Atypical polypoid adenomyomas of the endometrium

TLDR

Five atypical polypoid adenomyomas of the endometrium were identified in premenopausal women. The polyps exhibited irregular atypical glands with squamous metaplasia and a smooth‑muscle mesenchyme, distinguishing them from invasive adenocarcinoma or malignant mixed Müllerian tumors. Electron microscopy confirmed a well‑differentiated smooth‑muscle component, and 4–24‑month follow‑up showed no recurrence, supporting conservative management of these focal, noninvasive lesions in premenopausal women.

Abstract

Five unusual polypoid lesions of the endometrium which we term atypical polypoid adenomyomas are described; these growths occurred in premenopausal women. Each of the polyps was characterized by irregular atypical glands with squamous metaplasia and a cellular, smooth muscle mesenchyme, having a pattern to be distinguished from infiltrating adenocarcinoma or a malignant mixed müllerian tumor. Electron microscopy in one case confirmed the presence of a well-differentiated smooth muscle component. These lesions were focal and noninvasive. Two of the three patients who had hysterectomies had small residual lesions confined to the endometrium. Follow-up from 4 to 24 months showed no recurrence. One patient had a second D & C reported as normal; she subsequently became pregnant. The benign behavior of these unusual polyps suggests that atypical adenomyomas can be managed conservatively in the premenopausal woman without the necessity of a hysterectomy.