Management of atypical polypoid adenomyoma of the uterus: A single center's experience

Abstract

Atypical polypoid adenomyoma (APA) is a rare uterine lesion, which has a high rate of recurrence and malignant transformation. How to treat this disease is crucial for the prognosis, but there are few reports on it.We retrospectively reviewed the clinical records of all the patients diagnosed with APA after surgical therapy in our hospital. All the clinical information, pathological results, treatment, and outcome were retrieved from the clinical records.A total of 43 patients were diagnosed with APA. The median age was 56.0 years (range: 17-71 years). Primary treatments included hysteroscopic transcervical resection (TCR) of the lesions in 34 patients (79.1%), hysterectomy and bilateral salping-oophenrectomy in 5 (11.6%), hysterectomy in 1 (2.3%), and primary cytoreductive surgery for ovary cancer in 3. A total of 42 patients were followed up for a mean period of 26.9 months (range 2-57 months). Three of them recurred. One patient underwent hysterectomy after recurrence, and TCR was performed for the other 2. High-dose progestogen was given to the 2 recurrent patients after TCR.Hysterectomy is the primary therapeutic choice for postmenopausal patients with APA. Conservative treatment of APA with TCR is safe and efficient.

Figure 1

(A) Atypical polypoid adenomyomas (APA) under a hysteroscope. (B) Macroscopic findings of the APA. The lesions have a shape of endometrial polyp (arrow) with or without stalk. The lesions commonly locate in the lower segment of the uterine. (C) The microscopic findings of APA (H&E staining, original magnification ×40). The epithelium of APA is composed with atypical endometrial glands which are interspersed, clustered, or in lobules. The glands derive from endometrium with squamous metaplasia (mulberry-like) and atypical cells at varying degrees. Myofibromatous stroma are present among the glands.

Figure 2

(A) Atypical polypoid adenomyomas associated with complex atypical hyperplasia of the other endometrium. Foci progressed to be endometrial adenocarcinoma (grade I) and invades into the superficial muscularis (<1/2 of the muscular wall). No obvious vascular cancer emboli found. Immunohistological analysis revealed ER+, PR+, and Ki67 positive rate of 30%, P16 patchy+, P53 ± . (B) Atypical polypoid adenomyomas coexisted with endometrial adenocarcinoma (grade I). Squamous metaplasia of the foci was observed. Cancerous tissue invades into the superficial muscularis (<1/2 of the muscular wall). No obvious vascular cancer emboli were found. Immunohistological analysis revealed that weak ER+, PR+, and P53 ± , P16 diffuse + (H&E staining, original magnification ×40). (C) Atypical polypoid adenomyomas coexisted with endometrial adenocarcinoma (grade I-II). Cancerous tissue invades into superficial muscularis (>1/2 of the muscular wall). No obvious vascular cancer emboli were found. Immunohistological analysis revealed weak ER 60+, PR50%+, and P53 ± (H&E staining, original magnification ×40).