Hysteroscopic treatment of atypical polypoid adenomyoma diagnosed incidentally in a young infertile woman.
OBJECTIVE
To describe the conservative treatment of an atypical polypoid adenomyoma (APA) in a young infertile patient using a modification of the technique previously reported for the conservative treatment of stage IA endometrial cancer.


METHODS
Case report.


METHODS
Department of Gynaecology and Obstetrics and Pathophysiology of Human Reproduction of the University of Naples "Federico II."


METHODS
A 35-year-old woman diagnosed incidentally with an APA during routine investigation for primary infertility.


METHODS
Conservative resectoscopic treatment using a four-step technique in which each step is characterized by a pathological analysis: the removal of the APA (step 1), the removal of endometrium adjacent to the APA (step 2), the removal of the myometrium underlying the APA (step 3), and multiple random endometrial biopsies (step 4).


METHODS
Complete resection of the APA and ruling out of any malignancy.


RESULTS
The conservative surgery was effective as histological examination of all specimens confirmed an APA confined to the endometrium without any other premalignant or malignant lesion. Transvaginal ultrasound and office hysteroscopy with target biopsies at 1 and 6 months after surgery were negative for atypia and malignancy.


CONCLUSIONS
Our technique under a close, intermittent postoperative surveillance might represent a good therapeutic option for those women with APA who wish to preserve their fertility as well as for those at high medical risk for hysterectomy.
Di Spiezio Sardo
Attilio
A
Department of Gynaecology and Obstetrics, University of Naples Federico II, Naples, Italy. cdispie@tin.it
Mazzon
Ivan
I
Gargano
Virginia
V
Di Carlo
Costantino
C
Guida
Maurizio
M
Mignogna
Chiara
C
Bifulco
Giuseppe
G
Nappi
Carmine
C
D018194:Adenomyoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D000465:Algorithms; D016889:Endometrial Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D033162:Incidental Findings; D007247:Infertility, Female / Q000209:etiology*; D008954:Models, Biological