Atypical polypoid adenomyoma of the uterus: A clinicopathological analysis of 28 cases

Abstract

Objective: To investigate the clinicopathological characteristics of uterine atypical polypoid adenomyoma (APAM), including the cases with coexistent endometroid endometrial adenocarcinoma (EEA). Method: A retrospective analysis of the clinical data, morphologic features, and immunohistochemistry of 28 consecutive cases of uterine APAM diagnosed in our Department between January 2001 and December 2014 was done. Results: The mean age of the patients was 41 (range, 26–61). Only five patients were postmenopausal, and seven were undergoing evaluation for infertility. Microscopic examination disclosed endometrial glands with varying degrees of hyperplasia and cytological atypia within a myofibromatous stroma. Squamous metaplasia was present in 25(89 %), and foci of well-differentiated EEA coexisted in 5 (17.9 %) cases. In 4 (14,3 %) other patients moderately differentiated EEA was present both in APAM and endometrial fragments. Nine patients were initially treated with hysterectomy and the remaining 19 with curettage, polypectomy, or hysteroscopic transcervical resection, followed by hormonal therapy in 10 cases. There was one recurrence documented, while in 3 (13.6 %) of these patients the APAMs persisted up to 2 years. All patients except the one with advanced stage EEA (FIGO stage IIIC) were well and alive 16–147 (mean, 71) months after primary treatment. Conclusion: Although the clinical behavior of APAM is benign in most cases, it can be associated with sterility and rarely with endometrial carcinoma. Therefore a meticulous pathological evaluation of specimen of APAM is necessary for the detection of the coexistence of EEA.