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Wang X, Guo Y. Clinical analysis of 44 cases of atypical polypoid adenomyoma of the uterus. BMC Womens Health 2022; 22:60. [PMID: 35246106 PMCID: PMC8895791 DOI: 10.1186/s12905-022-01643-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atypical polypoid adenomyoma (APA) is a rare intrauterine polypoid lesion that occurs predominantly in premenopausal women. Although APA was previously considered a benign lesion and treated conservatively, an increasing number of cases show that APA has a high rate of recurrence or residual disease and that it precedes the development of carcinoma. The clinical management of APA remains to be established. The aim of this study was to analyse the clinicopathological features of APA and discuss its diagnosis and prognosis. METHODS Forty-four patients with APA were admitted to Beijing Obstetrics and Gynecology Hospital from 2005 to 2019, and their clinical and histopathologic features were evaluated. B-ultrasound was performed, and all the patients (n = 44) underwent hysteroscopy. Endometrium excision was performed by means of the four-step diagnosis and treatment method. Hysteroscopic transcervical resection (TCR) was performed in 5 patients with APA-H and 11 with APA-L. Except for one patient who underwent transcervical endometrial resection, all the patients underwent hysterectomy and salpingectomy or salpingo-oophorectomy. Data from a median follow-up of 42 months (ranging from 3 to 174 months) were available for these patients. RESULTS Pathological diagnosis were made according to the degree of abnormality of the APA surface glands, resulting in APA-L in 36 patients and APA-H in 8 patients. Among these patients, 28 (25 APA-L and 3 APA-H) were treated conservatively. The effect of the four-step diagnosis and treatment method as an APA therapy was excellent. During the follow-up, no evidence of recurrence was found. CONCLUSIONS For patients with intracavitary lesions > 1 cm, the hysteroscopic four-step diagnosis and treatment method and pathological diagnosis are the basis of clinical treatment. More than 30% of APA surface glands have complex structures characterized by branching and budding or other high-risk factors, such as endometrial hyperplasia, which are indications for hysterectomy. For patients who desire to become pregnant or to preserve the uterus, hysteroscopy with complete excision of the lesions should be the preferred treatment method. The patients should be treated and followed up closely with regular hysteroscopy and endometrial biopsy.
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Affiliation(s)
- Xin Wang
- Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, 17 Qihelou Street, Dongcheng District, 100006, Beijing, China
| | - Yinshu Guo
- Department of Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, 17 Qihelou Street, Dongcheng District, 100006, Beijing, China.
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Omori M, Kawai M, Ogawa T, Sasatsu S, Fukasawa H, Nakazawa K, Kondo T, Hirata S. Lesion-targeted cytology to improve cytological sampling for atypical polypoid adenomyomas of the uterus: A case series and review of the literature. Cytopathology 2020; 31:579-585. [PMID: 32779225 DOI: 10.1111/cyt.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Atypical polypoid adenomyomas (APAs) are uncommon tumours consisting of atypical endometrioid glands and fibromyomatous stroma. Identifying the biphasic nature of atypical glandular components and spindle mesenchymal components without atypia is crucial for the cytological diagnosis of APA. We investigated the utility of lesion-targeted cytology (LTC) to directly collect firm spindle components. METHODS We recruited seven consecutive surgical patients who underwent cytological examinations before surgery and were diagnosed with APA on postoperative histological examinations. Cytological smears were obtained by routine sampling in five cases and by targeted sampling using transvaginal ultrasonography, that is, LTC, in two cases. We retrospectively analysed the cytological findings from our cases and compared them to those of APA cases previously reported in the English literature. RESULTS Among 5/7 cases that involved routine cytological sampling, normal cytological findings were found in 2 and atypical glandular cells were found in 3, but spindle cells from mesenchymal components were not detected. In contrast, among 2/7 cases in which sampling involved LTC, spindle cells without atypia, in addition to atypical glandular cells were found. CONCLUSIONS Lesion-targeted cytology is useful to assess mesenchymal components of APAs and may improve the cytological diagnosis of APA.
