasis pulmonares.)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.77 719.95 m
517.12 719.95 l
S
0 0 0 0 k
26.77 788 490.35 -56 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
10 0 0 10 26.7705 734.168 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(J. I. Bermejo Aycart y cols.)Tj
ET
0 0 0 0 k
26.77 48 24.01 -17.01 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
10 0 0 10 26.7705 33.1601 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(40)Tj
ET
0 0 0 0 k
27.02 691.36 231.77 -174.48 re
f
Q
q
1 i
27.02 691.36 231.77 -174.48 re
W* n
/GS1 gs
q
233.1649 0 0 176.0257 26.32 516.1043 cm
/Im1 Do
Q
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
/GS1 gs
27.02 691.36 231.77 -174.48 re
S
0 0 0 0 k
26.77 509.32 232.27 -41.65 re
f
BT
/F1 1 Tf
9 0 0 9 26.7705 503.1609 Tm
0 0 0 1 k
0 Tc
0.1164 Tw
(Figura 1. Metstasis ovrica de un carcinosarcoma. Se aprecia)Tj
1.0753 -1.1948 TD
0.0115 Tw
(en la imagen ocupacin del hilio ovrico por grupos celulares)Tj
T*
0 Tw
(de un tumor sarcomatoso uterino.)Tj
ET
0 0 0 0 k
285.1 455.43 231.77 -152.81 re
f
Q
q
1 i
285.1 455.43 231.77 -152.81 re
W* n
/GS1 gs
q
232.7979 0 0 154.0786 284.58 301.8314 cm
/Im2 Do
Q
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
/GS1 gs
285.1 455.43 231.77 -152.81 re
S
0 0 0 0 k
284.85 295.62 232.27 -29.21 re
f
BT
/F1 1 Tf
9 0 0 9 284.8479 289.4623 Tm
0 0 0 1 k
0 Tc
0.0818 Tw
(Figura 3. Sarcoma del estroma endometrial. Detalle de la ante-)Tj
1.0753 -1.1948 TD
0 Tw
(rior con imgenes de degeneracin clcica.)Tj
ET
0 0 0 0 k
285.1 266.16 231.77 -158.9 re
f
Q
q
1 i
285.1 266.16 231.77 -158.9 re
W* n
/GS1 gs
q
233.4687 0 0 160.5098 284.25 106.4502 cm
/Im3 Do
Q
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
/GS1 gs
285.1 266.16 231.77 -158.9 re
S
0 0 0 0 k
284.85 98.74 232.27 -42.09 re
f
BT
/F1 1 Tf
9 0 0 9 284.8479 92.5897 Tm
0 0 0 1 k
0 Tc
0.0291 Tw
(Figura 4. Detalle microscpico de un sarcoma de la estroma en-)Tj
1.0753 -1.1948 TD
0.0088 Tc
0.1162 Tw
(dometrial. Se aprecian las clulas monomorfas del compo-)Tj
T*
0 Tc
0.072 Tw
(nente del sarcoma del estroma endometrial junto a imgenes)Tj
T*
0 Tw
(de hialinizacin.)Tj
ET
0 0 0 0 k
284.85 691.61 232.27 -229.61 re
f
285.1 691.36 126.93 -217.2 re
f
Q
q
1 i
285.1 691.36 126.93 -217.2 re
W* n
/GS1 gs
q
128.3015 0 0 218.1557 284.28 473.5843 cm
/Im4 Do
Q
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
/GS1 gs
285.1 691.36 126.93 -217.2 re
S
0 0 0 0 k
419.08 574.09 98.04 -100.18 re
f
BT
/F1 1 Tf
9 0 0 9 419.0836 540.3818 Tm
0 0 0 1 k
0 Tc
0 Tw
(Figura 2. Sarcoma del)Tj
0 -1.1948 TD
(estroma endometrial.)Tj
