[Clinicopathologic analysis of 14 cases of atypical polypoid adenomyoma of endometrium with the emphasis on its cancerous transformation].

ABSTRACT

OBJECTIVE: To analyze the clinicopathologic characteristics of atypical polypoid adenomyoma (APA) of endometrium, and investigate the special characteristics of cancerous transformation from APA. METHODS: Fourteen cases of APA were collected in General Hospital of People's Liberation Army from January 2007 to March 2013. The clinical data, morphologic features, immunohistochemistry and the related literature were reviewed. RESULTS: The median age of the 14 patients was 38 years (ranged from 23 to 72 years), only 1 patient was postmenopausal. The most common symptom was irregular vaginal bleeding (4/14), and 4 patients were identified during routine physical examination for infertility. Among 14 cases, 4 cases were diagnosed as well differentiated endometrioid adenocarcinoma originating from APA, and their median age was 35 years (ranged from 28 to 41 years); color Doppler flow imaging (CDFI) of ultrasound showed rich blood flow signal. The tumors with cancerous components were obviously larger than the usual APA (mean diameter 4.7 versus 1.8 cm). Histologically, irregular and branched glands were embedded in fibromuscular stroma and the glandular epithelium were atypical hyperplasia in varying degrees. While carcinoma developed in the APA, the sieve, solid and papillary structures were noticeable, and necrosis were common. CONCLUSIONS: APA is a rare lesion of the uterus. Although the clinical behavior is benign in most cases, there may be possible for some cases developing carcinomas. If the APA mass is more than 4 cm in diameter, and microscopically demonstrates prominent sieve, solid, papillary structures and necrosis, the diagnosis of carcinoma developed from APA can be made. Thorough analysis should be done before the most proper therapeutic regimen is drawn up.