Atypical Polypoid Adenomyoma (APAM) (original) (raw)
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Diagnostics
Atypical polypoid adenomyoma (APA) is a rare tumor developed from a mix of cells of epithelial and mesenchymal origin. We present the case of an 84-year-old patient with atypical polypoid adenomyoma on the vaginal vault, after total hysterectomy with total adnexectomy for endometrial hyperplasia with atypia four years ago. Not following regular indicated gynecological appointments, the symptoms presented were vaginal bleeding and anemia. The importance of the case consists both in the unique way in which the adenomyoma appears on the vaginal vault and in the subsequent evolution of this pathology. After complete resection, it recurs in five months with a malignant transformation into carcinosarcoma. This fact shows that adenomas can turn not only into carcinomas but also the mesenchymal component can progress to sarcoma, a fact of exceptional rarity. Follow-up and accurate diagnosis are essential for proper management, which is a challenge anyway due to the lack of case studies.
Endometrial Adenocarcinomaarising in Atypical Polypoidadenomyoma: A Case Report
DergiPark (Istanbul University), 2014
Atipik polipoid adenomyoma uterusun benign yapıda ve nadir görülen bir tümörüdür. Bununla birilikte bazı hastalarda atipik polipoid adenomyoma ya endometrioid adenokarsinomu ile birliktelik gösterir yada kompleks endometriyal hiperplaziye benzer şekilde bu kanserin gelişmesine öncülük eder. Atipik polipoid adenomyoma çoğunlukla doğurganlık yaşındaki kadınlarda görülür ve infertilite öyküsü ile yakından ilişkilidir. Çalışmamızda şimdiye kadar bildirilen en genç olgulardan birisini sunmaktayız. 29 yaşında bir kadın hasta düzensiz ve aşırı kanama, pelvik ağrı, alt uterin segment ve servikal kanala tamamıyla yerleşmiş uterus kaynaklı bir kitle ile kliniğimize başvurdu. Total abdominal histerektomi yapılan hastada, morfolojik ve histopatolojik bulgulara dayanarak endometrial adenokarsinomanın eşlik ettiği atipik polipoid adenomyoma tanısı konuldu. Hastamızın 22 aydan daha uzun bir süreçde takiplerinde hastalık tekrarı görülmedi. Nadir görülmesine rağmen, endometriyum adenokarsinomu, serviks adenokarsinomu veya alt uterin segment kaynaklı kitlelerin ayırıcı tanısında atipik polipoid adenomyoma tanısı akılda bulundurulmalıdır. Anahtar kelimeler: Atipik polipoid adenomyoma, endometriyum kanseri. Atypical polypoid adenomyoma is an uncommon and benign tumor of the uterus. In some patients, however, APA has been found to coexist with or to precede the development of an endometrioid adenocarcinoma similarly to complex endometrial hyperplasia. Atypical polypoid adenomyoma affecting mainly women of child-bearing age and infertility is a common association. We present one of the few youngest cases report. A 29-year-old woman presented with irregular, heavy menses, pelvic pain and uterine mass located entirely in the lower uterine segment and cervical canal. Total abdominal hysterectomy was performed and based on the morphological and histopathological findings a diagnosis of atypical polypoid adenomyoma with coexistent endometrial adenocarcinoma was made. She has remained disease-free for over 22 months. Although rare, the diagnosis of atypical polypoid adenomyoma should be considered in the differential diagnoses of endometrial adenocarcinoma, cervical adenocarcinoma and the mass located in the lower uterine segment.
Polypoid Adenomyoma of the Uterus
Cureus
Polypoid adenomyoma is a rare uterine endometrial polypoid tumor of mixed epithelial and mesenchymal origin. Although the clinical and pathologic features of polypoid adenomyomas have been described extensively, imaging findings for these tumors have not been frequently reported in the literature. On imaging, their features may be confused with prolapsed leiomyomas or malignancy. Hemorrhagic cystic spaces in a prolapsed uterine tumor within the vagina should raise consideration of a diagnosis of polypoid adenomyoma. Such bloodcontaining cystic spaces would be unusual findings in leiomyomas and malignancy. Diagnosing polypoid adenomyoma is vital because it can potentially be managed by hysteroscopic resection, unlike an ordinary form of adenomyosis.
Molecular pathology of atypical polypoid adenomyoma of the uterus
Human Pathology, 2003
Atypical polypoid adenomyoma (APA) is an uncommon and benign tumor of the uterus. In some patients, however, APA has been found to coexist with or to precede the development of an endometrioid adenocarcinoma similarly to complex endometrial hyperplasia. The molecular changes underlying the progression from APA to adenocarcinoma are unknown. DNA from paraffin-embedded tissue of 6 APAs was evaluated for microsatellite instability (MI), MLH-1 promoter hypermethylation, and CTNNB-1 mutations. Tissue sections were also subjected to MLH-1, MSH-2, and -catenin immunostaining. MI was not detected in any case. Two tumors exhibited MLH-1 promoter hypermethylation and showed focal negative MHL-1 immunostaining; 1 of these showed marked architectural complexity and cellular pleomorphism. Five cases presented -catenin nuclear immunoreactivity, but none of them had CTNNB-1 mutations. The results of this study suggest that APA and complex endometrial hyperplasia may share some molecular alterations. Some APAs exhibit MLH-1 promoter hypermethylation with focal lack of MLH-1 immunostaining, a molecular abnormality involved in the transition from complex atypical hyperplasia to endometrioid adenocarcinoma. HUM PATHOL 34:784-788. © 2003 Elsevier Inc. All rights reserved.