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Affiliation(s)
- Makiko Omori
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masataka Kawai
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuyuki Ogawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Satoko Sasatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroko Fukasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kumiko Nakazawa
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Biasioli A, Londero AP, Orsaria M, Scrimin F, Mangino FP, Bertozzi S, Mariuzzi L, Cagnacci A. Atypical polypoid adenomyoma follow-up and management: Systematic review of case reports and series and meta-analysis. Medicine (Baltimore) 2020; 99:e20491. [PMID: 32590732 PMCID: PMC7328951 DOI: 10.1097/md.0000000000020491] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer.Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed. METHODS This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018. RESULTS We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33-57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11-39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15-67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9-29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0-23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65-52.92%; P < .05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed. CONCLUSION This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies.
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Affiliation(s)
- Anna Biasioli
- Clinic of Obstetrics and Gynecology, University Hospital of Udine
| | - Ambrogio P. Londero
- Clinic of Obstetrics and Gynecology, University Hospital of Udine
- Ennergi Research
| | - Maria Orsaria
- Institute of Pathology, University Hospital of Udine
| | - Federica Scrimin
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste (TS)
| | | | - Serena Bertozzi
- Ennergi Research
- Department of Medical Area (DAME), University of Udine, Udine (UD)
| | - Laura Mariuzzi
- Institute of Pathology, University Hospital of Udine
- Department of Medical Area (DAME), University of Udine, Udine (UD)
| | - Angelo Cagnacci
- Clinic of Obstetrics and Gynecology, DINOGMI, IRCCS San Martino Hospital, University of Genova, Genova (GE), Italy
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Stromal p16 Expression Helps Distinguish Atypical Polypoid Adenomyoma From Myoinvasive Endometrioid Carcinoma of the Uterus. Am J Surg Pathol 2019; 43:1526-1535. [DOI: 10.1097/pas.0000000000001320] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lu B, Yu M, Shi H, Chen Q. Atypical polypoid adenomyoma of the uterus: A reappraisal of the clinicopathological and immunohistochemical features. Pathol Res Pract 2019; 215:766-771. [DOI: 10.1016/j.prp.2019.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/19/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023]
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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.
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Affiliation(s)
- Bo Ma
- Department of Gynecology and Obstetrics
| | | | - Yixin Liu
- Department of Pathology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
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Endocervical Atypical Polypoid Adenomyoma. J Minim Invasive Gynecol 2016; 23:130-2. [DOI: 10.1016/j.jmig.2015.08.879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/22/2022]
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Takahashi H, Yoshida T, Matsumoto T, Kameda Y, Takano Y, Tazo Y, Inoue H, Saegusa M. Frequent β-catenin gene mutations in atypical polypoid adenomyoma of the uterus. Hum Pathol 2013; 45:33-40. [PMID: 24182564 DOI: 10.1016/j.humpath.2013.06.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
Atypical polypoid adenomyoma (APA) is an uncommon polypoid lesion of the uterus. To clarify the mechanism of its histogenesis, we examined the functional role of β-catenin, with reference to expression of p21(waf1), cyclin D1, cyclin E, CD10, and α-smooth muscle actin (SMA), as well as cell proliferation, in 7 lesions. In the epithelial components, expression of nuclear β-catenin, p21(waf1), and cyclin D1 was increased in a stepwise fashion from normal tissue through complex atypical hyperplasia and adenomyoma to APA lesions, particularly in squamous morular areas, whereas cell proliferation, as well as cyclin E expression, was significantly decreased in the latter. Similar findings were evident in the stromal lesions, with the exception of a case of nuclear β-catenin. In addition, coexpression of CD10 and α-SMA markers was observed in the stromal components in 3 APA cases, in line with the results of normal secretory endometrial and adenomyoma samples, suggesting that cells progress to myofibromatous cells in response to differentiation-promoting events. Finally, β-catenin gene (CTNNB1) mutations were detected in all APA cases, the single nucleotide substitutions being in the epithelial but not the stromal components. These findings suggest that activation of β-catenin signaling, probably secondary to the gene abnormalities, plays an important role in the formation of the complex epithelial architecture in APAs, leading to inhibition of cell proliferation through overexpression of p21(waf1). In contrast, changes in the stromal cell phenotype may occur through a shift from CD10 to α-SMA immunopositivity, independent of CTNNB1 status.
