A clinicopathological study of 39 cases of atypical polypoid adenomyoma of the uterus

Abstract

ObjectiveTo clarify the clinical and pathological characteristics of atypical polypoid adenomyoma (APA) in order to improve the criteria used to diagnose and treat this disease.Study designIn 39 cases of APA, retrospective analysis was performed of theclinical data, pathological characteristics, and the follow-up findings in patients admitted to the Peking University People's Hospital from 2007 to 2019.ResultsThe median age was 39.6 years (range 24–60 years). Thirty seven patients were premenopausal (i.e.94.9 ​%) and eighteen patients were nullipara (i.e. 46.2 ​%). Abnormal uterine bleeding was the most common presenting symptom. Hysteroscopic transcervical resection (i.e.TCR) identified lesions in 35 cases whereas: a) hysterectomy identified them in 3 cases; b) dilatation and curettage (D&C) identified them in 1 case. Immunohistochemical analysis was performed on 24 samples. In the glandular component, hormone receptors were positively expressed. In all cases, Ki67 expression was detectable in approximately 50 ​% of the cases. In those samples, its presence was definitive in eighteen of the nineteen cases (94.7 ​%,18/19), p53 positive expression was present in most cases (68.8 ​%,11/16), and PTEN positive expression was detected in 40 ​% (4/10). Stroma immunophenotype expression was exhibited as follows: a)CD10-(12/12), Desmin +(6/7); b) Vimentin +(4/4); c) α-SMA+ (3/3) and; d) p16 positve staining in of 80 ​%(4/5).The concurrent amount of atypical endometrial hyperplasia with atypical polypoid adenomyoma was 23.1 ​%(9/39), while its concurrent level of endometrial carcinoma with atypical polypoid adenomyoma was 7.7 ​% (3/39). Fertility preserving treatments were performed in 20 patients with strong childbearing desires. Their pregnancy success was 15 ​%(3/20) and the live birth frequency was 10 ​%(2/10). Follow-up findings were available in 36 cases (92.3 ​%) with a medial follow-up of 48.1 months (range 4–122 months). Its pathological recurrence and frequency of progression into endometrial carcinoma were both 5 ​%(1/20). One case died of another type of malignancy, while the other patients were alive.ConclusionsAPA occurs mostly during the years of a women's reproductive period. Its diagnosis is based on the analysis of pathological and immunohistochemical findings. Individuals diagnosed with APA are at risk to coexist with endometrial carcinoma and atypical endometrial hyperplasia. For those individuals who desire retaining fertility, the treatment strategy involves performing TCR completely remove the lesions and close follow-up for surveillance of possible progressive APA recurrence. For those individuals who have no fertility desire, hysterectomy may be a preferred option.

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

“…Their sizes range from 0.5 to 10 cm, with an average diameter of 2.2 cm. All of these properties are similar to those reported in the reviews by Matsumoto, Zhu, Wong, and Kihara [ 7 , 8 , 18 , 19 ] ( Table 3 ). The blood vessels on the surface of the lesions are abundant and thick.…”

“…The gross appears as border clear, quality medium-sized tumor with a pedicle, which is often confused with endometrial polyps, cervical polyps, uterine myoma, or polypoid carcinomas [ 4 , 17 ]. According to our patient’s hysteroscopic findings, the lesion usually occurs in the uterine fundus, sometimes in the lower uterine segments or cervical canal, but it has also been reported to involve the oviduct in monkeys [ 7 , 8 , 13 ]. Lesions are usually single, occasionally multiple.…”

“…The data for the relationship between pregnancy and delivery history and infertility in the present study showed nearly a quarter (26.1%) of them were nullipara, and the rate of infertility was 22.7%. In Matsumoto’s review of 29 patients, the majority of patients were nullipara (86.2%), and the infertility rate was 35.5% [ 7 ], while in the report by Zhu, 12 (30.8%) of the 30 patients whose history of pregnancy and delivery was known were nulligravida [ 8 ]. Many patients with APA are nulligravida and/or nullipara, and whether the presence of APA is a cause or an outcome is unclear but suggests an association with infertility.…”

Atypical Polypoid Adenomyoma of The Uterus：Benign or malignant potential?

“…The gross appears as border clear, quality medium-sized tumor with pedicle, which is often confused with endometrial polyps, cervical polyps, uterine myoma, or polypoid carcinomas (6,14). The lesion usually occurs in the lower uterine segments, sometimes in the uterine fundus or cervical canal, but it has also been reported to involve the oviduct in monkeys (15)(16)(17). Lesions are usually single, occasionally multiple (15,16).…”

“…The lesion usually occurs in the lower uterine segments, sometimes in the uterine fundus or cervical canal, but it has also been reported to involve the oviduct in monkeys (15)(16)(17). Lesions are usually single, occasionally multiple (15,16). Their sizes range from 0.1 to 12 cm, with an average diameter of 2 cm (18,19).…”