Ati̇pi̇k Poli̇poi̇d Adenomyoma Ve Bu Tümörden Kaynaklanan Endometri̇al Adenokarsi̇noma: Olgu Sunumu
Türk Jinekolojik Onkoloji Dergisi, 2014
Atipik polipoid adenomyoma uterusun benign yapıda ve nadir görülen bir tümörüdür. Bununla birilikte bazı hastalarda atipik polipoid adenomyoma ya endometrioid adenokarsinomu ile birliktelik gösterir yada kompleks endometriyal hiperplaziye benzer şekilde bu kanserin gelişmesine öncülük eder. Atipik polipoid adenomyoma çoğunlukla doğurganlık yaşındaki kadınlarda görülür ve infertilite öyküsü ile yakından ilişkilidir. Çalışmamızda şimdiye kadar bildirilen en genç olgulardan birisini sunmaktayız. 29 yaşında bir kadın hasta düzensiz ve aşırı kanama, pelvik ağrı, alt uterin segment ve servikal kanala tamamıyla yerleşmiş uterus kaynaklı bir kitle ile kliniğimize başvurdu. Total abdominal histerektomi yapılan hastada, morfolojik ve histopatolojik bulgulara dayanarak endometrial adenokarsinomanın eşlik ettiği atipik polipoid adenomyoma tanısı konuldu. Hastamızın 22 aydan daha uzun bir süreçde takiplerinde hastalık tekrarı görülmedi. Nadir görülmesine rağmen, endometriyum adenokarsinomu, serviks adenokarsinomu veya alt uterin segment kaynaklı kitlelerin ayırıcı tanısında atipik polipoid adenomyoma tanısı akılda bulundurulmalıdır. Anahtar kelimeler: Atipik polipoid adenomyoma, endometriyum kanseri. Atypical polypoid adenomyoma is an uncommon and benign tumor of the uterus. In some patients, however, APA has been found to coexist with or to precede the development of an endometrioid adenocarcinoma similarly to complex endometrial hyperplasia. Atypical polypoid adenomyoma affecting mainly women of child-bearing age and infertility is a common association. We present one of the few youngest cases report. A 29-year-old woman presented with irregular, heavy menses, pelvic pain and uterine mass located entirely in the lower uterine segment and cervical canal. Total abdominal hysterectomy was performed and based on the morphological and histopathological findings a diagnosis of atypical polypoid adenomyoma with coexistent endometrial adenocarcinoma was made. She has remained disease-free for over 22 months. Although rare, the diagnosis of atypical polypoid adenomyoma should be considered in the differential diagnoses of endometrial adenocarcinoma, cervical adenocarcinoma and the mass located in the lower uterine segment.
Endometrioid Adenocarcinoma Arising in Adenomyoma in a Woman with a Genital Prolapse - Case Report
Open access Macedonian journal of medical sciences, 2018
Endometrial cancer is the third-ranked genital malignancy in women and includes 3% of cancer deaths. There is a 2.8% chance of a woman developing endometrial cancer during her lifetime. Low-grade endometrioid adenocarcinomas are often seen along with endometrial hyperplasia, but high-grade endometrioid adenocarcinomas have more solid sheets of less-differentiated tumour cells, which are no longer organised into glands, often associated with surrounded atrophic endometrium. We present an unusual case of endometrial adenocarcinoma arising in adenomyoma in 74-year old woman presented with genital prolapse, without other clinical symptoms. Ultrasound evaluation revealed endometrium with 4 mm-thickness and atrophic ovaries. The cervical smear was normal. The patient underwent a total vaginal hysterectomy. The histopathology of the anterior uterine wall revealed an intramural adenomyoma of 4 mm in which some endometrial glands with malignant transformation of well-differentiated endometri...
Endometrial adenocarcinoma arising in adenomyosis: case report and review of literature
Adenomyosis is a common benign gynecological condition in women of reproductive age. While endometrial cancer co-existing with adenomyosis is common, endometrial carcinoma arising from endometrial cells within adenomyosis (EC-AIA) is rare. We present an unusual case of EC-AIA in a 62-year-old woman with no clinical symptoms. EC-AIA should be considered as a different diagnosis from concurrent endometrial cancer and adenomyosis. EC-AIA should also be considered in adenomyosis patients with intact endometrium and vaginal bleeding and in those with a history of adenomyosis at reproductive age regardless of the occurrence of vaginal bleeding. Periodic follow-up is recommended in women diagnosed with adenomyosis at reproductive age.