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Affiliation(s)
- Hiroyuki Takahashi
- Department of Pathology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
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Matsumoto T, Hiura M, Baba T, Ishiko O, Shiozawa T, Yaegashi N, Kobayashi H, Yoshikawa H, Kawamura N, Kaku T. Clinical management of atypical polypoid adenomyoma of the uterus. A clinicopathological review of 29 cases. Gynecol Oncol 2013; 129:54-7. [DOI: 10.1016/j.ygyno.2012.12.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 12/21/2012] [Accepted: 12/24/2012] [Indexed: 11/16/2022]
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[Atypical polypoid adenomyoma: retrospective study about 8 cases from Jeanne-de-Flandre Hospital between 1996 and 2008]. ACTA ACUST UNITED AC 2012; 42:84-91. [PMID: 22306097 DOI: 10.1016/j.gyobfe.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 07/05/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To propose a therapeutic approach and follow-up of patients with atypical polypoid adenomyoma (APA) wishing to remain fertile. PATIENTS AND METHOD We are presenting a retrospective study of eight APA cases. RESULTS Two patients immediately received radical treatment, and one patient had an endometrial thermocoagulation. The remaining five patients received a conservative treatment with ultrasound and hysteroscopic monitoring. Among them, two had full-term pregnancies, one is being treated for infertility, in one case, the APA disappeared after three hysteroscopy-curettages and macroprogestative treatment. Lastly, one of our patients died from an aggressive endometrioid ovarian bilateral tumour associated with an endometrial adenocarcinoma. DISCUSSION AND CONCLUSION Radical treatment is necessary for cases of APA in women no longer wishing to remain fertile. For those wishing to remain fertile, we can offer a conservative treatment once they have been informed regarding the associated risk of relapse, degeneration, and ovarian lesions which necessitate stricter follow-up.
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Edwards JM, Alsop S, Modesitt SC. Coexisting atypical polypoid adenomyoma and endometrioid endometrial carcinoma in a young woman with Cowden Syndrome: Case report and implications for screening and prevention. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:29-31. [PMID: 24371612 DOI: 10.1016/j.gynor.2011.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/27/2011] [Indexed: 11/29/2022]
Abstract
► Cowden Syndrome is a rare hereditary cancer syndrome, which confers an increased risk of breast, thyroid, endometrial and colon cancer. ► Atypical polypoid adenomyoma does not generally represent a premalignant lesion, but must be carefully screened for foci of malignancy. ► Cancer screening must be intensified for patients who meet the diagnostic criteria for Cowden Syndrome.
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Affiliation(s)
- James M Edwards
- Department of Obstetrics and Gynecology, Duke University Medical Center, DUMC Box 3616, Durham, NC, USA
| | - Skylar Alsop
- Department of Pathology, Maryview Medical Center, 3636 High Street, Portsmouth, VA 23707, USA
| | - Susan C Modesitt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, PO Box 800712, Charlottesville, VA 22908, USA
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Yahata T, Nonaka T, Watanabe A, Sekine M, Tanaka K. Complete hysteroscopic resection of a large atypical polypoid adenomyoma, followed by a successful pregnancy. Fertil Steril 2011; 95:2435.e9-11. [DOI: 10.1016/j.fertnstert.2011.03.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/16/2011] [Indexed: 10/18/2022]
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Kisu I, Banno K, Yanokura M, Kobayashi Y, Ueki A, Ono A, Masuda K, Yamagami W, Nomura H, Hirasawa A, Susumu N, Aoki D. Atypical Polypoid Adenomyoma (APAM) of the Uterine: Relationship with Endometrial Cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jct.2011.24061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- S. Alsammoua
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - P. J. Teoh
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - L. Khalifa
- Department of Obstetrics and Gynaecology, Dumfries and Galloway Royal Infirmary, Dumfries, UK
