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Butureanu T, Haliciu AM, Apetrei AM, Pavaleanu I, Socolov RV, Balan RA. Prolapsed Atypical Polypoid Adenomyoma-A Case Report and Literature Review. Life (Basel) 2023; 13:2352. [PMID: 38137953 PMCID: PMC10744584 DOI: 10.3390/life13122352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, usually leading to misdiagnosis. Histopathologically, it is a biphasic tumor, represented by the endometrioid glands with a complex histoarchitecture, with sometimes squamous morular metaplasia or cytologic atypia, interspersed with a fibromyomatous stroma. This tumor has a high incidence of recurrence. We present a very rare case of a 21-year-old patient, a virgin, without a significant medical history, with a bleeding mass occupying the vagina. The mass was excised using forceps, scissors, and a suture of the visible pedicle. After a four-year follow-up and no additional medical treatment, no relapse was observed. Given the risk of recurrence and progression, APAM might be treated via a hysterectomy in patients with no desire for pregnancy. Due to a lower recurrence rate, the conservative treatment of atypical polypoid adenomyoma performed via an operative hysteroscopy represents the best choice. Previously diagnosed in hysterectomy specimens, with the introduction of better-performing indirect imaging techniques, adenomyosis is a clinical entity that has the possibility of being diagnosed in the presurgical stage.
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Affiliation(s)
- Tudor Butureanu
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Ana-Maria Haliciu
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Ana-Maria Apetrei
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Ioana Pavaleanu
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Razvan Vladimir Socolov
- Department of Mother and Child, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (T.B.); (I.P.); (R.V.S.)
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
| | - Raluca Anca Balan
- “Elena Doamna” University Hospital of Obstetrics and Gynecology, 49, Elena Doamna St., 700398 Iasi, Romania;
- Department of Morpho-Functional Sciences I, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Omori M, Kawai M, Ogawa T, Sasatsu S, Fukasawa H, Nakazawa K, Kondo T, Hirata S. Lesion-targeted cytology to improve cytological sampling for atypical polypoid adenomyomas of the uterus: A case series and review of the literature. Cytopathology 2020; 31:579-585. [PMID: 32779225 DOI: 10.1111/cyt.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Atypical polypoid adenomyomas (APAs) are uncommon tumours consisting of atypical endometrioid glands and fibromyomatous stroma. Identifying the biphasic nature of atypical glandular components and spindle mesenchymal components without atypia is crucial for the cytological diagnosis of APA. We investigated the utility of lesion-targeted cytology (LTC) to directly collect firm spindle components. METHODS We recruited seven consecutive surgical patients who underwent cytological examinations before surgery and were diagnosed with APA on postoperative histological examinations. Cytological smears were obtained by routine sampling in five cases and by targeted sampling using transvaginal ultrasonography, that is, LTC, in two cases. We retrospectively analysed the cytological findings from our cases and compared them to those of APA cases previously reported in the English literature. RESULTS Among 5/7 cases that involved routine cytological sampling, normal cytological findings were found in 2 and atypical glandular cells were found in 3, but spindle cells from mesenchymal components were not detected. In contrast, among 2/7 cases in which sampling involved LTC, spindle cells without atypia, in addition to atypical glandular cells were found. CONCLUSIONS Lesion-targeted cytology is useful to assess mesenchymal components of APAs and may improve the cytological diagnosis of APA.
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Affiliation(s)
- Makiko Omori
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masataka Kawai
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuyuki Ogawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Satoko Sasatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroko Fukasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kumiko Nakazawa
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Immunohistochemical results and case report of an incidental finding of uterine polypoid adenomyoma after long-time therapy for metrorrhagia. Pathol Res Pract 2020; 216:152998. [PMID: 32534705 DOI: 10.1016/j.prp.2020.152998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022]
Abstract
We present a 25-year-old female woman with a 9-year history of metrorrhagia, in whom a uterine polypoid adenomyoma (UPA) was incidentally detected. Intense nuclear staining in the uterine adenomyoma tissue showed an immunoreaction with BAF250a/ARID1A, Arginase-2 as well as 1LRH-2E1/NR5A2, suggesting a role of these proteins and transcriptional activity of their genes in uterine polypoid adenomyoma development. Neither Nidogen-2 nor SF-1/NR5A1 were expressed in UPA.
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