Atypical Polypoid Adenomyoma (APAM) of the Uterine: Relationship with Endometrial Cancer


Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pathologically, APAM consist of irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells within the stroma, and have a similar form to adenocarcinoma, adenofibroma, adenosarcoma, and carcinosarcoma. Therefore, differential diagnosis is required in many cases. APAM is pathologically classified as a benign lesion and clinically has a comparatively favorable outcome. However, treatment and follow-up observation should be performed carefully because recurrence and residual lesions occur in many patients after conservative treatment. Concomitant development of endometrial adenocarcinoma also occurs in many cases and it is difficult to differentiate this disease from APAM. Thus, diagnosis of APAM should be made carefully, particularly since the number of cases of endometrial adenocarcinoma has increased in recent years. Furthermore, APAM tends to develop during a woman’s reproductive years, and fertility sparing treatment should be considered. Here, we review the clinicopathological characteristics of APAM, including the difficulty of diagnosis as a benign or malignant uterine tumor, and we examine the relationship between APAM and endometrial cancer.

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I. Kisu, K. Banno, M. Yanokura, Y. Kobayashi, A. Ueki, A. Ono, K. Masuda, W. Yamagami, H. Nomura, A. Hirasawa, N. Susumu and D. Aoki, "Atypical Polypoid Adenomyoma (APAM) of the Uterine: Relationship with Endometrial Cancer," Journal of Cancer Therapy, Vol. 2 No. 4, 2011, pp. 458-462. doi: 10.4236/jct.2011.24061.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] M. T. Mazur, “Atypical Polypoid Adenomyoma of the Endometrium,” American Journal of Surgical Pathology, Vol. 5, No. 5, 1981, pp. 473-482.
[2] T. Maeda, U. Tateishi, Y. Sasajima, T. Hasegawa, H. Daisaki, Y. Arai and K. Sugimura, “Atypical Polypoid Adenomyoma of the Uterus: Appearance on 18F-FDG PET/MRI Fused Images,” American Journal of Roentgenology, Vol. 186, No. 2, 2006, pp. 320-323. doi:10.2214/AJR.04.1799
[3] F. A. Tavassoli, “World Health Organization Classification of Tumors, Pathology and Genetics of Tumors of the Breast and Female Genital Organs,” IARC Press, Lyon, 2003.
[4] R. H. Young, T. Treger and R. E. Scully, “Atypical Polypoid Adenomyoma of the Uterus; a Report of 27 Cases,” American Journal of Clinical Pathology, Vol. 86, No. 2, 1986, pp. 139-145.
[5] D. C. Chhieng, P. A. Elgert, J. F. Cangiarella and J. M. Cohen, “Cytologic of Polypoid Adenomyomas: A Report of Two Cases,” Diagnostic Cytopathology, Vol. 22, No. 3, 2000, pp. 176-180. doi:10.1002/(SICI)1097-0339(20000301)22:3<176::AID-DC9>3.0.CO;2-H
[6] J. Kimura, H. Okamoto, H. Yamamoto, T. Mazaki and T. Kitamura, “Cytologic Futures of Atypical Polypoid Adenomyoma of the Endometrium—A Case Report,” Acta Cytologica, Vol. 47, No.2, 2003, pp. 287-292.
[7] T. A. Longacre, M. H. Chung, R. V. Rouse and M. R. Hendrickson, “Atypical Polypoid Adenomyomas (Atypical Polypoid Adenomyomas) of the Uterus: A Clinicopathologic Study of 55 Cases,” American Journal of Surgical Pathology, Vol. 20, No. 12, 1996, pp. 1-20.
[8] T. Sugiyama, S. Ota, T. Nishida, N. Okura, K. Tanabe and M. Yakushiji, “Two Cases of Endometrial Adenocarcinoma Arising from Atypical Polypoid Adenomyoma,” Gynecologic Oncology, Vol. 71, No. 1, 1998, pp. 141-144. doi:10.1006/gyno.1998.5137
[9] R. A. Soslow, M. H. Chung, R. V. Rouse, M. R. Hendrickson and T. A. Longacre, “Atypical Polypoid Adenomyoma (APA) versus Well-Differentiated Endometrial Carcinoma with Prominent Stromal Matrix: An Immunohistochemical Study,” International Journal of Gynecological Pathology, Vol. 15, No. 3, 1996, pp. 209-216.
