2期的に子宮鏡視下病巣切除術で治療しえたポリープ状異型腺筋腫（APAM）の1例

抄録

  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.