Clinicopathological Characteristics of Atypical Polypoid Adenomyoma of the Uterus in Association With Endometrial Atypical Hyperplasia and Endometrioid Carcinoma
Atypical polypoid adenomyoma (APA) is an uncommon biphasic uterine tumor characterized by irregularly shaped, atypical endometrial glands haphazardly distributed within a fibromuscular stroma. APA is frequently associated with atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (AH/EIN) and endometrioid endometrial carcinoma (EC). This study aimed to characterize the clinicopathological features and outcomes of APA concomitant with AH/EIN and EC. Nineteen cases of APA coexisting with AH/EIN or EC were retrospectively analyzed. Clinical presentation, pathological findings, treatment modalities, and outcomes were reviewed. Most patients (78.9%) were of reproductive age (26-45 years). The most common presenting symptom was abnormal uterine bleeding (47.4%), while 26.3% were asymptomatic. EC and AH/EIN were identified in 14 (73.7%) and five (26.3%) patients, respectively. Compared with AH/EIN, EC more often demonstrated cribriform architecture, papillary intraluminal growth, and stromal desmoplasia. Six of the 14 patients with EC underwent hysterectomy and remained recurrence-free. Of the eight patients managed with progestin therapy, four had persistent EC or AH/EIN on follow up curettage at three months. Similarly, one of the five patients with AH/EIN treated conservatively showed persistent disease after three months of progestin therapy. Nevertheless, all patients were disease-free at the last follow-up. In APA, meticulous pathological evaluation is essential to detect concurrent AH/EIN or EC. Although conservative management may be appropriate for selected patients, close surveillance is necessary to monitor for persistence or recurrence. Hysterectomy remains a definitive and reliable therapeutic option.