Clinical Analysis of 44 Cases of Atypical Polypoid Adenomyoma of the Uterus

Background: Atypical polypoid adenomyoma (APA) is a rare intrauterine polypoid lesion that occurs predominantly in premenopausal women. Although, it is considered as a benign lesion and treated conservatively previously, more and more cases show that APA has a high rate of recurrence or residual, and is found to precede 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 2005-2019, and their clinical and histopathologic features were evaluated. B-ultrasound was performed, and all 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 cases with APA-H and 11 with APA-L. Except for one patient who underwent transcervical endometrial resection, all 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 diagnoses were made according to the degree of abnormality of APA surface glands, resulting in APA-L in 36 cases and APA-H in 8 cases. Among these cases, 28 (25 APA-L and 3 APA-H) were treated conservatively. “Four-step diagnosis and treatment” method performed a excellent effect for APA therapy. During the follow-up no evidence of recurrence was found.Conclusions: For cases with intracavitary lesions > 1 cm, hysteroscopic “four-step diagnosis and treatment” 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 with the desire to become pregnant or for uterine preservation, hysteroscopy with complete excision of the lesions should be the preferred treatment method. The patients should be treated individually, followed up closely, and followed up by regular hysteroscopy and endometrial biopsy.