Gynecology, Shikoku Cancer Center, Japan.
Gynecol Oncol. 2013 Apr;129(1):54-7. doi: 10.1016/j.ygyno.2012.12.040. Epub 2013 Jan 3.
The clinical management of atypical polypoid adenomyoma (APAM) of the uterus remains to be established. We collected APAM cases, reviewed the clinicopathological features, and discussed the clinical management.
Twenty-nine patients with APAM were identified by searching the tumor registry of the Japan Clinical Oncology Group (JCOG). Clinical information and histological specimens were obtained from 13 institutional members of the JCOG, and a central pathological review was performed.
The mean age of the patients was 38 years (range, 22-58). Squamous metaplasia was present in 19 cases (65.5%), and well-differentiated endometrioid adenocarcinoma coexisted in 5 cases (17.2%). Primary treatment consisted of dilatation and curettage in 9 patients (31.0%), vaginal resection in 2 patients (6.9%), hysteroscopic transcervical resection (TCR) using hysteroscopy in 10 patients (34.5%), and hysterectomy in 8 patients (27.6%). There were recurrences in 5 (23.8%) of the 21 cases in which fertility was preserved, and the recurrent rate was 10% (1/10) in patients those were treated with TCR and 36.4% (4/11) in those the other treatment options were selected. All patients were alive after primary treatment (a mean follow-up period was 39.6 months; range, 1-202).
The clinical outcome of APAM is benign. However, differential diagnosis should be performed because of its histological similarity to invasive endometrial carcinoma and the possibility of coexistence with other endometrial neoplasms. TCR is a recommended diagnostic and treatment option for patients who desire to preserve fertility.
子宫非典型息肉样腺肌瘤（APAM）的临床处理仍有待确立。我们收集了 APAM 病例，复习了临床病理特征，并讨论了临床处理。
通过检索日本临床肿瘤学组（JCOG）的肿瘤登记处，确定了 29 例 APAM 患者。从 JCOG 的 13 个机构成员处获得了临床信息和组织学标本，并进行了中心病理复查。
患者的平均年龄为 38 岁（范围，22-58 岁）。19 例（65.5%）存在鳞状上皮化生，5 例（17.2%）并存分化良好的子宫内膜样腺癌。初次治疗包括 9 例（31.0%）刮宫术、2 例（6.9%）阴道切除术、10 例（34.5%）宫腔镜经宫颈切除（TCR）和 8 例（27.6%）子宫切除术。在保留生育能力的 21 例中有 5 例（23.8%）复发，TCR 治疗患者的复发率为 10%（1/10），而选择其他治疗方案的患者为 36.4%（4/11）。所有患者在初次治疗后均存活（平均随访时间为 39.6 个月；范围，1-202）。
APAM 的临床结果为良性。然而，由于其组织学与浸润性子宫内膜癌相似，且可能与其他子宫内膜肿瘤共存，因此应进行鉴别诊断。TCR 是保留生育能力患者的推荐诊断和治疗选择。