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Horita A, Kurata A, Komatsu K, Yajima M, Sakamoto A. Coexistent atypical polypoid adenomyoma and complex atypical endometrial hyperplasia in the uterus. Diagn Cytopathol 2009; 38:527-32. [DOI: 10.1002/dc.21263] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Low-grade endometrial adenocarcinoma: a diagnostic algorithm for distinguishing atypical endometrial hyperplasia and other benign (and malignant) mimics. Adv Anat Pathol 2009; 16:1-22. [PMID: 19098463 DOI: 10.1097/pap.0b013e3181919e15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The distinction between endometrial hyperplasia and well-differentiated adenocarcinoma of the endometrium continues to be a difficult differential diagnosis in surgical pathology. Evidence-based diagnostic criteria for well-differentiated endometrial adenocarcinoma focus on histologic features that predict myoinvasion in the hysterectomy specimen. Only 2 diagnostic criteria with significant power aid in this distinction: complex glandular architectural patterns (glandular confluence, intraglandular complexity, and hierarchical papillary architecture) and marked cytologic atypia beyond that typically defined as atypical hyperplasia (ie, prominent macronucleoli visible at low power and marked nuclear pleomorphism). Application of these 2 criteria in problematic endometrial proliferations allows stratification of patients into 3 risk categories: very low risk (< 0.05% risk of myoinvasion at hysterectomy)=complex atypical hyperplasia; intermediate risk (5.5% risk of myoinvasion at hysterectomy)=complex atypical hyperplasia, cannot exclude well-differentiated adenocarcinoma (borderline); and high risk (20% risk of myoinvasion at hysterectomy)=well-differentiated adenocarcinoma. In order to optimize the use of these diagnostic criteria, a variety of gland forming lesions that may mimic well-differentiated endometrioid adenocarcinoma must first be excluded. In addition, unusual morphologic patterns of low-grade endometrioid adenocarcinoma should be recognized, as they may cause confusion with other, higher grade (and therefore, more clinically aggressive) endometrial processes.
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CD10 Immunostaining distinguishes atypical polypoid adenomyofibroma (atypical polypoid adenomyoma) from endometrial carcinoma invading the myometrium. Hum Pathol 2008; 39:1446-53. [DOI: 10.1016/j.humpath.2008.02.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 02/12/2008] [Accepted: 02/18/2008] [Indexed: 11/19/2022]
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Di Spiezio Sardo A, Mazzon I, Gargano V, Di Carlo C, Guida M, Mignogna C, Bifulco G, Nappi C. Hysteroscopic treatment of atypical polypoid adenomyoma diagnosed incidentally in a young infertile woman. Fertil Steril 2008; 89:456.e9-12. [PMID: 17706212 DOI: 10.1016/j.fertnstert.2007.02.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 02/27/2007] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the conservative treatment of an atypical polypoid adenomyoma (APA) in a young infertile patient using a modification of the technique previously reported for the conservative treatment of stage IA endometrial cancer. DESIGN Case report. SETTING Department of Gynaecology and Obstetrics and Pathophysiology of Human Reproduction of the University of Naples "Federico II." PATIENT(S) A 35-year-old woman diagnosed incidentally with an APA during routine investigation for primary infertility. INTERVENTION(S) Conservative resectoscopic treatment using a four-step technique in which each step is characterized by a pathological analysis: the removal of the APA (step 1), the removal of endometrium adjacent to the APA (step 2), the removal of the myometrium underlying the APA (step 3), and multiple random endometrial biopsies (step 4). MAIN OUTCOME MEASURE(S) Complete resection of the APA and ruling out of any malignancy. RESULT(S) The conservative surgery was effective as histological examination of all specimens confirmed an APA confined to the endometrium without any other premalignant or malignant lesion. Transvaginal ultrasound and office hysteroscopy with target biopsies at 1 and 6 months after surgery were negative for atypia and malignancy. CONCLUSION(S) Our technique under a close, intermittent postoperative surveillance might represent a good therapeutic option for those women with APA who wish to preserve their fertility as well as for those at high medical risk for hysterectomy.
