Abstract
BACKGROUND/AIM: Atypical polypoid adenomyoma (APA) is an uncommon biphasic uterine tumor characterized by irregularly shaped, atypical endometrial glands haphazardly distributed within a fibromuscular stroma. APA is frequently associated with atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (AH/EIN) and endometrioid endometrial carcinoma (EC). This study aimed to characterize the clinicopathological features and outcomes of APA concomitant with AH/EIN and EC. PATIENTS AND METHODS: Nineteen cases of APA coexisting with AH/EIN or EC were retrospectively analyzed. Clinical presentation, pathological findings, treatment modalities, and outcomes were reviewed. RESULTS: Most patients (78.9%) were of reproductive age (26-45 years). The most common presenting symptom was abnormal uterine bleeding (47.4%), while 26.3% were asymptomatic. EC and AH/EIN were identified in 14 (73.7%) and five (26.3%) patients, respectively. Compared with AH/EIN, EC more often demonstrated cribriform architecture, papillary intraluminal growth, and stromal desmoplasia. Six of the 14 patients with EC underwent hysterectomy and remained recurrence-free. Of the eight patients managed with progestin therapy, four had persistent EC or AH/EIN on follow up curettage at three months. Similarly, one of the five patients with AH/EIN treated conservatively showed persistent disease after three months of progestin therapy. Nevertheless, all patients were disease-free at the last follow-up. CONCLUSION: In APA, meticulous pathological evaluation is essential to detect concurrent AH/EIN or EC. Although conservative management may be appropriate for selected patients, close surveillance is necessary to monitor for persistence or recurrence. Hysterectomy remains a definitive and reliable therapeutic option.