Pregnant outcomes of atypical polypoid adenomyoma treated with progestin therapy

We aimed to investigate the long-term clinical and pregnancy outcome in patients with atypical polypoid adenomyoma (APA) after hysteroscopic excision.

We analyzed the clinicopathological features, including pregnancy outcomes, in 10 APA patients who had been treated with hysteroscopic excision of the lesion and progesterone therapy.

The patients were all nulliparous, and nine had been clinically diagnosed as infertile. There were five patients with complex endometrial hyperplasia at the time of initial diagnosis, two of them had had recurrence of complex hyperplasia, and there was another one who had had complex hyperplasia 18 months after initial diagnosis. The patients had been treated with polypectomy under hysteroscopy and a long-term progestin therapy. They had achieved complete regression, but four had a recurrent or persistent disease. Two patients had eventually undergone hysterectomy due to endometrial carcinoma at 102 months (patient 2) or persisting complex atypical hyperplasia at 131 months (patient 5) after initial diagnosis. All patients were alive with no evidence of disease during a follow-up period of 19-145 months. Seven patients had succeeded in pregnancy with nine live births. Three pregnancies had been achieved by in vitro fertilization and embryo transfer.

Fertility-sparing surgery under hysteroscopy with progesterone therapy and appropriate assistant reproduction technology is an alternative option for young APA patients. However, close follow-up is required for these patients.