T*
(Se aprecia detalle)Tj
T*
(macroscpico de un tumor)Tj
T*
(que ocupa prcticamente)Tj
T*
(la totalidad de la cavidad)Tj
T*
(uterina.)Tj
ET
Q
endstream
endobj
16 0 obj
<<
/ProcSet [/PDF /Text /ImageB ]
/Font <<
/F1 6 0 R
/F2 7 0 R
>>
/XObject <<
/Im1 17 0 R
/Im2 18 0 R
/Im3 19 0 R
/Im4 20 0 R
>>
/ExtGState <<
/GS1 8 0 R
>>
>>
endobj
22 0 obj
<<
/Length 8491
>>
stream
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 0 k
/GS1 gs
26.73 691.61 490.35 -634.96 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 26.7332 682.0326 Tm
0 0 0 1 k
/GS1 gs
-0.0002 Tc
0 Tw
(Discusin)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
11 0 0 11 37.4765 657.9843 Tm
0 0 0 1 k
/GS1 gs
0.0133 Tc
0.1117 Tw
(De nuestra poblacin estudiada de 463 mujeres)Tj
-0.9767 -1.1818 TD
0 Tc
0.0932 Tw
(que realizaron tratamiento con 20 mg/diarios de ta-)Tj
T*
0.0022 Tw
(moxifeno por cncer de mama, 7 mujeres desarrolla-)Tj
T*
0.019 Tw
(ron un cncer de endometrio \(1.55% de la poblacin)Tj
T*
0.0443 Tw
(en estudio y 2.52 por mil mujeres ao\) siendo cinco)Tj
T*
0.1177 Tw
(de ellos adenocarcinomas de endometrio, un tumor)Tj
T*
0.0055 Tc
0.1195 Tw
(Mlleriano mixto heterlogo y un sarcoma del es-)Tj
T*
0 Tc
0 Tw
(troma endometrial. )Tj
0.9767 -1.1818 TD
0.0005 Tc
0.1245 Tw
(El tamoxifeno es un modulador selectivo del re-)Tj
-0.9767 -1.1818 TD
0 Tc
0.1137 Tw
(ceptor estrognico, utilizado como tratamiento hor-)Tj
T*
0.122 Tw
(monal estndar en la mujer con cncer de mama y)Tj
T*
0.0091 Tc
0.1159 Tw
(receptores de estrgenos positivo y como coadyu-)Tj
T*
0.0231 Tc
0.1019 Tw
(vante en algunos cnceres de mama metastsico,)Tj
T*
0 Tc
0.0768 Tw
(hasta que se concluyan los estudios con inhibidores)Tj
T*
0.0052 Tw
(de la aromatasa, sigue siendo de eleccin en mujeres)Tj
T*
0.0488 Tw
(postmenopusicas con cncer de mama y receptores)Tj
T*
0.0014 Tc
0.1236 Tw
(de estrgeno positivo)Tj
6.6 0 0 6.6 123.8615 453.6143 Tm
0 Tc
0 Tw
(5)Tj
11 0 0 11 127.1707 449.9843 Tm
0.0014 Tc
0.1236 Tw
[(. No obstante no se aconseja)]TJ
-9.1307 -1.1818 TD
0.0024 Tc
0.1226 Tw
[(su uso durante ms de cinco aos por el riesgo de)]TJ
T*
0 Tc
0 Tw
(cncer sobre el endometrio)Tj
6.6 0 0 6.6 145.5256 427.6143 Tm
(6)Tj
11 0 0 11 148.8257 423.9843 Tm
(.)Tj
-10.1227 -1.1818 TD
0.0172 Tw
(La patologa endometrial es ms frecuente en mu-)Tj
-0.9767 -1.1818 TD
0.0014 Tc
0.1236 Tw
(jeres con cncer de mama tratadas con tamoxifeno)Tj
T*
0 Tc
0.0223 Tw
(que en las no tratadas)Tj
6.6 0 0 6.6 122.3942 388.6143 Tm
0 Tw
(7)Tj
11 0 0 11 125.6942 384.9843 Tm
0.0223 Tw
(, existen mltiples publicacio-)Tj
-8.9965 -1.1818 TD
0.0615 Tw
