Recurrent atypical polypoid adenomyoma and pregnancy: A new conservative approach with levonorgestrel-releasing intrauterine system

Solima, Eugenio; Liprandi, Valeria; Belloni, Gaia Maria; Vignali, Michele; Busacca, Mauro

doi:10.1016/j.gore.2017.07.002

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…We hypothesized that the progesterone released from the LNG‐IUS would be able to clear the hypothetical microscopic residual tumor. There is a previous case report of LNG‐IUS usage for recurrent APA, suggesting the effectiveness of the LNG‐IUS for treatment of recurrent APA patients who want to preserve fertility . As in our case, it may be useful when there is a possibility of microscopic residual tumor following primary treatment.…”

Section: Discussionsupporting

confidence: 55%

Successful laparotomy tumor resection and levonorgestrel‐releasing intrauterine system for atypical polypoid adenomyoma

Narumi

Takei

Morisawa

et al. 2018

J of Obstet and Gynaecol

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Hysteroscopic transcervical resection (TCR) is often performed as fertility sparing treatment for atypical polypoid adenomyoma (APA) patients. However, TCR has the risk of uterine wall perforation, especially when the tumor extends deeply into the uterine muscle layer. We report an APA patient in whom it was impossible to completely resect the tumor by TCR, but laparotomy tumor resection followed by levonorgestrel-releasing intrauterine system (LNG-IUS) was successful. The patient was a 35-year-old nulligravida woman. We performed laparotomy tumor resection and inserted the LNG-IUS into uterine cavity just after surgery. Microscopic residual tumor was suspected based on histopathological findings. However, the patient has not relapsed for 26 months, even though the LNG-IUS was removed after 6 months. Laparotomy tumor resection may be one fertility sparing treatment option for APA patients. Furthermore, it may be effective to use the LNG-IUS after surgery for two purposes that are adhesion prevention and tumor disappearance.

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Section: Discussionsupporting

confidence: 55%

Successful laparotomy tumor resection and levonorgestrel‐releasing intrauterine system for atypical polypoid adenomyoma

Narumi

Takei

Morisawa

et al. 2018

J of Obstet and Gynaecol

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“…There is a previous report of recurrent APAM treated with high-dose medroxyprogesterone acetate (MPA) followed by maintenance therapy with dienogest [8]. Another study reported a case of recurrent APAM in a patient with and adjuvant progestin-releasing intrauterine device, who later delivered a baby [9]. Although it is a proof-of-concept that the usual-dose progestin can treat APAM, a benign, ER-positive, progesterone receptor-positive tumor related to unopposed estrogen [3,10], some other authors prefer highdose MPA for maintenance.…”

Section: Discussionmentioning

confidence: 99%

Impact of Modern Systemic Therapies and Clinical Markers on Treatment Outcome for Metastatic Melanoma in A Real-World Setting

Łudzik

2022

OJCAM

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This work is licensed under Creative Commons Attribution 4.0 License OJCAM.MS.ID.000656. Case PresentationA 26-year-old woman (height, 166 cm; weight, 59.2 kg; body mass index, 21.5 kg/m2) having severe hypermenorrhea and dysmenorrhea with endometrial hypertrophy was referred to our hospital. She had a 35-40-day long menstrual cycle and no history of intercourse. She had no relevant past medical or family history. Physical examination revealed no remarkable findings. Her hemoglobin level was low (8.0 g/dL). Transrectal ultrasonography revealed a high echoic lesion in the endometrium measuring

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“…In post-menopausal women, hysterectomy is often considered the preferred treatment for atypical polypoid adenomyoma (APAM). However, for patients who wish to retain their fertility potential, a more conservative surgical approach is typically recommended [17].…”

Section: Treatmentmentioning

confidence: 99%

“…Additionally, the use of a levonorgestrel intrauterine device (IUD) has been suggested as a form of maintenance therapy for young women who wish to preserve their fertility [17].…”

Section: Treatmentmentioning

confidence: 99%

Prolapsed Atypical Polypoid Adenomyoma—A Case Report and Literature Review

Butureanu,

Haliciu,

Apetrei

et al. 2023

Life

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Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, usually leading to misdiagnosis. Histopathologically, it is a biphasic tumor, represented by the endometrioid glands with a complex histoarchitecture, with sometimes squamous morular metaplasia or cytologic atypia, interspersed with a fibromyomatous stroma. This tumor has a high incidence of recurrence. We present a very rare case of a 21-year-old patient, a virgin, without a significant medical history, with a bleeding mass occupying the vagina. The mass was excised using forceps, scissors, and a suture of the visible pedicle. After a four-year follow-up and no additional medical treatment, no relapse was observed. Given the risk of recurrence and progression, APAM might be treated via a hysterectomy in patients with no desire for pregnancy. Due to a lower recurrence rate, the conservative treatment of atypical polypoid adenomyoma performed via an operative hysteroscopy represents the best choice. Previously diagnosed in hysterectomy specimens, with the introduction of better-performing indirect imaging techniques, adenomyosis is a clinical entity that has the possibility of being diagnosed in the presurgical stage.

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Recurrent atypical polypoid adenomyoma and pregnancy: A new conservative approach with levonorgestrel-releasing intrauterine system

Abstract: HighlightsLevonorgestrel IUD was effective in treatment of recurrent APA.No side effects were reported.No impairments on a subsequent pregnancy were reported.

Cited by 5 publications

References 9 publications

Successful laparotomy tumor resection and levonorgestrel‐releasing intrauterine system for atypical polypoid adenomyoma

Successful laparotomy tumor resection and levonorgestrel‐releasing intrauterine system for atypical polypoid adenomyoma

Impact of Modern Systemic Therapies and Clinical Markers on Treatment Outcome for Metastatic Melanoma in A Real-World Setting

Prolapsed Atypical Polypoid Adenomyoma—A Case Report and Literature Review

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