子宮鏡下で切除した子宮ポリープ状異型腺筋腫（atypical polypoid adenomyoma: APAM）の一例

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Atypical polypoid adenomyoma (APAM) is an endometrial tumor that arises from the uterine corpus or cervix in premenopausal woman. Although APAM is pathologically benign, it should be distinguished from atypical endometrial hyperplasia and complex invasive endometrial adenocarcinoma (G1) because these conditions are similar and often coexist. We report a patient with APAM treated with hysteroscopic transcervical resection (TCR). The 28-year-old nullipara patient had hypermenorrhea for 1 year and genital bleeding for 3 months. Ultrasound and MRI revealed a 27 mm×12 mm tumor in the uterine cavity, which was considered to be an endometrial polyp or submucosal myoma. TCR was performed after GnRHa administration for 3 months. Pathological diagnosis showed APAM. Dilatation and curettage was performed 1 month after surgery, showing several residual atypical glands of APAM. The patient was followed every 3 months, and no recurrence of APAM has been detected for 1.5 years. Although clinical management of APAM has not been established, TCR is a reliable procedure for conservative treatment under careful follow-up.
日本産科婦人科内視鏡学会の論文