(nes que demuestran un incremento del riesgo relati-)Tj
T*
0.0506 Tw
(vo del cncer endometrial en mujeres con cncer de)Tj
T*
0.075 Tc
0.0542 Tw
[(mama tratadas con tamoxifeno versus las no)]TJ
T*
0.0057 Tc
0 Tw
(tratadas)Tj
6.6 0 0 6.6 61.4352 336.6143 Tm
0.0056 Tc
[(7-1)61.3(1)]TJ
11 0 0 11 73.2773 332.9843 Tm
0.0057 Tc
0.1193 Tw
(, Odds Ratio \(OR\) = 2.4, 95% Intervalo)Tj
-4.2313 -1.1818 TD
0 Tc
0.1079 Tw
(de Confianza \(CI\) = 1.8-3.0 e ntimamente relacio-)Tj
T*
0.0095 Tc
0.1155 Tw
(nado con la duracin del tratamiento; si compara-)Tj
T*
0 Tc
0.0234 Tw
(mos tratadas ms de 5 aos con no tratadas el riesgo)Tj
T*
0 Tw
(aumenta OR = 3.6 95% CI = 2.6-4.8.)Tj
0.9767 -1.1818 TD
-0.0001 Tc
0.0937 Tw
[(Adems el riesgo es mayor de desarrollar T)34.9(umo-)]TJ
-0.9767 -1.1818 TD
0.0175 Tc
0.1074 Tw
(res Mllerianos mesodrmicos mixtos OR = 13.5)Tj
T*
0.0205 Tc
0.1045 Tw
(95% CI 4.1-44.5 que adenocarcinomas OR = 2.1)Tj
T*
0 Tc
0.0478 Tw
[(95% CI 1.6-2.7 o carcinomas de clulas claras y se-)]TJ
T*
-0.0001 Tc
0.0001 Tw
(rosopapilares OR = 3.1 95% CI = 0.8-17.9)Tj
6.6 0 0 6.6 213.8728 219.6143 Tm
0 Tc
0 Tw
(12)Tj
11 0 0 11 220.4729 215.9843 Tm
(.)Tj
-16.636 -1.1818 TD
0.0521 Tw
(La mayora de los carcinomas diagnosticados son)Tj
-0.9767 -1.1818 TD
0.1083 Tw
(endometrioides o adenocarcinomas como ocurre en)Tj
T*
-0.0001 Tc
0 Tw
(nuestra serie)Tj
6.6 0 0 6.6 82.0017 180.6143 Tm
0 Tc
(9, 13)Tj
11 0 0 11 95.2019 176.9843 Tm
(.)Tj
-5.2478 -1.1818 TD
0.0005 Tc
0.1245 Tw
(En estudios recientes se ha puesto de manifiesto)Tj
-0.9767 -1.1818 TD
0.0072 Tc
0.1178 Tw
(que los cnceres endometriales en postmenopusi-)Tj
T*
0 Tc
0.0678 Tw
(cas con cncer de mama y tratadas con tamoxifeno,)Tj
T*
0.0432 Tw
(fueron de diagnstico en estadio ms avanzado y de)Tj
T*
0.0049 Tc
0.12 Tw
(peor pronstico que los tumores que desarrollaban)Tj
T*
0.0045 Tc
0.1205 Tw
(las pacientes no tratadas con tamoxifeno)Tj
6.6 0 0 6.6 213.401 102.6143 Tm
[(7, 9, 1)61.4(1, 14, 15)]TJ
11 0 0 11 256.2525 98.9843 Tm
0 Tc
0 Tw
(.)Tj
-20.8654 -1.1818 TD
0.0695 Tw
[(Las dos pacientes descritas en nuestra casustica tu-)]TJ
T*
0 Tw
(vieron una evolucin muy desfavorable. )Tj
0.9767 -1.1818 TD
(T)Tj
0.542 0 TD
0.0009 Tc
0.1241 Tw
[(ambin se ha descrito una mayor incidencia de)]TJ
21.9429 56.7273 TD
0 Tc
0.0294 Tw
(este tipo de sarcomas en las mujeres tratadas con ta-)Tj
0 -1.1818 TD
0.0102 Tc
0.1148 Tw
[(moxifeno frente a las no tratadas \(15.4% vs 2.9%)]TJ
T*
0.024 Tc
0.101 Tw
(p>0.02 de todas las pacientes con tumores uteri-)Tj
T*
-0.0002 Tc
0 Tw
(nos\))Tj
6.6 0 0 6.6 303.7491 648.6143 Tm
0 Tc
(1)Tj
0.4386 0 TD
