Hysteroscopic transcervical resection is useful to diagnose myometrial invasion in atypical polypoid adenomyoma coexisting with atypical endometrial hyperplasia or endometrial cancer with suspicious myometrial invasion

Wataru Yamagami, Nobuyuki Susumu, Tomomi Ninomiya, Naoki Nakadaira, Naomi Iwasa, Michiko Kuwahata, Hiroyuki Nomura, Fumio Kataoka, Kouji Banno, Daisuke Aoki

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Aim Management of atypical polypoid adenomyoma (APAM) is complicated because it can sometimes coexist with atypical endometrial hyperplasia (AEH) or endometrioid adenocarcinoma. It is often difficult to assess myometrial invasion in APAM complicated with endometrial cancer. We encountered three patients who, contrary to magnetic resonance imaging, did not have myometrial invasion on hysteroscopic transcervical resection (TCR) and therefore could have fertility preserved, and consequently could become pregnant. Methods We removed the polypoid lesion and a 3-5 mm-thick layer of the normal inner membrane at the root of the polypoid lesion, and then performed total curettage. Several pathological diagnostic procedures were then carried out on each of these resected specimens. Thereafter, high-dose medroxyprogesterone acetate (MPA) was initiated. Results All three patients underwent hysteroscopic transcervical tumor resection. The pathological diagnoses were as follows: patient 1, G1 endometrioid adenocarcinoma (EMG1) + APAM; patients 2,3, AEH + APAM. No findings of myometrial invasion in the resected root specimen were observed in any patient. In all cases, high-dose MPA was initiated. After the disappearance of tumors, each patient achieved pregnancy. Complications such as placenta accreta were not observed at the time of delivery. Conclusion In patients with APAM and AEH or EMG1, TCR may aid accurate diagnosis when myometrial invasion is unclear on diagnostic imaging.

Original languageEnglish
Pages (from-to)768-775
Number of pages8
JournalJournal of Obstetrics and Gynaecology Research
Volume41
Issue number5
DOIs
Publication statusPublished - 2015 May 1

Keywords

  • atypical polypoid adenomyoma
  • endometrial cancer
  • hysteroscopic transcervical resection
  • medroxyprogesterone acetate
  • myometrial invasion

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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