JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY
Online ISSN : 1884-5746
Print ISSN : 1884-9938
Case report
Atypical Polypoid Adenomyoma Treated by a Two-Stage Trans-Cervical Resection: Case Report
Shin TakenakaMiki MoriokaTetsuya IshikawaKosuke TotakeShoko AonoHideyasu ToyosawaMichiko ArakiTakashi MimuraHanako ShimizuChiaki IitsukaShingou MiyamotoAkihiko SekizawaMiki Kushima
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2013 Volume 29 Issue 2 Pages 453-458

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Abstract
  An atypical polypoid adenomyoma (APAM) is classified as a benign, mixed epithelial and mesenchymal tumor. It is a broad-based polypoid tumor that rarely arises in the uterus of sexually mature women. We report a case of a woman diagnosed with an APAM. A 40-year-old nulligravida with a chief complaint of dysfunctional vaginal bleeding was found to have a 2 cm tumor in the uterine lower body by an ultrasound examination. An endometrial biopsy detected an APAM and atypical endometrial hyperplasia (AEH). We performed a hysteroscopic transcervical resection (TCR) as well as a dilation and curettage. Endoscopy revealed a 2 cm broad-based polypoid tumor. We could not identify a clear borderline between the normal muscle layer and the APAM. We resected as much of the tumor as possible. The pathological diagnosis was APAM and AEH. The patient wished to preserve her fertility, therefore we administered medroxyprogesterone therapy for the AEH postoperatively. Two months postoperatively, residual APAM was suspected by endometrial biopsy and MRI, therefore we performed a repeat TCR. We could not clearly identify tumor tissue; however, we resected the suspicious area detected by the MRI. The pathological diagnosis was APAM. No recurrence occurred 10 months postoperatively. Although a fertility-preserving procedure for an APAM has not been established, TCR appears to be the procedure of choice for resection under direct vision.
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© 2013 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy
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