(1, 14, 15)Tj
11 0 0 11 329.7439 644.9843 Tm
(.)Tj
-3.1082 -1.1818 TD
0.1121 Tw
(No existen test de diagnstico temprano ni reco-)Tj
-0.9767 -1.1818 TD
0.0576 Tw
(mendaciones para el diagnstico de estas patologas)Tj
T*
0.0335 Tw
(en mujeres que toman tamoxifeno, siendo el sangra-)Tj
T*
0.012 Tw
(do vaginal el nico elemento de alarma, como igual-)Tj
T*
0.1168 Tw
(mente piensa el Colegio Americano de Obstetras y)Tj
T*
0 Tw
(Gineclogos.)Tj
0.9767 -1.1818 TD
0.0649 Tw
(Existen factores que incrementan el riesgo de de-)Tj
-0.9767 -1.1818 TD
0.005 Tc
0.12 Tw
(sarrollar adenocarcinomas como son la obesidad o)Tj
T*
0.0021 Tc
0.1229 Tw
(la terapia hormonal sustitutiva slo con estrgenos)Tj
T*
0 Tc
0.0625 Tw
(en la menopausia y la radioterapia en el caso de los)Tj
T*
0.0162 Tw
[(sarcomas, por ello podramos replantearnos un trata-)]TJ
T*
0.0949 Tw
(miento concreto con tamoxifeno ante estos factores)Tj
T*
-0.0001 Tc
0.0778 Tw
(de riesgo y sustituirlo por otros frmacos como son)Tj
T*
0 Tc
0 Tw
(los inhibidores de la aromatasa.)Tj
9 0 0 9 381.5912 387.2309 Tm
(Correspondencia:)Tj
0 -1.1948 TD
-0.0001 Tc
(Dr. J. I. Bermejo Aycart)Tj
T*
0 Tc
(Servicio de Ginecologa y Obstetricia)Tj
T*
(Complejo Hospitalario)Tj
T*
(Hospital General de Segovia)Tj
T*
-0.0001 Tc
(Carretera de vila, s/n)Tj
T*
0 Tc
(E-40002 Segovia)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
14 0 0 14 284.8106 267.9843 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(Bibliografa)Tj
ET
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
9 0 0 9 289.3106 244.231 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0.0903 Tw
[(1.)-661.7(Cohen I. Endometrial pathologies associated with postme-)]TJ
1.4117 -1.1948 TD
0.0489 Tc
0.0761 Tw
(nopausal tamoxifen treatment. Ginecology Oncology)Tj
T*
0 Tc
0 Tw
(2004;94:256-266.)Tj
-1.4117 -1.4338 TD
(2.)Tj
1.4117 0 TD
0.008 Tc
0.1169 Tw
(Bertelli G, Venturini M, Del Mastro L, et al. Tamoxifen)Tj
0 -1.1948 TD
0 Tc
0.0457 Tw
(and the endometrium: findings of pelvic ultrasound exami-)Tj
T*
0.1093 Tw
(nation and endometrial biopsy in asymtomatic breast can-)Tj
T*
0 Tw
(cer patients. Breast Cancer Res Treat 1998;47:41-46.)Tj
-1.4117 -1.4338 TD
0.0723 Tw
[(3.)-661.7(Love CD, Muir BB, Scrimgeour JB, et al. Investigation of)]TJ
1.4117 -1.1948 TD
0.0052 Tc
0.1198 Tw
(endometrial abnormalities in asymtomatic women treated)Tj
T*
0 Tc
0.0049 Tw
(with tamoxifen and an evaluation of the role of endometrial)Tj
T*
0 Tw
(screening. J Clin Oncol 1999;17:2050-2054.)Tj
-1.4117 -1.4338 TD
-0.0001 Tc
0.099 Tw
[(4.)-661.8(Seoud MA-F, Shamseddine A, Kahlil A, et al. Tamoxifen)]TJ
