Fertility-sparing treatment for atypical polypoid adenomyoma
Introduction: Atypical polypoid adenomyoma (APA) has classically been described as a benign lesion of the endometrium; however, recent studies have identified risk of progression to malignant pathology. Standard treatment includes hysterectomy but since many patients with APA are young and desire fe...
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| Language: | English |
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Elsevier
2025-04-01
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| Series: | Gynecologic Oncology Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352578925000396 |
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| author | Isabel Beshar Susan Lang Oliver Dorigo Brooke E Howitt Caroline Liu Amer Karam |
| author_facet | Isabel Beshar Susan Lang Oliver Dorigo Brooke E Howitt Caroline Liu Amer Karam |
| author_sort | Isabel Beshar |
| collection | DOAJ |
| description | Introduction: Atypical polypoid adenomyoma (APA) has classically been described as a benign lesion of the endometrium; however, recent studies have identified risk of progression to malignant pathology. Standard treatment includes hysterectomy but since many patients with APA are young and desire fertility, uterine-sparing options have been explored. In this study, we examine long-term outcomes of fertility-sparing treatment, including hysteroscopic resection and progesterone therapy, on progression to hyperplasia or endometrial carcinoma. Methods: We performed a retrospective cohort study of patients with APA from January 1st 2000 to December 31st 2023 at our quaternary care center. Sociodemographic factors, treatment options (including hysterectomy, hysteroscopy, chemoradiation, and/or hormonal therapy), pathology pre- and post-treatment, and live birth rates, were abstracted from the record. Institutional review board approval was obtained prior to data collection. Results: Sixty-six patients were included in our study time-period. One in three patients (n = 37, 60.7 %) in our cohort opted for fertility-sparing treatment, especially among young (mean age 33.6), nulliparous patients. Most patients underwent hysteroscopic resection (70.8 %), compared to progesterone-only therapy (16.7 % with intrauterine device (IUD) and 12.5 % with oral progesterone). Over two decades, 33.3 % of our cohort progressed to hyperplasia or carcinoma; 29.2 % had persistence of APA pathology; and 33.3 % had resolution of APA. On average, patients progressed within 4.5 years of therapy. There were three births. Discussion: High rates of resolution of APA pathology were observed amongst those undergoing hysteroscopic resection with or without placement of IUD. While not statistically significant due to our sample size, lower rates of resolution were observed among those on hormonal therapy alone, especially oral progesterone. |
| format | Article |
| id | doaj-art-e46fedbce38e4cc3a5dbd14210bc4171 |
| institution | DOAJ |
| issn | 2352-5789 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj-art-e46fedbce38e4cc3a5dbd14210bc41712025-08-20T03:10:31ZengElsevierGynecologic Oncology Reports2352-57892025-04-015810171410.1016/j.gore.2025.101714Fertility-sparing treatment for atypical polypoid adenomyomaIsabel Beshar0Susan Lang1Oliver Dorigo2Brooke E Howitt3Caroline Liu4Amer Karam5Department of Obstetrics & Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA; Corresponding author.Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Stony Brook Medicine, Stony Brook, NY 11794, USADivision of Gynecology Oncology, Department of Obstetrics & Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USADepartment of Pathology, Stanford University, 300 Pasteur Dr Rm H2110, Palo Alto, CA 94304, USAStanford School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USADivision of Gynecology Oncology, Department of Obstetrics & Gynecology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USAIntroduction: Atypical polypoid adenomyoma (APA) has classically been described as a benign lesion of the endometrium; however, recent studies have identified risk of progression to malignant pathology. Standard treatment includes hysterectomy but since many patients with APA are young and desire fertility, uterine-sparing options have been explored. In this study, we examine long-term outcomes of fertility-sparing treatment, including hysteroscopic resection and progesterone therapy, on progression to hyperplasia or endometrial carcinoma. Methods: We performed a retrospective cohort study of patients with APA from January 1st 2000 to December 31st 2023 at our quaternary care center. Sociodemographic factors, treatment options (including hysterectomy, hysteroscopy, chemoradiation, and/or hormonal therapy), pathology pre- and post-treatment, and live birth rates, were abstracted from the record. Institutional review board approval was obtained prior to data collection. Results: Sixty-six patients were included in our study time-period. One in three patients (n = 37, 60.7 %) in our cohort opted for fertility-sparing treatment, especially among young (mean age 33.6), nulliparous patients. Most patients underwent hysteroscopic resection (70.8 %), compared to progesterone-only therapy (16.7 % with intrauterine device (IUD) and 12.5 % with oral progesterone). Over two decades, 33.3 % of our cohort progressed to hyperplasia or carcinoma; 29.2 % had persistence of APA pathology; and 33.3 % had resolution of APA. On average, patients progressed within 4.5 years of therapy. There were three births. Discussion: High rates of resolution of APA pathology were observed amongst those undergoing hysteroscopic resection with or without placement of IUD. While not statistically significant due to our sample size, lower rates of resolution were observed among those on hormonal therapy alone, especially oral progesterone.http://www.sciencedirect.com/science/article/pii/S2352578925000396Atypical polypoid adenomyomaHysteroscopyEndometrial hyperplasiaResection |
| spellingShingle | Isabel Beshar Susan Lang Oliver Dorigo Brooke E Howitt Caroline Liu Amer Karam Fertility-sparing treatment for atypical polypoid adenomyoma Gynecologic Oncology Reports Atypical polypoid adenomyoma Hysteroscopy Endometrial hyperplasia Resection |
| title | Fertility-sparing treatment for atypical polypoid adenomyoma |
| title_full | Fertility-sparing treatment for atypical polypoid adenomyoma |
| title_fullStr | Fertility-sparing treatment for atypical polypoid adenomyoma |
| title_full_unstemmed | Fertility-sparing treatment for atypical polypoid adenomyoma |
| title_short | Fertility-sparing treatment for atypical polypoid adenomyoma |
| title_sort | fertility sparing treatment for atypical polypoid adenomyoma |
| topic | Atypical polypoid adenomyoma Hysteroscopy Endometrial hyperplasia Resection |
| url | http://www.sciencedirect.com/science/article/pii/S2352578925000396 |
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