Oncologic outcomes of conservative treatment of atypical polypoid adenomyoma of the uterus: A two‐center experience

Abstract

Objective Atypical polypoid adenomyoma (APA) is a rare uterine premalignant lesion mainly occurring in premenopausal and nulliparous women. Although hysteroscopic resection (HR) has showed promising results, the conservative management of APA in young women is not standardized, and few data are available in the literature. We aimed to assess oncologic outcomes of the conservative treatment of APA. Methods A multicenter observational retrospective cohort study was performed including all patients with APA who underwent conservative treatment from January 2006 to June 2020. Rates of each oncologic outcome (i.e. initial complete response, persistence, progression to cancer, recurrence, long‐term treatment success, and treatment failure) were calculated for all conservative treatment together and separately. Results Twenty‐five patients were included. Conservative treatments consisted of HR alone (n = 14) and HR + progestin (n = 11). Overall, 24 (96%) patients showed initial complete response, of which 21 (84%) showed long‐term treatment success; four (16%) patients had progression to cancer, of which two (8%) first recurred as APA. Long‐term treatment success was achieved in 13 of 14 (92.9%) patients with HR alone and 8 of 11 (72.3%) with HR + progestin. Conclusion Conservative treatment appears to be a safe option in women with APA. The four‐steps HR might be considered as the first‐line conservative approach, while the addition of progestin does not seem to improve oncologic outcomes. However, the risk of progression to cancer highlights the need for a close and long‐term follow up with ultrasonography and hysteroscopic biopsies, and for hysterectomy in patients not desiring pregnancy.

Clinicopathological characteristics and fertility preserving treatment of atypical polypoid adenomyoma

“…( 11 , 21 ) reported that hormonal therapy with medroxyprogesterone acetate is associated with a reduced recurrence rate in patients with APA. In contrast, a multicenter observational retrospective cohort study of 24 patients reported that conservative treatment for APA achieved long-term success in 92.9% of patients who received hysteroscopy alone and 72.3% of patients who underwent hysteroscopy plus progestin ( 14 ), indicating that hysteroscopy is the better treatment approach. Furthermore, a systematic review reported no significant differences between hysteroscopy alone and hysteroscopy with hormone maintenance in terms of the rate of cancer progression (10.8% vs .…”

“…Some studies have demonstrated that progestin therapy after hysteroscopic resection prevents recurrence and the progression to endometrial cancer in patients with APA compared with untreated patients (9-12). In contrast, other studies report that progestin therapy is ineffective (13,14). Third, the impact of concurrent APA on the outcomes of fertility-preserving treatment in patients with EAH and EEC has not been thoroughly explored.…”

Detection and Classification of Hysteroscopic Images Using Deep Learning

“…After DL model building, the model should undergo external validation and improvement, with the inclusion of further images and videos from other centers. When a high DL model performance is obtained, the inclusion of cases with other rarer intrauterine pathologies (e.g., Mullerian malformations, atypical polypoid adenomioma, pecoma, sarcoma, trophoblastic disease, retained products of conception) [27][28][29][30] might make the DL model testable in the clinical practice thorough comparison of diagnostic performance by expert endoscopists.…”