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European Journal of Medical Research

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Open Access 01-12-2023 | Hysteroscopy | Research

The typical polypoid adenomyoma is a special form of endometrial polyp: a case-controlled study with a large sample size

Authors: Xinmei Wang, Hongyuan Zhang, Juan Xu, Pengpeng Qu

Published in: European Journal of Medical Research | Issue 1/2023

Abstract

Purpose

To investigate clinicopathological differences between typical endometrial polypoid adenomyomas (TPAs) and endometrial polyps (EPs) and to determine the risk factors and recurrence of TPA and further clarify the pathogenesis and treatment of TPA.

Methods

We reviewed the medical records of 488 women with TPA and 500 women with EP. Then, we analyzed the clinical features and manifestations, ultrasonic manifestations, hysteroscopic morphology, and pathological results. In addition, 360 cases of TPA and 367 cases of EP were followed up for 22–77 months and the risk factors TPA recurrence were assessed.

Results

We detected significant differences in age, menopausal status, body mass index (BMI), the number of pregnancies, and parity between the two groups (P < 0.05). Hysteroscopy revealed that the incidence of polyps > 3 cm in diameter and multiple polyps in the TPA group was significantly higher than that in the EP group (P < 0.01). In addition, the rate of recurrence in the TPA group was significantly higher than that in the EP group (P < 0.05). Over three pregnancies, menopause, curettage, and the application of polyp clamps were all identified as independent risk factors for the recurrence of TPA (P < 0.05).

Conclusion

In addition to high estrogen levels, endometrial injury was identified as the main contributor to TPA pathogenesis. Hysteroscopic electrotomy was identified as the preferential treatment for TPA to avoid recurrence, especially in women with risk factors. Increasing the depth of ablation may prevent the recurrence of TPA more efficiently.

Kenny SL, McCluggage WG. Adenomyomatous polyp of the endometrium with prominent epithelioid smooth muscle differentiation: report of two cases of a hitherto undescribed lesion. Int J Surg Pathol. 2014;22(4):358–63. https://doi.org/10.1177/1066896913499630.CrossRefPubMed

Gilks CB, Clement PB, Hart WR, Young RH. Uterine adenomyomas excluding atypical polypoid adenomyomas and adenomyomas of endocervical type: a clinicopathologic study of 30 cases of an underemphasized lesion that may cause diagnostic problems with brief consideration of adenomyomas of other female genital tract sites. Int J Gynecol Pathol. 2000;19(3):195–205. https://doi.org/10.1097/00004347-200007000-00001.CrossRefPubMed

McCluggage WG. A practical approach to the diagnosis of mixed epithelial and mesenchymal tumours of the uterus. Mod Pathol. 2016;29(Suppl 1):S78-91. https://doi.org/10.1038/modpathol.2015.137.CrossRefPubMed

Lu Z, Chen J. Introduction of WHO classification of tumors of female reproductive organs, fourth edition. Zhonghua Bing Li Xue Za Zhi. 2014;43(10):649–50.PubMed

Raghavendra Babu YP, Karki RK, Menezes RG, Jagadish Rao PP, Shetty BS, Sahu KK. Adenomyomatous polyp of the uterus: report of an autopsy case and review of the literature. J Forensic Leg Med. 2012;19(4):236–8. https://doi.org/10.1016/j.jflm.2012.02.003.CrossRefPubMed

Tahlan A, Nanda A, Mohan H. Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature. Int J Gynecol Pathol. 2006;25(4):361–5. https://doi.org/10.1097/01.pgp.0000209570.08716.b3.CrossRefPubMed

Mazur MT. Atypical polypoid adenomyomas of the endometrium. Am J Surg Pathol. 1981;5(5):473–82. https://doi.org/10.1097/00000478-198107000-00006.CrossRefPubMed

Biasioli A, Londero AP, Orsaria M, Scrimin F, Mangino FP, Bertozzi S, Mariuzzi L, Cagnacci A. Atypical polypoid adenomyoma follow-up and management: systematic review of case reports and series and meta-analysis. Medicine. 2020;99(26):e20491. https://doi.org/10.1097/MD.0000000000020491.CrossRefPubMedPubMedCentral

Kaveh M, Sadegi K, Salarzaei M, Parooei F. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the EP in women with abnormal uterine bleeding: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne. 2020;15(3):403–15. https://doi.org/10.5114/wiitm.2020.93791.CrossRefPubMedPubMedCentral

10.

Sajjad N, Iqbal H, Khandwala K, Afzal S. Polypoid adenomyoma of the uterus. Cureus. 2019;11(2):e4044. https://doi.org/10.7759/cureus.4044.CrossRefPubMedPubMedCentral

11.

Fukuda M, Sakurai N, Yamamoto Y, Taoka H, Asakawa Y, Kurasaki A, Oharaseki T, Takahashi K, Kubushiro K. Case of atypical polypoid adenomyoma that possibly underwent a serial progression from endometrial hyperplasia to carcinoma. J Obstet Gynaecol Res. 2011;37(5):468–71. https://doi.org/10.1111/j.1447-0756.2010.01365.x.CrossRefPubMed

12.

