Analysis Of Clinical Characteristics Of 14 Cases Of Atypical Polypoid Adenomyoma Of Uterus

Objective Atypical polypoid adenomyoma(APA) is a mixed epithelial and mesenchymal tumor,which is rare in clinical practice.This article retrospectively analyzed the clinical and pathological data of 14 cases of atypical polypoid adenomyoma to explore the clinical features,pathological features,related diagnosis and treatment schemes,and prognosis of APA.Methods The clinical and pathological data of 14 cases with APA admitted to the Dalian Maternal and Child Health Hospital from June 2010 to September 2019 were retrospectively analyzed,and follow-up investigations were performed to analyze the diagnosis and treatment plan and prognosis.Results Of 14 patients,the mean age was(36.64 ± 9.14)years(rang 24-63)years.7cases of childbearing were completed,7 cases had no birth history,6 cases had no pregnancy history,and 1 case had primary infertility.The BMI of the 14 patients ranged from 18.44 to 39.51 kg /?,with an average of(26.32 ± 6.61)kg /?.Complications and history of surgery: 1 case of diabetes,1 case of hypertension,2 cases of adenomyosis,1 case of breast fibroid surgery,1 case of uterine fibroid.10 patients presented with abnormal uterine bleeding,such as irregular menstruation,excessive menstruation,prolonged menstrual periods,and intermenstrual bleeding.2 patients were diagnosed with lower abdominal pain and 2 had asymptomatic physicalexamination.Ultrasound examinations of patients with APA all showed intrauterine mass lesions or endometrial thickening.13 cases were located in the uterine cavity,of which4 cases were located in the lower segment of the uterine cavity and 1 case was located in the cervical canal.7 of the 14 cases had a blood flow resistance index(RI)of 0.39 to0.69,which is mostly medium to high blood flow resistance.Ultrasound diagnosis prompts: 6 cases were diagnosed with endometrial polyps,4 cases with submucosal fibroids,2 cases with abnormal intrauterine echo,1 case with endometrial thickening,and 1 case with endometrial lesions.13 of the 14 cases underwent hysteroscopy,7 cases were single polyp-like neoplasms,and 6 cases were multiple polyp-like or papillary processes with uneven thickening of the endometrium,with a diameter of 0.3 to 3.1 cm;8 cases Abnormal blood vessels can be seen on the surface of the tumor;11 cases were located in the uterine cavity,2 of which were located in the lower segment of the uterine cavity,1 in the cervical canal,and 1 in both the uterine cavity and the cervical canal.Hysteroscopic diagnosis: 6 of 13 cases were diagnosed with endometrial polyps and / or cervical polyps,of which 1 had endometrial proliferative disease;5 were diagnosed with endometrial disease,and 2 were diagnosed with endometrial proliferation disease.Eleven routine CA125 tests were performed,ranging from 4.11 to 162.4 U / ml.Nine patients showed varying degrees of anemia,ranging from 59 to 105 g / L.All 14 cases were confirmed by histological pathology,of which 11 cases were diagnosed pathologically after hysteroscopic lesion resection,2 cases were diagnosed by diagnostic curettage,and 1 case was confirmed by total resection.11 of the 14 cases underwent hysteroscopic resection,of which 4 received adjuvant progestin therapy,3 were not treated further,and 4(3 with endometrial cancer and 1 with APA)underwent hysterectomy again;2 cases underwent hysterectomy(1case of APA combined with adenomyosis,1 case of endometrial adenosarcoma)after diagnosis and curettage;1 case did not continue treatment after 2 times curettage;hysterectomy was performed 7 to 49 days after hysteroscopic lesion removal orcurettage.14 patients were followed up to February 2020,with a follow-up time of 5 to 116 months,and a median follow-up time of 52.5 months.7 of the 14 patients underwent hysteroscopic resection,of which 4 received adjuvant progestin therapy and 3 did not receive further treatment;1 died of lung cancer 8 years later,and 6 survived disease-free.6 patients underwent hysterectomy,including one with endometrial cancer who died of lung metastasis 1 year after surgery and 5 survived without disease;one died of renal failure 15 days after the second diagnosis and curettage.Of the 7 cases with no childbearing history,2 had undergone hysterectomy,1 died from renal failure,and 4 were infertile.Conclusion APA is a rare mixed epithelial and mesenchymal tumors(MMT).Occurs in women of childbearing period,and the lesions are mostly located in the uterine cavity,showing a polyp-like change.The clinical manifestations are mainly abnormal uterine bleeding,color Doppler ultrasound and hysteroscopy have lesions that are single or multiple polypoid changes,uneven thickening of the surrounding endometrium and rich blood flow signals,but there is no specificity.Histopathological manifestations are complicated structure,atypical endometrial glands and smooth muscle or fibromyomatous interstitial cells,which need to be distinguished from endometrial polyps and submucosal fibroids.APA can coexist with endometrial proliferation,endometrial cancer,or progress to endometrial cancer.APA treatment is mainly based on hysterectomy,fertility preservation is feasible under hysteroscopic lesion resection,combined with endometrial hyperplasia combined with progestin treatment.If there is no other disease,the prognosis is generally good.