Atypical polypoid adenomyoma of uterus:a clinicopathological analysis of 11 cases

ZHAI Cui-jing; ZHANG Hong-kai

doi:10.3969/j.issn.1007-8096.2025.06.002

Abstract：Objective To explore the clinical and pathological characteristics and the relationship with the prognosis in 11 patients with uterine atypical polypoid adenomyoma(APA).Methods The clinicopathological features,treatment and prognosis of 11 APA patients treated in Fuxing Hospital Affiliated to Capital Medical University from January 2012 to August 2024 were retrospectively analyzed.Results Abnormal uterine bleeding was the most common reason for admission,followed by B-scan findings of endometrial polyps or submucosal fibroids.Of these,2 patients developed endometrial cancer after 7-11 months and underwent total hysterectomy and double adnexectomy.No clear tumor progression was observed in other patients during regular follow-up.Some patients had complicated atypical hyperplasia,endometrial polyps,and uterine leiomyoma.Microscopically,the endometrial glands showed complex atypical hyperplasia,and the interstitial tissue was obvious muscular stroma,accompanied by relatively obvious morular metaplasia.Immunohistochemical analysis was performed on 11 samples.The expression of ER and PR in endometrial glands was strongly positive in all specimens.The expression of Ki-67 ranged from 3%～70%.All p53 was expressed in wild type.PTEN and PAX2 were significantly absent only in advanced cases,and no significant deletion or deletion ratio was less than 30%in other cases.β-catenin staining showed obvious nuclear positive expression only in the glandular epithelium of 2 cases,but clearly in the morula metaplasia area.CD10 and p16 were positively expressed in the morula metaplasia area.After diagnosis of APA,all patients underwent endometrial lesion resection,and 2 of them received adjuvant therapy with high dose of hormones after surgery and succeeded in pregnancy.Conclusion APA is more commonly found in women of childbearing age.The diagnosis is based on pathologic analysis,and the differential diagnosis is mainly invasive endometrioid carcinoma.Most APA patients have a low rate of progression after endometrial resection,and conservative treatment can be used in close follow-up for those with fertility requirements.However,due to the potential for malignant transformation and recurrence in some patients.For patients with no fertility requirements or highly suspected cancer,total hysterectomy is feasible.Molecular studies on APA are needed.