Lin YH, Chou YY, Huang LW, Seow KM, Hwang JL. An adenomyomatous polyp presenting as a large hypervascular tumor and its response to a gonadotropin-releasing hormone agonist. Taiwan J Obstet Gynecol. 2013;52(1):129–30. https://doi.org/10.1016/j.tjog.2013.01.016.CrossRefPubMed

13.

Patel N, Hatfield J, Sohaey R, Coakley FV. MRI of prolapsed polypoid adenomyoma: Expanding the differential diagnosis for the broccoli sign. Clin Imaging. 2018;52:177–9. https://doi.org/10.1016/j.clinimag.2018.08.001.CrossRefPubMed

14.

Strickland KC, Yuan L, Quade BJ, Nucci MR, Howitt BE. Clinicopathological and immunohistochemical features of uterine adenomyomatous polyps. Hum Pathol. 2019;84:239–45. https://doi.org/10.1016/j.humpath.2018.10.002.CrossRefPubMed

15.

Horita A, Kurata A, Komatsu K, Yajima M, Sakamoto A. Coexistent atypical polypoid adenomyoma and complex atypical endometrial hyperplasia in the uterus. Diagn Cytopathol. 2010;8(7):527–32. https://doi.org/10.1002/dc.21263.CrossRef

16.

Habiba M, Brosens I, Zannoni GF, Benagiano G. Uncommon mixed endometrial-myometrial benign tumors of the reproductive tract: literature review. Gynecol Obstet Invest. 2019;84(6):521–47. https://doi.org/10.1159/000499019.CrossRefPubMed

17.

Takeuchi M, Matsuzaki K, Uehara H, Shimazu H, Nishitani H. A case of adenomyomatous polyp of the uterus associated with tamoxifen therapy. Radiat Med. 2005;23(6):432–4.PubMed

18.

Nasu K, Arima K, Yoshimatsu J, Miyakawa I. Adenomyomatous polyp of the uterus in a patient receiving tamoxifen. Jpn J Clin Oncol. 1997;27(5):350–2. https://doi.org/10.1093/jjco/27.5.350.CrossRefPubMed

19.

Huang C, Hong MK, Ding DC. Endometrial adenomyoma polyp caused postmenopausal bleeding mimicking uterine malignancy. Gynecol Minim Invasive Ther. 2017;6(3):129–31. https://doi.org/10.1016/j.gmit.2016.08.006.CrossRefPubMed

20.

Douchi T, Yoshinaga M, Katanozaka M, Mitani M, Nagata Y. Relationship between body mass index and transvaginal ultrasonographic endometrial thickness in postmenopausal women. Acta Obstet Gynecol Scand. 1998;77(9):905–8.CrossRefPubMed

21.

Song SE, Sung DJ, Park BJ, Kim MJ, Cho SB. Kim KA (2011) MR imaging features of uterine adenomyomas. Abdom Imaging. 2011;36(4):483–8. https://doi.org/10.1007/s00261-010-9640-6.CrossRefPubMed

22.

Laurelli G, Falcone F, Scaffa C, Messalli EM, Del Giudice M, Losito S, Greggi S. Fertility-sparing management of low-grade endometrial stromal sarcoma: analysis of an institutional series and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2015;195:61–6. https://doi.org/10.1016/j.ejogrb.2015.09.041.CrossRefPubMed

23.

Kawaguchi M, Kato H, Suzui N, Furui T, Morishige KI, Goshima S, Matsuo M. MR imaging findings differentiating uterine submucosal polypoid adenomyomas from endometrial polyps. Br J Radiol. 2019;92(1095):20180430. https://doi.org/10.1259/bjr.20180430.CrossRefPubMedPubMedCentral

24.

McCluggage WG, Hamal P, Traub AI, Walsh MY. Uterine adenolipoleiomyoma: a rare hamartomatous lesion. Int J Gynecol Pathol. 2000;19(2):183–5. https://doi.org/10.1097/00004347-200004000-00015.CrossRefPubMed

25.

Paradisi R, Rossi S, Scifo MC, Dall’O’ F, Battaglia C, Venturoli S. Recurrence of endometrial polyps. Gynecol Obstet Invest. 2014;78(1):26–32. https://doi.org/10.1159/000362646.CrossRefPubMed

26.

Matoba Y, Banno K, Kobayashi Y, Kisu I, Aoki D. Atypical polypoid adenomyoma treated by hysteroscopy with photodynamic diagnosis using 5-aminolevulinic acid: A case report. Photodiagnosis Photodyn Ther. 2019;27:295–7. https://doi.org/10.1016/j.pdpdt.2019.06.019.CrossRefPubMed

27.

Wortman M. “See-and-Treat” hysteroscopy in the management of endometrial polyps. Surg Technol Int. 2016;28:177–84.PubMed

Title: The typical polypoid adenomyoma is a special form of endometrial polyp: a case-controlled study with a large sample size
Authors: Xinmei Wang
Hongyuan Zhang
Juan Xu
Pengpeng Qu
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Hysteroscopy
Published in: European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-023-01286-1

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Springer Medicine

The typical polypoid adenomyoma is a special form of endometrial polyp: a case-controlled study with a large sample size

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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