Atypical polypoid adenomyoma

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Atypical polypoid adenomyoma
Atypical polypoid adenomyoma under high magnification
Synonyms	APA
Pronounce	N/A
Specialty	N/A
Symptoms	Abnormal uterine bleeding, pelvic pain
Complications	Potential for endometrial cancer
Onset	Reproductive age
Duration	Chronic
Types
Causes	Unknown
Risks	Obesity, polycystic ovary syndrome (PCOS), nulliparity
Diagnosis	Histopathology
Differential diagnosis	Endometrial polyp, endometrial hyperplasia, leiomyoma
Prevention
Treatment	Surgical resection, hormonal therapy
Medication	Progestin
Prognosis	Generally good with treatment
Frequency	Rare
Deaths	N/A

Atypical polypoid adenomyoma (APA) is a rare uterine lesion that is considered a benign tumor but has the potential for malignant transformation. It is characterized by a combination of glandular and stromal components, with atypical endometrial glands embedded within a smooth muscle stroma. APA primarily affects women of reproductive age and is often associated with abnormal uterine bleeding.

Pathophysiology

APA is composed of atypical endometrial glands that are irregularly shaped and often exhibit nuclear atypia. These glands are surrounded by a stroma that resembles smooth muscle, which can sometimes be confused with leiomyoma or other mesenchymal tumors. The exact pathogenesis of APA is not fully understood, but it is thought to arise from the endometrium and may be influenced by hormonal factors.

Clinical Presentation

Patients with APA typically present with abnormal uterine bleeding, which may include menorrhagia or metrorrhagia. Some patients may also experience pelvic pain or infertility. The lesion is often discovered incidentally during evaluation for these symptoms or during routine gynecological examinations.

Diagnosis

The diagnosis of APA is primarily made through histopathological examination. A biopsy or curettage of the uterine lining is performed, and the tissue is examined under a microscope. The presence of atypical glands within a smooth muscle stroma is characteristic of APA. Immunohistochemistry may be used to differentiate APA from other similar lesions, such as endometrial carcinoma or adenosarcoma.

Treatment

The management of APA depends on the patient's symptoms and desire for future fertility. In women who wish to preserve fertility, conservative treatment with hormonal therapy or hysteroscopic resection may be considered. In cases where fertility preservation is not a concern, or if there is suspicion of malignant transformation, a hysterectomy may be recommended.

Prognosis

APA is generally considered a benign lesion, but there is a risk of progression to endometrial carcinoma, particularly if atypical hyperplasia is present. Regular follow-up and monitoring are important for patients with APA, especially those who opt for conservative management.

See also

• Endometrial hyperplasia
• Endometrial carcinoma
• Leiomyoma
• Adenosarcoma