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Butureanu T, Haliciu AM, Apetrei AM, Pavaleanu I, Socolov RV, Balan RA. Prolapsed Atypical Polypoid Adenomyoma-A Case Report and Literature Review. Life (Basel) 2023; 13:2352. [PMID: 38137953 PMCID: PMC10744584 DOI: 10.3390/life13122352] [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: 11/05/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, usually leading to misdiagnosis. Histopathologically, it is a biphasic tumor, represented by the endometrioid glands with a complex histoarchitecture, with sometimes squamous morular metaplasia or cytologic atypia, interspersed with a fibromyomatous stroma. This tumor has a high incidence of recurrence. We present a very rare case of a 21-year-old patient, a virgin, without a significant medical history, with a bleeding mass occupying the vagina. The mass was excised using forceps, scissors, and a suture of the visible pedicle. After a four-year follow-up and no additional medical treatment, no relapse was observed. Given the risk of recurrence and progression, APAM might be treated via a hysterectomy in patients with no desire for pregnancy. Due to a lower recurrence rate, the conservative treatment of atypical polypoid adenomyoma performed via an operative hysteroscopy represents the best choice. Previously diagnosed in hysterectomy specimens, with the introduction of better-performing indirect imaging techniques, adenomyosis is a clinical entity that has the possibility of being diagnosed in the presurgical stage.
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Affiliation(s)
- Tudor Butureanu
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Ana-Maria Haliciu
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Ana-Maria Apetrei
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Ioana Pavaleanu
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Razvan Vladimir Socolov
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Raluca Anca Balan
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
- Department of Morpho-Functional Sciences I, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Han L, Shi G, Ruan J. An unusual imaging of atypical polypoid adenomyoma in a 21-year-old woman. J Minim Invasive Gynecol 2021; 29:462-464. [PMID: 34929397 DOI: 10.1016/j.jmig.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Ling Han
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, China (all authors)
| | - Gang Shi
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, China (all authors)
| | - Jiaying Ruan
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, China (all authors)..
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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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