Hysteroscopic treatment of atypical polypoid adenomyoma diagnosed incidentally in a young infertile woman

Sardo, Attilio Di Spiezio; Mazzon, Ivan; Gargano, Virginia; Carlo, Costantino Di; Guida, Maurizio; Mignogna, Chiara; Bifulco, Giuseppe; Nappi, Carmine

doi:10.1016/j.fertnstert.2007.02.061

Cited by 36 publications

(31 citation statements)

References 13 publications

(33 reference statements)

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“…Nasu et al suggested that estrogen-related factors play a key role in the pathogenesis of APA [16]. Some other authors reported detection of occult APA during an infertility work-up [10,11]. It is unclear whether APA is the cause of infertility, whether an endocrine environment that causes infertility also causes APA, or whether the two situations can coexist.…”

Section: Discussionmentioning

confidence: 99%

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

Nomura

Sugiyama

Tanigawa

et al. 2015

Arch Gynecol Obstet

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Section: Discussionmentioning

confidence: 99%

“…Obesity [1], prolonged estrogenic stimulation [9], and infertility [10,11] are reported to be risk factors of APA. Although those factors are thought to be hormone related, most of the available treatment options for patients with APA involve surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Nomura

Sugiyama

Tanigawa

et al. 2015

Arch Gynecol Obstet

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“…Obesity (1), prolonged estrogenic stimulation (9), and infertility (10,11) are among the causes of the disease. Although APA has been mainly treated surgically, it may not be a rational treatment option.…”

Section: Introductionmentioning

confidence: 99%

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

Nomura

Sugiyama

Tanigawa

et al. 2018

Japanese Journal of Clinical Oncology

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Background: As atypical polypoid adenomyoma (APA) has been reported to be a hormone-related tumor, we aimed to analyze the efficacy and safety of maintenance hormonal therapy after fertility-preserving treatment of these patients with medroxyprogesterone acetate (MPA). Methods: Data were retrospectively analyzed from patients with APA who were treated with a fertility-preserving regimen including MPA between October 2001 and December 2011. Eighteen patients were treated with MPA and 14 (77.8%) achieved either a complete or a partial response after the planned treatment. Five patients took progestin for maintenance therapy. Results: Eighteen patients were treated for a mean observation period of 96.7 months. While taking the maintenance therapy, no patient had APA relapse. One patient developed welldifferentiated endometrioid adenocarcinoma 18 months after she stopped taking maintenance progestin. Eleven patients without maintenance therapy underwent hysterectomy, andnine of them developed well-differentiated endometrial cancer. Through univariate analysis, there was a significant difference in time to hysterectomy between patients with and without maintenance therapy (P = 0.015). Through multivariate analysis, body mass index (BMI), menstrual status before protocol therapy, maintenance treatment, and pregnancy were found to be significantly associated with a lower risk of hysterectomy. No patient had a recurrence of APA after hysterectomy during the observation period (median, 54 months; range, 2-148 months). Conclusion: No patient showed progression while receiving hormonal therapy, including initial protocol therapy. Maintenance hormonal therapy after treatment with MPA was highly effective and safe, particularly in patients with BMI ≧24 kg/m 2 and irregular menstruation cycle.

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“…Even though the risk of malignancy is rare, even the most experienced operator cannot exclude malignancy or premalignant lesions (i.e., atypical polypoid adenomyoma) from the histological analysis (22), especially when the morphologic appearance of a lesion is obscure (e.g., polypoid contour) (23). Furthermore, the lack of a histological analysis may lead to a dangerous diagnostic delay in detecting mesenchymal tumors, which usually show aggressive biological behavior.…”

Section: Risk Of Malignancymentioning

confidence: 99%

The destiny of myomas: should we treat small submucous myomas in women of reproductive age?

Bettocchi

Siristatidis

Pontrelli

et al. 2008

Fertility and Sterility

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Hysteroscopic treatment of atypical polypoid adenomyoma diagnosed incidentally in a young infertile woman

Cited by 36 publications

References 13 publications

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

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

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

The destiny of myomas: should we treat small submucous myomas in women of reproductive age?

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