Fertility-preserving management of atypical polypoid adenomyoma (APAM) in 2 young women

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We report 2 cases of young women diagnosed with atypical polypoid adenomyoma (APAM). [Case 1] A 29-year-old woman (nulligravida) with a chief complaint of menorrhagia was found to have a 2-cm tumor in the uterine body and referred to our hospital. Endometrial biopsy detected atypical endometrial hyperplasia, complex and transcervical resection (TCR) and dilation and curettage (D&C) procedures were performed. The final diagnosis was APAM. No residual tumor was found in a post-surgery hysteroscopic examination. 6 years later, MRI revealed a 2-cm tumor in the uterus and recurrence of APAM was diagnosed from D&C findings. The tumor grew to 4-cm in diameter within 3 months and TCR was performed. However, the tumor grew in size and she suffered from menorrhagia 6 months later. A laparotomy was performed to resect the tumor, with a negative resected margin. No recurrence was noted 10 months after the surgery. [Case 2] A 27-year-old woman (nulligravida) with menorrhagia underwent TCR to remove endometrial polyps in the fundus of the uterus and a biopsied specimen of the endometrium in the posterior isthmus of the uterus detected atypical endometrial hyperplasia, complex. A D&C procedure revealed no atypical endometrium findings and she was carefully followed. 2 years later, an ultrasound examination revealed a 1-cm tumor in the posterior isthmus of the uterus and biopsied endometrial specimens detected a well-differenciated endometrioid adenocarcinoma. In order to rule out myometrial and cervical invasion, TCR was performed and a diagnosis of APAM was established. No recurrence was seen 11 months after surgery. [Adv Obstet Gynecol, 64 (4) : 483-489 ,2012(H24.11)]

Fertility-preserving management of atypical polypoid adenomyoma (APAM) in 2 young women

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