A Clinicopathological Review of 203 Cases of Atypical Polypoid Adenomyoma of the Uterus

Abstract

Objective: To provide a reference for the diagnosis and treatment of atypical polypoid adenomyoma (APA). Methods: This was a retrospective study of 203 APA patients from 2011 to 2021. The clinicopathological characteristics, treatments, and prognosis were analyzed. Results: The average age at diagnosis of APA patients was 39.30 ± 11.01 years, and premenopausal women accounted for 81.3%. Abnormal uterine bleeding or menorrhagia were the most common clinical manifestations of APA. The uterine fundus (78.3%), followed by the lower segment of the uterus (11.8%), was the most common location of the APA lesions. Abnormal blood vessels were seen on the surface of 28 APA tumors. APA can coexist with atypical endometrial hyperplasia (18.2%) and endometrial cancer (10.8%). Immunohistochemical analysis was performed on 99 samples. In the glandular component, ER (94.8%), PR (94.8%), Ki-67 (51.5%), p53 (45.6%), PTEN (18.8%), and mismatch repair proteins (96.4%) were positively expressed. Stromal immunophenotype expression was exhibited as follows: CD10-(89.5%), p16+(86.9%), h-caldesmon-(66.7%), Desmin+(75%), and Vimentin+(88.9%). Fifty-five APA patients received TCR, and 33 of them received adjuvant therapy after the operation. The postoperative recurrence rate (9.1% vs. 36.4%, p < 0.05) and malignant transformation rate (3.0% vs. 18.2%, p < 0.05) of the treated group were significantly lower than the untreated group. Conclusions: APA usually occurs in women of childbearing age, and the diagnosis is based on pathological morphology. APA has a low malignant potential, and those who have fertility requirements can undergo conservative TCR treatment, supplemented by progesterone treatment after surgery and close follow-up. Total hysterectomy is the treatment of choice for APA patients with atypical endometrial hyperplasia around the lesion.

Clinicopathological characteristics and fertility preserving treatment of atypical polypoid adenomyoma

“…36.4%) and malignant transformation rate (3.0% vs . 18.2%) in the treated group versus the untreated group ( 12 ), providing evidence to support the use of progestogen in the treatment of APA. Additionally, two studies by Nomura et al.…”

“…However, we observed that a total of six individuals developed endometrial hyperplastic diseases: three patients who received high-dose progestin treatment developed EAH, two patients who underwent Diane-35 cyclic therapy developed CH, and one patient treated with Diane-35 developed EAH. A previous retrospective study of 55 patients who underwent hysteroscopic transcervical resection to comprehensively remove lesions reported a significantly lower postoperative recurrence rate (9.1% vs. 36.4%) and malignant transformation rate (3.0% vs. 18.2%) in the treated group versus the untreated group (12), providing evidence to support the use of progestogen in the treatment of APA. Additionally, two studies by Nomura et al (11,21) reported that hormonal therapy with medroxyprogesterone acetate is associated with a reduced recurrence rate in patients with APA.…”

“…Second, it is uncertain whether APA without concurrent endometrial hyperplastic lesions requires progestin treatment after hysteroscopic complete resection of the APA lesions. 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 ).…”