1.4117 -1.1948 TD
0 Tc
0.0719 Tw
(and endometrial pathologies: a prospective study. Gynecol)Tj
T*
0 Tw
(Oncol 1999;75:15-19.)Tj
-1.4117 -1.4338 TD
0.0549 Tw
[(5.)-661.7(Tamoxifen for early breast cancer: an overview of the ran-)]TJ
1.4117 -1.1948 TD
0.0259 Tw
[(domised trials. Early Breast Cancer Trialists Collaborative)]TJ
T*
0 Tw
(Group. Lancet 1998;351:1451-1467.)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.74 719.95 m
517.08 719.95 l
S
0 0 0 0 k
26.73 788 490.35 -56 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
10 0 0 10 382.1097 734.168 Tm
0 0 0 1 k
/GS1 gs
0 Tc
-0.0001 Tw
(Oncologa, 2005; 28 \(7\):338-342)Tj
ET
0 0 0 0 k
493.07 48 24.01 -17.01 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
10 0 0 10 507.0804 33.1601 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(41)Tj
ET
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
419 427 m
517.08 427 l
S
Q
endstream
endobj
23 0 obj
<<
/ProcSet [/PDF /Text ]
/Font <<
/F1 6 0 R
/F2 7 0 R
>>
/ExtGState <<
/GS1 8 0 R
>>
>>
endobj
25 0 obj
<<
/Length 3429
>>
stream
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
0 0 0 0 k
/GS1 gs
26.77 691.61 490.35 -634.96 re
f
0 0 0 1 K
0 J 0 j 0.5 w 10 M []0 d
26.77 719.95 m
517.12 719.95 l
S
26.77 788 490.35 -56 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F2 1 Tf
10 0 0 10 26.7705 734.168 Tm
0 0 0 1 k
/GS1 gs
-0.0001 Tc
0 Tw
(J. I. Bermejo Aycart y cols.)Tj
ET
0 0 0 0 k
26.77 48 24.01 -17.01 re
f
Q
q
1 i
0 822 541 -822 re
0 822 m
W n
0.015 822.015 540.99 -822 re
W n
BT
/F1 1 Tf
10 0 0 10 26.7705 33.1601 Tm
0 0 0 1 k
/GS1 gs
0 Tc
0 Tw
(42)Tj
ET
0 0 0 0 k
26.77 691.61 490.35 -191.96 re
f
BT
9 0 0 9 31.2705 685.4518 Tm
0 0 0 1 k
0.1071 Tw
[(6.)-661.7(Kloos I, Delaloge S, Pantier P, et al. Tamoxifen related)]TJ
1.4117 -1.1948 TD
0.0877 Tw
(uterine carcinosarcomas occur under/after prolonged treat-)Tj
T*
-0.0001 Tc
0.0372 Tw
(ment: report of five cases and review of the literature. Int J)Tj
T*
0 Tc
0 Tw
(Gynecol Cancer 2002;12:496-500.)Tj
-1.4117 -1.4338 TD
0.0663 Tw
[(7.)-661.7(Deligdisch L, Kalir N, Cohen CJ, et al. Endometrial histo-)]TJ
1.4117 -1.1948 TD
0.0505 Tw
(pathology in 700 patients treated with tamoxifen for breast)Tj
T*
0 Tw
(cancer. Gynecol Oncol 2000;78:181-186.)Tj
-1.4117 -1.4338 TD
0.1035 Tw
[(8.)-661.7(Fornander T, Cedermak B, Mattson A, et al. Adjuvant ta-)]TJ
1.4117 -1.1948 TD
0.0582 Tw
(moxifen in early breast cancer: occurrence of new primary)Tj
T*
0 Tw
(cancers. Lancet 1989;I:117-120.)Tj
-1.4117 -1.4338 TD
0.0972 Tw
[(9.)-661.7(Mignotte H, Lasset C, Bonadona V, et al. Iatrogenic risks)]TJ