[10] D. Baschinsky, S. Keyhani-Rofagha and A. Hameed, “Exfoliative Cytology of Atypical Polypoid Adenomyoma, a Case Report,” Acta Cytologica, Vol. 43, No. 4, 1999, pp. 637-640.
[11] M. Fukunaga, Y. Endo, S. Ushigome and E. Ishikawa, “Atypical Polypoid Adenomyomas of the Uterus,” Histopathology, Vol. 27, No. 1, 1995, pp. 35-42.
[12] A. Di Spiezio Sardo, I. Mazzon, V. Gargano, et al., “Hysteroscopic Treatment of Atypical Polypoid Adenomyoma Diagnosed Incidentally in a Young Infertile Woman,” Fertility and Sterility, Vol. 89, No. 2, 2008, pp. 456.e9-e12. doi:10.1016/j.fertnstert.2007.02.061
[13] A. Y. Wong, K. S. Chan, W. L. Lau and L. C. Tang, “Pregnancy Outcome of a Patient with Atypical Polypoid Adenomyoma,” Fertility and Sterility, Vol. 88, No. 5, 2007, pp. e7-e9. doi:10.1016/j.fertnstert.2007.01.043
[14] P. B. Clement and R. H. Young, “Atypical Polypoid Adenomyoma of the Uterus Associated with Turner’s Syndrome: A Report of Three Cases, Including a Review of ‘Estrogen-Associated’ Endometrial Neoplasms and Neoplasms Associated with Turner’s Syndrome,” International Journal of Gynecological Pathology, Vol. 6, No. 2, 1987, pp. 104-113.
[15] K. Nasu, T. Miyazaki, N. Takai and I. Miyakawa, “Atypical Polypoid Adenomyoma in a Patient with Hyperprolactinemia,” International Journal of Gynecological Cancer, Vol. 11, No. 4, 2001, pp. 326-328.
[16] G. A. Viols and H. C. Ettler, “Atypical Polypoid Adenomyoma and Hysteroscopic Endometrial Ablation,” Journal of Obstetrics and Gynaecology Canada, Vol. 25, No. 9, 2003, pp. 760-762.
[17] M. K. Heatley, “Atypical Polypoid Adenomyoma: A Systemic Review of the English Literature,” Histopathology, Vol. 48, No. 5, 2006, pp. 609-610. doi:10.1111/j.1365-2559.2005.02315.x
[18] J. P. Baak, E. C. Wisse-Brekelmans, J. C. Fleege, et al., “Assessment of the Risk on Endometrial Cancer in Hyperplasia, by Means of Orphological and Morphological Features,” Pathology Research and Practice, Vol. 188, No. 7, 1992, pp. 856-859.
[19] R. J. Kurman, P. F. Kaminski and H. J. Norris, “The Behavior of Endometrila Hyperplasia: A Long-Term Study of ‘Untreated’ Hyperplasia in 170 Patients,” Cancer, Vol. 56, No. 2, 1985, pp. 403-412.
[20] M. Fukuda, N. Sakurai, Y. Yamamoto, et al., “Case of Atypical Polypoid Adenomyoma that Possibly Underwent a Serial Progression from Endometrial Hyperplasia to Carcinoma,” Journal of Obstetrics and Gynaecology Research, Vol. 37, No. 5, 2011, pp. 468-471. doi: 10.1111/j.1447-0756.2010.01365.x
[21] J. S. Berek and N. F. Hacker, “Practical Gynecologic Oncology”, 4th Edition, Williams & Wilkins, Philadelphia, 2005.
[22] T. Kaku, H. Yoshikawa, et al., “Conservative Therapy for Adenocarcinoma and Atypical Endometrial Hyperplasia of the Endometrium in Young Women: Central Pathologic Review and Treatment Outcome,” Cancer Letters, Vol. 167, No. 1, 2001, pp. 39-48. doi:10.1016/S0304-3835(01)00462-1
[23] Y. Nakamura, M. Kawamoto, M. Matsubara, et al., “Cytological Features of Atypical Polypoid Adenomyoma,” Journal of the Japanese Society of Clinical Cytology, Vol. 49, No. 3, 2010, pp. 171-176.
[24] Y. Ohishi, T. Kaku, H. Kobayashi, et al., “CD10 Immunostaining Distinguishes Atypical Polypoid Adenomyofibroma (Atypical Polypoid Adenomyoma) from Endometrial Carcinoma Invading the Myometrium,” Human Pathology, Vol. 39, No. 10, 2008, pp. 1446-1453. doi:10.1016/j.humpath.2008.02.006
[25] M. Guida, E. Greco, A. Di Spiezio Sardo, et al., “Successful Pregnancy after Four-Step Hysteroscopic Technique for the Treatment of Atypical Polypoid Adenomyoma,” Fertility and Sterility, Vol. 89, No. 5, 2008, pp. 1283-1284. doi:10.1016/j.fertnstert.2008.01.093

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