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Wong AYK, Chan KS, Lau WL, Tang LCH. Pregnancy outcome of a patient with atypical polypoid adenomyoma. Fertil Steril 2007; 88:1438.e7-9. [PMID: 17482169 DOI: 10.1016/j.fertnstert.2007.01.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 01/05/2007] [Accepted: 01/05/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Detailed description and follow-up of a patient with atypical polypoid adenomyoma and infertility, from investigation until delivery of a healthy baby. DESIGN Case report. SETTING Tertiary infertility center. PATIENT(S) A patient suffering from persistent APA and infertility. INTERVENTION(S) Danggui (Angelica sinensis) and low-dose aspirin. MAIN OUTCOME MEASURE(S) Pregnancy and live birth. RESULT(S) Conception after Danggui but intrauterine death at 25 weeks. Successful live birth after Danggui plus low-dose aspirin. CONCLUSION(S) Danggui corrected atypical polypoid adenomyoma and led to pregnancy twice in the same patient. Low-dose aspirin may improve the circulation in the placental bed and lead to live birth.
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Affiliation(s)
- Alice Y K Wong
- Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong, People's Republic of China.
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Mount SL, Cooper K. Tumours with divergent müllerian differentiation of the uterine corpus. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cdip.2005.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vilos GA, Ettler HC. Atypical polypoid adenomyoma and hysteroscopic endometrial ablation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2003; 25:760-2. [PMID: 12970811 DOI: 10.1016/s1701-2163(16)31005-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 49-year-old woman presenting with menometrorrhagia underwent an office endometrial biopsy that indicated features suspicious for atypical polypoid adenomyoma (APA) but was inconclusive. The woman requested further evaluation prior to consenting to a hysterectomy and bilateral salpingo-oophorectomy. Hysteroscopy demonstrated a fleshy 2 cm to 3 cm sessile polypoid tumour, which was resected with the entire endometrium. The histology confirmed APA. Although amenorrhea was achieved, the gynaecological oncologist recommended the woman undergo hysterectomy, which she did 4 months later. Pathologic examination of the uterus revealed no residual endometrium or APA. As this tumour generally occurs in premenopausal women, and as conserving fertility potential may be an important consideration, hysteroscopic resection of such tumours may be a therapeutic option in women who wish to retain their uterus or who would be at high medical risk for hysterectomy. However, close, intermittent postoperative surveillance is recommended.
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Affiliation(s)
- George A Vilos
- Departments of Obstetrics and Gynaecology, The University of Western Ontario, London, ON, Canada
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Ota S, Catasus L, Matias-Guiu X, Bussaglia E, Lagarda H, Pons C, Muñoz J, Kamura T, Prat J. Molecular pathology of atypical polypoid adenomyoma of the uterus. Hum Pathol 2003; 34:784-8. [PMID: 14506639 DOI: 10.1016/s0046-8177(03)00246-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Atypical polypoid adenomyoma (APA) is an uncommon and benign tumor of the uterus. In some patients, however, APA has been found to coexist with or to precede the development of an endometrioid adenocarcinoma similarly to complex endometrial hyperplasia. The molecular changes underlying the progression from APA to adenocarcinoma are unknown. DNA from paraffin-embedded tissue of 6 APAs was evaluated for microsatellite instability (MI), MLH-1 promoter hypermethylation, and CTNNB-1 mutations. Tissue sections were also subjected to MLH-1, MSH-2, and beta-catenin immunostaining. MI was not detected in any case. Two tumors exhibited MLH-1 promoter hypermethylation and showed focal negative MHL-1 immunostaining; 1 of these showed marked architectural complexity and cellular pleomorphism. Five cases presented beta-catenin nuclear immunoreactivity, but none of them had CTNNB-1 mutations. The results of this study suggest that APA and complex endometrial hyperplasia may share some molecular alterations. Some APAs exhibit MLH-1 promoter hypermethylation with focal lack of MLH-1 immunostaining, a molecular abnormality involved in the transition from complex atypical hyperplasia to endometrioid adenocarcinoma.