1.4117 -1.1948 TD
0.0866 Tw
(of endometrial carcinoma after treatment for breast cancer)Tj
T*
0.0974 Tw
(in a large French case control study. Int J Cancer 1998;)Tj
T*
0 Tw
(76:325 330.)Tj
-1.9117 -1.4338 TD
-0.0001 Tc
0.0816 Tw
[(10.)-661.8(Early Breast Cancer Trialists Collaborative Group. Syste-)]TJ
1.9117 -1.1948 TD
0 Tc
0.11 Tw
(mic treatment of early breast cancer by hormonal, cytoto-)Tj
T*
0 Tw
(xic and immune therapy. Lancet 1992;339:1-15, 71-85.)Tj
26.7636 20.0727 TD
0.015 Tc
0.0833 Tw
[(11.)-616.7(Lasset C, Bonadona V, Mignotte H, Bremond A. Tamo-)]TJ
1.9117 -1.1948 TD
0.09 Tc
0.3902 Tw
(xifen and risk of endometrial cancer. Lancet)Tj
T*
0.015 Tc
0 Tw
(2001;357:66-7.)Tj
-1.9117 -1.4338 TD
-0.0001 Tc
0.1091 Tw
[(12.)-661.8(Swerdlow AJ, Jones ME, British Tamoxifen Second Can-)]TJ
1.9117 -1.1948 TD
0.0127 Tc
0.1122 Tw
[(cer Study Group. Tamoxifen treatment for breast cancer)]TJ
T*
0.0088 Tc
0.1161 Tw
(and risk of endometrial cancer: a case control study. J)Tj
T*
-0.0001 Tc
0 Tw
(Nat Cancer Inst 2005 Mar 2;97\(5\):375-84)Tj
-1.9117 -1.4338 TD
0.015 Tc
0.0662 Tw
[(13.)-616.7(Barakat RR, Wong G, Curtis JP, et al. Tamoxifen use in)]TJ
1.9117 -1.1948 TD
0.0168 Tc
0.1232 Tw
(breast cancer patients who subsequently developed cor-)Tj
T*
0.0199 Tc
0.12 Tw
(pus cancer is not associated with a higher incidence of)Tj
T*
0.015 Tc
0.0411 Tw
(adverse histologic features. Gynecol Oncol 1994;55:164-)Tj
T*
0 Tw
(168.)Tj
-1.9117 -1.4338 TD
0 Tc
0.0948 Tw
[(14.)-661.7(Narod SA, Pal T, Graham T, et al. Tamoxifen and risk of)]TJ
1.9117 -1.1948 TD
0 Tw
(endometrial cancer. Lancet 2001;357:65-66)Tj
-1.9117 -1.4338 TD
0.0903 Tw
[(15.)-661.7(Bergman L, Beelen ML, Gallee MP, et al. Risk and prog-)]TJ
1.9117 -1.1948 TD
0.0581 Tw
[(nosis of endometrial cancer after tamoxifen for breast can-)]TJ
T*
0 Tw
(cer. Lancet 2000;356:881-887.)Tj
ET
Q
endstream
endobj
26 0 obj
<<
/ProcSet [/PDF /Text ]
/Font <<
/F1 6 0 R
/F2 7 0 R
>>
/ExtGState <<
/GS1 8 0 R
>>
>>
endobj
17 0 obj
<<
/Type /XObject
/Subtype /Image
/Width 506
/Height 382
/BitsPerComponent 8
/ColorSpace /DeviceGray
/Length 67379
/Filter /DCTDecode
>>
stream
Adobe d C
~
s !1AQa"q2B#R3b$r%C4Scs5D'6Tdt&
EFVU(eufv7GWgw8HXhx)9IYiy*:JZjz ? #iZHchUcʴvcZ~( *A
CG5lzOixV܂Hd*8@"tazk,o+UO-HBkJӧӇZf+Y+۷2aP7$spt*g>rۓBn!n߷\mQa=
E,J ^1ke itIC
AI;z|}vĿn7x+T<ઙ7
}~cOEY:䬣 qx?ݜJZ拱!QNثKe,Щux/mያdmf2 K]ȯf >I!nj2(oQvwcz, ֟Ncnk,%]x>2~ xS
o iU}grAXG ң[Lʋ$~!4
HYex|Udv=`XR?RC#I jӗ[zp,R 9 Y# t]5G0E}i,F`$E[vg{,VQT5_TW
I4e@j
{uk*I$9TPN|\]˳rt&)/7av* hHڛу$E /֦]$;Վ M].P'3d(xt`~w*8V.O=
*X!]ԤoI.L*5a`e"֢i$j@m~JhEqME
qTE`v0NZPR