Endocervical Atypical Polypoid Adenomyoma.

Area of Science:

• Gynecologic Oncology
• Reproductive Medicine
• Surgical Pathology

Background:

• Atypical polypoid adenomyomas (APAMs) are rare, potentially recurrent uterine tumors predominantly affecting premenopausal women.
• APAMs can coexist with or precede endometrial adenocarcinoma, necessitating careful management and long-term follow-up, especially after conservative treatments.
• The rarity of APAMs, with fewer than 250 reported cases globally, highlights the need for detailed case reports.

Observation:

• A 41-year-old nulliparous woman presented with menometrorrhagia and an incidentally discovered endocervical atypical polypoid adenomyoma during hysteroscopy.
• The patient also had a concurrent 5 cm submucous myoma, three endometrial polyps, and diffuse adenomyosis.
• She expressed a desire for future pregnancy.

Findings:

• The patient underwent successful hysteroscopic resection of the APAM and endometrial polyps.
• Laparoscopic myomectomy and wedge resection of adenomyosis were also performed concurrently.
• Post-treatment, the patient is enrolled in an in vitro fertilization (IVF) program and remains symptom-free at 4 months.

Implications:

• This case demonstrates the feasibility of fertility-sparing management for APAM in women desiring pregnancy.
• Multimodal surgical approaches can effectively address coexisting uterine pathologies like myomas and adenomyosis alongside APAM.
• Successful conservative treatment of APAM may preserve reproductive potential and improve quality of life, warranting consideration in selected patients.