Atypical polypoid adenomyoma mixed with endometrioid carcinoma: a case report

The following is a description of an extremely rare tumor of the uterus, malignant atypical polypoid adenomyoma (APA), admixed with well-differentiated endometroid carcinoma, in a 29-year-old patient previously treated for sterility in whom, due to the existence of a ten-millimeter sessile tumor on the uterine corpus, verified by transvaginal ultrasonography (TVUS), a hysteroscopic resection of the anomaly was performed. The patient underwent all requisite examinations and was referred to the malignant diseases panel for an examination and a decision on further treatment. As the patient wished to preserve fertility, the authors decided to continue performing regular controls at intervals of two to three months. The first subsequent control called for a TVUS examination or one using another imaging method, with a multiple endometrial biopsy with curettage of the endocervix. The results of the first examination promised that fertility could be preserved. Therapy with medroxyprogesterone acetate (MPA) in daily dosages of 200 to 500 mg was advised, which the patient intentionally did not take. A spontaneous desired pregnancy was verified following the first control.

Atypical endometrial polipoid adenoma; Hysteroscopic resection; Fertility preservation.

[1] Iori K., Kouji B., Megumi Y., Yusuke K., Arisa U., Asuka O. et al.: “Atipical polipoid adenomyoma ( APAM) of the uterine-relationship with endometrial cancer”. J. Cancer Therapy, 2011, 2, 458.

[2] Mazur M.T.: “Atypical polypoid adenomyoma of the endometrium”. Am. J. Surg. Pathol., 1981, 5, 473.

[3] Fukuda M., Sakurai N., Yamamoto Y., Taoka H., Asakawa Y., Kurasaki A. et al.: “Case of atypical polypoid adenomyoma that possibly underwent a serial progression from endometrial hyperplasia to carcinoma”. J. Obstet. Gynaecol. Res., 2011, 37, 468.

[4] Fukanaga M., Endo Y., Ushigome S., Ishikawa E., " Atypical polypoid adenomyomas of the uterus”. Histopathology, 1995, 27, 35.

[5] Maeda T., Tateishi U., Sasajima Y., Hasegawa T., Daisaki H., Arai Y., Sugimura K.: “Atypical polypoid adenomyoma of the uterusappearance on F-FDG PET/MRI Fused images”. Am. J. Roentgenol., 2006, 186, 320.

[6] Young R.H., Treger T., Scully E.: “Atypical polypoid adenomyoma of the uterus; a report of 27 cases”. Am. J. Clin. Pathol., 1986, 86, 139.

[7] Lee K.R.: “Atypical polypoid adenomyoma of the endometrium associated with adenomyomatosis and adenocarcinoma”. Gynecol. Oncol., 1993, 51, 416.

[8] Terada T.: “Atypical polypoid adenomyoma of the uterus: an immunohistochemical study on 5 cases”. Ann. Diagn. Pathol., 2011, 15, 338.

[9] Horita A., Kurata A., Maeda D., Fukayama M., Sakamoto A.: “Immunohistochemical characteristics of atypical polypoid adenomyoma with special reference to H-caldesmon”. Int. J. Gynecol. Pathol., 2011, 30, 64.

[10] Horita A., Kurata A., Komatsu K., Yajima M., Sakamoto A.: “Coexistent atypical polypoid adenomyoma and complex atypical endometrial hyperplasia in the uterus”. Diagn. Cytopathol., 2010, 38, 527.

[11] Longacre T. A., Chung H., Rouse R. V., Hendrickson M.R.: “Atypical polypoid adenomyofibromas (Atypical polypoid adenomyomas) of the uterus: a clinicopathologic study of 55 cases”. Am. J. Surg. Pathol., 1996, 20, 1.

[12] Di Spiezio Sardo A., Mazzon I., Gargano V., Di Carlo C., Guida M., Mignona C. et al.: “Hysteroscopic treatment of atypical polypoid adenomyoma diagnosed incidentally in young infertile woman”. Fertil. Steril., 2008, 89, 456. Epub 2007, Aug. 13.

[13] Clement P.B., Young R.H.: “Atypical polypoid adenomyoma of the uterus associated with Turner’s Syndrome: a report of three cases, including a review of estrogen-associated with Turner’s Syndrome”. Int. J. Gynecol. Pathol., 1987, 6, 104.

[14] Nasu K., Miyazaki T., Takai N., Miyakawa I.: “Atypical polypoid adenomyoma in patinet with hyperprolactinemia”. Int. Gynecol. Cancer, 2001, 11, 326.

[15] Burke C., Kelehan P., Wingfield M.: “Unsuspected endometrial pathology in subfertile woman”. Ir. Med. J., 2007, 100, 466.

[16] Sugiyama T., Ohta S., Nishida T., Okura N., Tanabe K., Yakushiji M.: “Two cases of endometrial adenocarcinoma arising from atypical polypoid adenomyoma”. Gynecol. Oncol., 1998, 71, 141.

[17] Baschinsky D., Keyhani-Rofagha S., Hameed A.: "Exfoliative cytology of atypical polypoid adenomyoma, a case report". Acta Cytologica, 1999, 43, 637.

[18] Dinas K., Daniilidis A., Drizis E., Zarabouks T., Tzafettas J.: “Incidental diagnosis of atypical polypoid adenomyoma in young infertile woman”. Eur. J. Gynaecol. Oncol., 2009, 30, 701.

[19] Yahata T., Nonaka T., Watanabe A., Sekine M., Tanaka K.: “Complete hysterosopic resection of large atypical polypoid adenomyoma, followed by a successful pregnancy”. Fertil. Steril., 2011, 95, 2435.

[20] Clouqueur E., Lucot J.P., Collinet P., Farine M.O., Kedraon O., Poncelet E.: “Atypical polypoid adenomyoma”. Gynecol. Obstet. Fertil., 2012, epub a head of print.

[21] Wong A.Y., Chan K.S., Lau W.L.,Tang L.C.: “Pregnancy outcome of patient with atypicalpolypoid adenomyoma”. Fertil. Steril., 2007, 88, 7.