Sun Yue, Tian Lina, Liu Guoyan
Key Laboratory of Cancer Prevention and Therapy of Tianjin, Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, China.
J Clin Med. 2023 Feb 14;12(4):1511. doi: 10.3390/jcm12041511.
To provide a reference for the diagnosis and treatment of atypical polypoid adenomyoma (APA).
This was a retrospective study of 203 APA patients from 2011 to 2021. The clinicopathological characteristics, treatments, and prognosis were analyzed.
The average age at diagnosis of APA patients was 39.30 ± 11.01 years, and premenopausal women accounted for 81.3%. Abnormal uterine bleeding or menorrhagia were the most common clinical manifestations of APA. The uterine fundus (78.3%), followed by the lower segment of the uterus (11.8%), was the most common location of the APA lesions. Abnormal blood vessels were seen on the surface of 28 APA tumors. APA can coexist with atypical endometrial hyperplasia (18.2%) and endometrial cancer (10.8%). Immunohistochemical analysis was performed on 99 samples. In the glandular component, ER (94.8%), PR (94.8%), Ki-67 (51.5%), p53 (45.6%), PTEN (18.8%), and mismatch repair proteins (96.4%) were positively expressed. Stromal immunophenotype expression was exhibited as follows: CD10-(89.5%), p16+(86.9%), h-caldesmon-(66.7%), Desmin+(75%), and Vimentin+(88.9%). Fifty-five APA patients received TCR, and 33 of them received adjuvant therapy after the operation. The postoperative recurrence rate (9.1% vs. 36.4%, < 0.05) and malignant transformation rate (3.0% vs. 18.2%, < 0.05) of the treated group were significantly lower than the untreated group.
APA usually occurs in women of childbearing age, and the diagnosis is based on pathological morphology. APA has a low malignant potential, and those who have fertility requirements can undergo conservative TCR treatment, supplemented by progesterone treatment after surgery and close follow-up. Total hysterectomy is the treatment of choice for APA patients with atypical endometrial hyperplasia around the lesion.
为非典型息肉样腺肌瘤（APA）的诊断和治疗提供参考。
这是一项对2011年至2021年期间203例APA患者的回顾性研究。分析了其临床病理特征、治疗方法及预后情况。
APA患者的平均诊断年龄为39.30±11.01岁，绝经前女性占81.3%。异常子宫出血或月经过多是APA最常见的临床表现。APA病变最常见的部位是子宫底部（78.3%），其次是子宫下段（11.8%）。28例APA肿瘤表面可见异常血管。APA可与非典型子宫内膜增生（18.2%）和子宫内膜癌（10.8%）共存。对99个样本进行了免疫组化分析。在腺性成分中，雌激素受体（ER，94.8%）、孕激素受体（PR，94.8%）、Ki-67（51.5%）、p53（45.6%）、PTEN（18.8%）和错配修复蛋白（96.4%）呈阳性表达。间质免疫表型表达情况如下：CD10-（89.5%）、p16+（86.9%）、h-钙调蛋白-（66.7%）、结蛋白+（75%）和波形蛋白+（88.9%）。5名APA患者接受了经宫颈子宫内膜切除术（TCR），其中33例术后接受了辅助治疗。治疗组的术后复发率（9.1%对36.4%，<0.05）和恶变率（3.0%对18.2%，<0.05）明显低于未治疗组。
APA通常发生于育龄期女性，诊断基于病理形态学。APA的恶性潜能较低，有生育要求者可进行保守的TCR治疗，术后辅以孕激素治疗并密切随访。对于病变周围有非典型子宫内膜增生的APA患者，全子宫切除术是首选治疗方法。
