Atypical polypoid adenomyoma of the endometrium: diagnosis and treatment. A case report

Domeniconi, Lucia; Amadori, Andrea; Maniglio, Paolo; Saragoni, Luca

doi:10.32074/1591-951x-112

Cited by 5 publications

(5 citation statements)

References 11 publications

(24 reference statements)

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“…There is no current gold standard for the clinical treatment of patients with APA. APA treatment can be individualized according to age, marital status, fertility requirements, personal circumstances and postoperative pathological diagnosis [ 23 , 30 , 36 , 37 ]. Total hysterectomy is recommended for menopausal or perimenopausal APA patients [ 5 , 7 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

A Clinicopathological Review of 203 Cases of Atypical Polypoid Adenomyoma of the Uterus

Yue

Liu

2023

JCM

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Objective: To provide a reference for the diagnosis and treatment of atypical polypoid adenomyoma (APA). Methods: This was a retrospective study of 203 APA patients from 2011 to 2021. The clinicopathological characteristics, treatments, and prognosis were analyzed. Results: The average age at diagnosis of APA patients was 39.30 ± 11.01 years, and premenopausal women accounted for 81.3%. Abnormal uterine bleeding or menorrhagia were the most common clinical manifestations of APA. The uterine fundus (78.3%), followed by the lower segment of the uterus (11.8%), was the most common location of the APA lesions. Abnormal blood vessels were seen on the surface of 28 APA tumors. APA can coexist with atypical endometrial hyperplasia (18.2%) and endometrial cancer (10.8%). Immunohistochemical analysis was performed on 99 samples. In the glandular component, ER (94.8%), PR (94.8%), Ki-67 (51.5%), p53 (45.6%), PTEN (18.8%), and mismatch repair proteins (96.4%) were positively expressed. Stromal immunophenotype expression was exhibited as follows: CD10-(89.5%), p16+(86.9%), h-caldesmon-(66.7%), Desmin+(75%), and Vimentin+(88.9%). Fifty-five APA patients received TCR, and 33 of them received adjuvant therapy after the operation. The postoperative recurrence rate (9.1% vs. 36.4%, p < 0.05) and malignant transformation rate (3.0% vs. 18.2%, p < 0.05) of the treated group were significantly lower than the untreated group. Conclusions: APA usually occurs in women of childbearing age, and the diagnosis is based on pathological morphology. APA has a low malignant potential, and those who have fertility requirements can undergo conservative TCR treatment, supplemented by progesterone treatment after surgery and close follow-up. Total hysterectomy is the treatment of choice for APA patients with atypical endometrial hyperplasia around the lesion.

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Section: Discussionmentioning

confidence: 99%

A Clinicopathological Review of 203 Cases of Atypical Polypoid Adenomyoma of the Uterus

Yue

Liu

2023

JCM

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“…Two to 5 years after surgical treatment is the peak time of APA recurrence among patients [ 28 , 29 ]. To avoid APA relapse, close follow-up should be conducted for 5 years.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of 44 cases of atypical polypoid adenomyoma of the uterus

Wang

Guo

2022

BMC Women's Health

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Background Atypical polypoid adenomyoma (APA) is a rare intrauterine polypoid lesion that occurs predominantly in premenopausal women. Although APA was previously considered a benign lesion and treated conservatively, an increasing number of cases show that APA has a high rate of recurrence or residual disease and that it precedes the development of carcinoma. The clinical management of APA remains to be established. The aim of this study was to analyse the clinicopathological features of APA and discuss its diagnosis and prognosis. Methods Forty-four patients with APA were admitted to Beijing Obstetrics and Gynecology Hospital from 2005 to 2019, and their clinical and histopathologic features were evaluated. B-ultrasound was performed, and all the patients (n = 44) underwent hysteroscopy. Endometrium excision was performed by means of the four-step diagnosis and treatment method. Hysteroscopic transcervical resection (TCR) was performed in 5 patients with APA-H and 11 with APA-L. Except for one patient who underwent transcervical endometrial resection, all the patients underwent hysterectomy and salpingectomy or salpingo-oophorectomy. Data from a median follow-up of 42 months (ranging from 3 to 174 months) were available for these patients. Results Pathological diagnosis were made according to the degree of abnormality of the APA surface glands, resulting in APA-L in 36 patients and APA-H in 8 patients. Among these patients, 28 (25 APA-L and 3 APA-H) were treated conservatively. The effect of the four-step diagnosis and treatment method as an APA therapy was excellent. During the follow-up, no evidence of recurrence was found. Conclusions For patients with intracavitary lesions > 1 cm, the hysteroscopic four-step diagnosis and treatment method and pathological diagnosis are the basis of clinical treatment. More than 30% of APA surface glands have complex structures characterized by branching and budding or other high-risk factors, such as endometrial hyperplasia, which are indications for hysterectomy. For patients who desire to become pregnant or to preserve the uterus, hysteroscopy with complete excision of the lesions should be the preferred treatment method. The patients should be treated and followed up closely with regular hysteroscopy and endometrial biopsy.

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“…Longacre et al propose that APA with markedly complex glands (high architectural index) be designated "APA of low malignant potential" to emphasize the potential risk for myometrial invasion [2]. Few researches have tried to identify useful immunohistochemical markers for differential diagnosis, but no one has been of essential help [7,8]. At present APA is histopathologically classified as a benign lesion [9].…”

Section: Discussionmentioning

confidence: 99%

Serous endometrial intraepithelial carcinoma coexistence with atypical polypoid adenomyoma in a young woman: a rare case

Mateva¹,

Nikolova²,

Yordanov³

et al. 2022

Ital J Gynaecol Obstet

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Background. Atypical polypoid adenomyoma (APA) is a rare lesion with less than 500 cases reported worldwide (in the literature). It is an unusual tumor of the uterus, first described by Mazur in 1981 that typically develops in young women, which are also associated with infertility. The disease is considered benign, but there is a significant risk of developing an endometrial carcinoma or a risk of recurrence. The most common histological type of associated adenocarcinoma is endometrioid endometrial carcinoma. Case presentation. In this study we present a case of APA concomitant with a serous endometrial intraepithelial carcinoma (SEIC) in a young woman, an occasion that has not been reported yet. Conclusions. When a patient is diagnosed as having APA, always an accompanying EC must be carefully searched.

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Atypical polypoid adenomyoma of the endometrium: diagnosis and treatment. A case report

Cited by 5 publications

References 11 publications

A Clinicopathological Review of 203 Cases of Atypical Polypoid Adenomyoma of the Uterus

A Clinicopathological Review of 203 Cases of Atypical Polypoid Adenomyoma of the Uterus

Clinical analysis of 44 cases of atypical polypoid adenomyoma of the uterus

Serous endometrial intraepithelial carcinoma coexistence with atypical polypoid adenomyoma in a young woman: a rare case

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