Case of atypical polypoid adenomyoma that possibly underwent a serial progression from endometrial hyperplasia to carcinoma

Abstract

Atypical polypoid adenomyoma is a rare uterine tumor composed of atypical endometrial glands, which often exhibit squamous metaplasia, and a cellular smooth muscle stroma. Although atypical polypoid adenomyoma is categorized as a benign lesion, it is reportedly associated with endometrial cancer, and it shows persistence and recurrence even after conservative medical treatment. We present a rare case of atypical polypoid adenomyoma that possibly underwent a serial pathological change from endometrial hyperplasia to carcinoma in a 40-year-old woman with no history of pregnancy. She was diagnosed with atypical polypoid adenomyoma during polypectomy surgery. After resecting the atypical polypoid adenomyoma, endometrial hyperplasia complex was detected. This condition eventually progressed from atypical hyperplasia complex to endometrial adenocarcinoma, and total abdominal hysterectomy was performed. A patient with atypical polypoid adenomyoma who wishes to preserve her fertility should be carefully monitored for endometrial carcinoma. If endometrial hyperplasia is detected in such a patient, a meticulous follow-up examination by performing endometrial biopsy is mandatory.

Long-term outcomes of fertility-sparing treatment of atypical polypoid adenomyoma with medroxyprogesterone acetate

“…Our study involves the longest follow-up period in conjunction with treatment of APA. The prognosis of APA is thought to be good (even though some patients with local excision of tumors progress to endometrial cancer or coexisting endometrial cancer after several years of followup) [3,6,15], and our data also show a good prognosis.…”

“…It is a polypoid tumor of the uterus composed of endometrial gland cells admixed with a stromal component of interlacing bundles of smooth muscle [1]. Although APA was previously considered to be a benign tumor, recent studies demonstrated its malignant potential and a high recurrence rate, leading to malignant transformation [2][3][4][5][6]. Hence, hysterectomy is the primary therapeutic choice for patients with APA.…”

Pregnant outcomes of atypical polypoid adenomyoma treated with progestin therapy

“…APA is basically classified as a benign disease; however, APA with marked complex glandular structures has been proposed as ‘APA with low malignant potential’ (APA‐LMP) to emphasize the potential risk for myometrial invasion and the possibility of recurrence or persistence after local excision . Moreover, APA can co‐exist with endometrial carcinoma and may even undergo carcinomatous transformation . The risk for endometrial carcinoma is estimated to be around 10% in patients with APA, much higher than that in healthy women.…”

Maintenance hormonal therapy after treatment with medroxyprogesterone acetate for patients with atypical polypoid adenomyoma

“…It has an architecturally complex and cytologically atypical glandular component that can be confused with well-differentiated adenocarcinoma. Although APA was previously considered a benign tumor, recent studies have demonstrated its malignant potential and high recurrence rate, leading to malignant transformation (1)(2)(3)(4)(5)(6)(7). Because it typically occurs in premenopausal women (1) and mainly in women of reproductive age (2), we come across patients who want to preserve their reproductive capacity.…”