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  Curetage utérin pour formation polypoïde chez une femme de 27ans.   Uterin curetting for a polypoid mass in a 27 years old female.  
     
     
     
   

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Diagnostic proposé

 

 

 

 

 

 

 

Adenomyome polypoïde atypique

 

Proposed diagnosis

 

 

 

 

 

 

 

Atypical polypoid adenomyoma

 
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  Am J Surg Pathol. 1996 Jan;20(1):1-20.

Atypical polypoid adenomyofibromas (atypical polypoid adenomyomas) of the uterus. A clinicopathologic study of 55 cases.

Longacre TA, Chung MH, Rouse RV, Hendrickson MR.

Division of Surgical Pathology, Stanford University Medical Center, CA 94305, USA.

Abstract

We present the clinicopathological and immunohistochemical features of 55 atypical polypoid adenomyofibromas, a definitional expansion of an entity previously reported as "atypical polypoid adenomyoma" (APA) of the uterus. Patients ranged in age from 25 to 73 (mean, 39.9) years. All but two of the patients were premenopausal, and 14 were undergoing evaluation for infertility. Histologically, the lesions featured a biphasic proliferation of architecturally complex and cytologically atypical endometrial glands within a myofibromatous stroma. The histologic pattern ranged from widely separated and loosely clustered irregular but branched glands embedded in broad zones of cellular myofibromatous stroma to those possessing crowded, markedly complex, branching glands separated by sparse intersecting fascicles of fibromuscular tissue. The stroma in all cases was actin or desmin positive or both. Morular/squamous metaplasia was present in all but two cases and florid in most. All cases exhibited architecturally complex glands, and in 25 cases the architectural complexity was indistinguishable from that of well-differentiated endometrial adenocarcinoma, as we have defined it; that is, they had a high architectural index. Twenty-nine patients were initially treated with polypectomy or curettage followed by hormonal therapy; persistent or recurrent APA developed in 45% of the patients in this group (33% with low architectural index vs. 60% with high architectural index). Five patients had successful pregnancies despite persistent disease. Superficial myoinvasion was identified in the hysterectomy specimen in two of 12 APAs with a high architectural index but not in 21 APAs with a low architectural index. All patients are alive and well 1 to 112 months after diagnosis (mean, 25.2 months). On the basis of this study, we propose that APAs with markedly complex glands (high architectural index) be designated "atypical polypoid adenomyofibromas of low malignant potential" (APA-LMP) to emphasize the potential risk for myometrial invasion. A treatment program featuring local excision accompanied by close follow-up is warranted for APA despite the presence of recurrent or persistent disease. Patients with APA-LMP may also, in selected cases, be managed with less than hysterectomy, although (as with the usual well-differentiated carcinoma) there is a small but definite risk associated with this approach.

 
     

Endometrial polyps. in Ackerman's Surgical Pathology

...Endometrial polyps having smooth muscle fibers (not connected with blood vessel walls) in addition to the customary glands and stroma are designated as adenomyomatous polyps (polypoid adenomyomas). They have a characteristic hard consistency and a grayish color. An important variant on the theme is the atypical polypoid adenomyoma. These tend to occur in premenopausal women (average age, 40 years) and present with abnormal uterine bleeding. Some are associated with Turner's syndrome.

Microscopically, they are identified by the fact that the glands occurring between the endometrial stroma and smooth muscle exhibit varying degrees of hyperplasia and atypia, sometimes approaching the appearance of carcinoma in situ. The danger is to misdiagnose them as adenocarcinomas with myometrial invasion. The behavior is generally benign, but cases have been seen with local recurrences, carcinomatous transformation, and coexistent endometrial or ovarian endometrioid carcinoma.