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Affiliation(s)
- Shunichiro Ota
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kurume University, Kurume, Japan
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Puca KE, Wu HHJ. Pathologic quiz case. An incidental endometrial tumor masked by large leiomyoma. Arch Pathol Lab Med 2002; 126:864, 865-6. [PMID: 12125647 DOI: 10.5858/2002-126-0864-pqcaie] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kathleen E Puca
- Department of Pathology, Ball Memorial Hospital, Muncie, Ind
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Clement PB, Young RH. Endometrioid carcinoma of the uterine corpus: a review of its pathology with emphasis on recent advances and problematic aspects. Adv Anat Pathol 2002; 9:145-84. [PMID: 11981113 DOI: 10.1097/00125480-200205000-00001] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review considers the pathologic features of endometrioid carcinoma of the uterine corpus, which accounts for approximately 80% of endometrial adenocarcinomas, with an emphasis on its histologic features, recent advances, and problematic aspects. In addition to typical endometrioid carcinoma, the variants of endometrioid carcinoma covered include secretory carcinoma, villoglandular endometrioid carcinoma, endometrioid carcinoma with small nonvillous papillae, endometrioid carcinomas with microglandular and sertoliform patterns, and endometrioid carcinomas with metaplastic changes. These changes include a variety of different appearances of squamous epithelia (ranging from mature and keratinizing to immature with only subtle evidence of a squamous nature), clear cells, surface changes resembling syncytial metaplasia or microglandular hyperplasia, ciliated cells, oxyphilic cells, and spindled epithelial cells (sarcomatoid carcinoma). The last is one of several variants that may cause a biphasic appearance, all of which should be distinguished from the malignant müllerian mixed tumor. Rare findings in endometrioid carcinomas include hyalinization, psammoma bodies, and foci of stromal metaplasia such as osteoid. Unusual growth patterns of endometrioid carcinomas include involvement of adenomyosis, the "diffusely" infiltrating pattern of myoinvasion, and a previously unemphasized pattern of myoinvasion with "pinched off" glands that may be cystic or have a pseudovascular appearance, often with a myxoid stromal reaction. Other aspects of endometrioid carcinoma discussed are its immunoprofile, grading, cervical involvement (including a hitherto undescribed "burrowing" pattern of extension within the cervix that can result in underdiagnosis of stage IIB disease), carcinoma arising in the lower uterine segment, carcinoma arising in polyps and adenomyomas, carcinoma in young women, tamoxifen-related carcinoma, associated ovarian endometrioid carcinoma, and peritoneal keratin granulomas. Finally, the differential diagnosis of endometrioid carcinoma is briefly considered with a section on benign mimics, including curettage-related changes, menstrual changes, adenomyosis-related problems, metaplastic changes, atypical polypoid adenomyoma, radiation atypia, and papillary proliferations, and a section on metastatic colonic carcinoma.
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Affiliation(s)
- Philip B Clement
- Department of Pathology, Vancouver General Hospital and Health Sciences Center and the University of British Columbia, Canada
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Jakus S, Edmonds P, Dunton C, Holland G. Atypical Polypoid Adenomyoma Mimicking Cervical Adenocarcinoma. J Low Genit Tract Dis 2002; 6:33-8. [PMID: 17050990 DOI: 10.1046/j.1526-0976.2002.61007.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Atypical polypoid adenomyoma (APA) of the uterus is a rare, benign lesion. Histologically, it is composed of a glandular and squamous cell proliferation with architectural complexity and cytologic atypia of glands, and a hypercellular smooth muscle stroma. APA is difficult to distinguish from well-differentiated adenocarcinoma of the uterus. In the case presented, the diagnosis of APA was confused pathologically, radiographically, and clinically with a cervical adenocarcinoma. A review of the English literature is presented.
