Surgical treatment of a rare case of atypical polypoid adenomyoma of the uterus in a menopausal patient: a case report

Abstract

Atypical polypoid adenomyoma is a rare benign
tumor of the uterus that usually affects women of
reproductive age and has an increased risk of
progression into endometrial cancer. The
pathogenetic mechanism has not been completely
clarified. Due to the rarity of the tumor, current
experience regarding the diagnostic and
therapeutic approach is limited. For menopausal
patients, hysterectomy seems to be the main
treatment option. Our case concerns an
asymptomatic menopausal patient with a vaginal
delivery in her obstetric history and no hereditary
history of gynecological cancer who came to the
outpatient clinic for a gynecological examination.
Transvaginal ultrasound revealed the presence of a
large, round solid mass with increased vascularity
within the endometrial cavity. A diagnostic dilation
and curettage of the endometrium was performed.
Histological examination of the endometrial biopsy
showed an atypical polypoid adenomyoma, and it
was decided to perform a total abdominal
hysterectomy with bilateral adnexectomy.
Histological examination of the surgical specimen
of the uterus revealed no residual disease, no
coexisting foci of atypical endometrial hyperplasia
or endometrial cancer. The postoperative course
was uneventful. The patient remains to this day
under regular follow-up. The present case report
highlights the significant difficulties involved in the
preoperative diagnosis of atypical polypoid
adenomyoma of the uterus and the difficult
differential diagnosis from atypical endometrial
hyperplasia and endometrial cancer, particularly in
menopausal patients. At the same time, it is pointed
out that despite its rarity, the early diagnosis of
atypical polypoid adenomyoma, especially in young
women, must be the main concern of the modern
gynaecologist, in order to design the optimal
treatment aimed at preserving fertility while
avoiding the risk of recurrence of damage or
malignant progression into endometrial cancer.