Introduction/Background Atypical polypoid adenomyoma (APA) is a rare intrauterine pathological finding, which can often be misdiagnosed as malignancy. It mostly affects premenopausal women. Therefore, treatment is predominantly conservative including hysteroscopic transcervical resection (TCR), dilatation and curettage (D&C), and hormonal therapy. Due to the high recurrence rate, the most effective treatment for perimenopausal and postmenopausal women is hysterectomy. Mortality rates have not been reported. Following study analyzed four cases of APA, diagnosed after TCR of intrauterine pathology in a single center.

Methodology Clinicopathological characteristics of APA were assessed by retrospective analysis of medical records containing patients age, parity, body mass index, menstrual status, symptoms, associated pathology, and treatment.

Results Four cases of APA were confirmed within specimens provided by TCR (figure 1). The patients ages varied between 31 and 52 years; two patients were premenopausal and two were perimenopausal. Three patients underwent previous endometrial sampling, which revealed either endometrial polyp or simple endometrial hyperplasia (table 1.). A 31-year-old patient with a 5 mm large intracavitary abnormality on ultrasound, underwent TCR. The abnormality (APA) was completely removed and successful pregnancy was achieved 14 months later.

Two months after delivery, TCR provided normal histopathological specimen.

A 38-year-old patient presented with infertility and abnormal uterine bleeding (AUB). After TCR of APA, patient started assisted reproductive treatment with frequent ultrasound monitoring.

For patients aged 48 and 52 year, who presented with intrauterine mass (largest diameter of 18 mm) and AUB, hysterectomy was recommended after confirmation of APA by TCR.

Clinical symptoms of APA included infertility and AUB. Transvaginal ultrasonography confirmed intracavitary lesions in all patients, with largest diameter of 18 mm and glandular polyp as associated pathology.

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Abstract 2022-RA-215-ESGO Figure 1

A typical polypoid adenomyoma contain irregular, often architecturally complex endometrioid gland, with squamous morules (B – CD10), set within myomatous stroma (C – SMA)

Conclusion In our institution, two patients are being conservatively treated for APA with one case of successful pregnancy. Due to the rarity of APA, further observation will evaluate the success of conservative treatment.

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