Atypical polypoid adenomyoma

A rare uterine tumor

Atypical polypoid adenomyoma (APA) is a rare uterine tumor that typically occurs in women of reproductive age. It is characterized by the presence of both glandular and stromal components, with atypical endometrial glands and a smooth muscle stroma. APA is considered a benign lesion, but it can be associated with endometrial hyperplasia and, in some cases, endometrial carcinoma.

Pathophysiology

APA is a biphasic tumor, meaning it contains two distinct types of tissue. The glandular component consists of atypical endometrial glands, which may show architectural complexity and cytological atypia. The stromal component is composed of smooth muscle cells, similar to those found in the myometrium. The interaction between these components is not fully understood, but it is thought that hormonal influences may play a role in the development of APA.

Clinical Presentation

Patients with APA often present with abnormal uterine bleeding, which may include menorrhagia or metrorrhagia. Some patients may also experience pelvic pain or discomfort. The lesion is usually discovered during evaluation for these symptoms, often through hysteroscopy or ultrasound imaging.

Diagnosis

The diagnosis of APA is typically made through histopathological examination of a biopsy or surgical specimen. The presence of atypical endometrial glands within a smooth muscle stroma is characteristic. Immunohistochemical staining can aid in the diagnosis, with markers such as estrogen receptor (ER) and progesterone receptor (PR) often being positive in the glandular component.

Treatment

The primary treatment for APA is surgical removal. This can be accomplished through hysteroscopic resection or, in some cases, hysterectomy. The choice of treatment depends on the size of the lesion, the patient's symptoms, and their desire for future fertility. In cases where APA is associated with endometrial hyperplasia or carcinoma, additional treatment may be necessary.

Prognosis

The prognosis for patients with APA is generally good, as it is a benign lesion. However, careful follow-up is recommended due to the potential association with endometrial hyperplasia and carcinoma. Recurrence after surgical removal is rare but can occur.

Related Pages

• Endometrial hyperplasia
• Endometrial carcinoma
• Uterine tumors
• Hysteroscopy