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Affiliation(s)
- Sharon Jakus
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
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Atypical Polypoid Adenomyoma Mimicking Cervical Adenocarcinoma. J Low Genit Tract Dis 2002. [DOI: 10.1097/00128360-200201000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kaku T, Yoshikawa H, Tsuda H, Sakamoto A, Fukunaga M, Kuwabara Y, Hataeg M, Kodama S, Kuzuya K, Sato S, Nishimura T, Hiura M, Nakano H, Iwasaka T, Miyazaki K, Kamura T. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 2001; 167:39-48. [PMID: 11323097 DOI: 10.1016/s0304-3835(01)00462-1] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thirty-nine patients with endometrioid adenocarcinoma (EA) and atypical hyperplasia (AH) of the endometrium who received conservative treatment to preserve fertility were collected from member institutions of the Japan Gynecologic Oncology Study Group. Twenty-nine and ten were originally diagnosed with EA without myometrial invasion and AH, respectively. We performed a central pathological review to make definite diagnoses, and the diagnosis of EA in 29 cases was changed to AH in ten, complex hyperplasia in three and atypical polypoid adenomyoma in three, and AH in ten was changed to EA in one and simple hyperplasia in one. Nine of 12 women (75%) with EA and 15 of 18 women (83%) with AH had an initial response to medroxyprogesterone acetate (MPA) treatment. Two of nine responders with EA later developed relapse, and one of them had metastasis to the left obturator lymph node. Two became pregnant, and one delivered one full-term infant. One of the responders with AH had a relapse in the endometrium. Five became pregnant, and four delivered four normal infants. The young women with endometrial carcinoma localized in the endometrium who wish to preserve fertility may be treated as successfully with MPA as those with AH.
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Affiliation(s)
- T Kaku
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, 812-8582, Fukuoka, Japan.
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Gilks CB, Clement PB, Hart WR, Young RH. Uterine adenomyomas excluding atypical polypoid adenomyomas and adenomyomas of endocervical type: a clinicopathologic study of 30 cases of an underemphasized lesion that may cause diagnostic problems with brief consideration of adenomyomas of other female genital tract sites. Int J Gynecol Pathol 2000; 19:195-205. [PMID: 10907166 DOI: 10.1097/00004347-200007000-00001] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report 30 uterine tumors composed of an admixture of endometrioid glands, endometrioid stroma, and smooth muscle that lacked the characteristic features of atypical polypoid adenomyoma. The patients ranged from 26 to 64 (median 47) years of age. The usual presenting symptom was abnormal vaginal bleeding, which was "massive" in two patients. Six patients were treated by polypectomy only, with hysterectomy performed in the remainder. Twenty-seven adenomyomas were in the corpus (22 submucosal, two mural, and three subserosal) and three in the cervix. The subserosal and submucosal examples were polypoid. The tumors were 0.3 to 17 cm in greatest dimension, and firm with cystic areas often present on sectioning. Focal hemorrhage was described in five cases. On microscopic examination, the tumors were composed of glands and cysts lined by endometrial-type epithelium separated by endometrial stroma and smooth muscle, with smooth muscle predominating. Minor foci of tubal-type epithelium (14 cases), mucinous endocervical-type epithelium (2 cases), and squamous epithelium (1 case) were present. The smooth muscle component was cellular in three cases and contained occasional bizarre nuclei in three cases. The epithelial cells were uniformly bland. No mitotic activity was observed in the epithelial or mesenchymal elements in 20 cases. In the remainder, up to 5 mitotic figures/10 high-power fields were observed in the epithelium (3 cases), the stroma and smooth muscle (3 cases), or both compartments (4 cases). Follow-up in 14 cases revealed no recurrence or extrauterine spread in any case. A diagnosis of adenocarcinoma or adenosarcoma was entertained by the submitting pathologist in five of 14 consultation cases. Adenomyomas are unusual benign uterine tumors that can be misdiagnosed, in part, because the lesion has not often received attention in the literature. The most realistic considerations in the differential diagnosis are atypical polypoid adenomyoma and adenosarcoma. The former, by definition, has epithelial atypia and the latter a malignant (usually low grade) stromal component with typically absent or inconspicuous smooth muscle. Distinction of adenomyoma from adenosarcoma may have significant therapeutic implications, particularly in young women.
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Affiliation(s)
- C B Gilks
- Department of Pathology, Vancouver Hospital & Health Sciences Centre, BC, Canada
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