Complete hysteroscopic resection of a large atypical polypoid adenomyoma, followed by a successful pregnancy

Hysteroscopic Transcervical Resection for Atypical Polypoid Adenomyoma of the Uterus: A Valid, Fertility-Preserving Option

“…The Japan Clinical Oncology Group reported that 1 of 10 patients (10%) experienced recurrence after TCR, although follow-up details were not described [11]. TCR is considered superior to simple polypectomy or D&C because it reduces th risk of insufficient tumor resection and avoids damage to normal endometrium [12]. The physical boundary between an APA and the stroma is usually sharp; however, focal extension of complex glands to the adjacent endometrium or superficial invasion into the myometrium is seen in some cases [6,13].…”

Hysteroscopic transcervical resection is useful to diagnose myometrial invasion in atypical polypoid adenomyoma coexisting with atypical endometrial hyperplasia or endometrial cancer with suspicious myometrial invasion

“…Yahata et al . also treated APAM patients with TCR and reported successful pregnancies after uterus‐preserving treatment …”

“…14,15 Yahata et al also treated APAM patients with TCR and reported successful pregnancies after uterus-preserving treatment. 16 To perform this treatment properly, it is important to evaluate the lesion preoperatively by examining any sites suspected of myometrial invasion using contrast-enhanced MRI and hysteroscopy, and by checking the thickness of the muscle wall at the said sites. But, given that APAM is a protruding lesion, it is often easy to identify sites suspected of myometrial invasion.…”

Case report of successful live birth in an infertile couple with male idiopathic hypogonadotropic hypogonadism/azoospermia and atypical polypoid adenomyoma of the uterus

“…Approximate 30 cases with successful live birth are literally identified in women with a history of APA [4][5][6][7][8][9][10]. Previous studies utilized uterus-conserving surgery such as endometrial curettage or hysteroscopic resection for women desiring babies, along with hormonal treatment with high-dose medroxyprogesterone acetate (200-600 mg/day) [4,5].…”

“…Previous studies utilized uterus-conserving surgery such as endometrial curettage or hysteroscopic resection for women desiring babies, along with hormonal treatment with high-dose medroxyprogesterone acetate (200-600 mg/day) [4,5]. The reported persistence and/or recurrence rate of APA following hysteroscopic resection (10.0%) is lower than that following endometrial curettage (23.8%-44.8%) [6][7][8][9][10]. The authors did not find any evidence of the recurrence in the secondand third-look hysteroscopic/histopathologic examinations.…”