Atypical Polypoid Adenoma – A Histopathological Enigma

Abstract

Atypical polypoid adenomyoma is an infrequent intrauterine polypoidal lesion. As per WHO classification of female genital tumors published in 2020, APA is classified as a mixed epithelial and mesenchymal tumor. The epithelial component comprises endometrioid-type glands with complex architecture, mild cytological atypia and fibromyomatous stroma with morular metaplasia. We present a case of a 32-year-old female with primary infertility; hysteroscopy showed a smooth polypoidal lesion over anterior wall of uterus. Complete transcervical resection of the lesion was done. Histopathology showed all the prementioned features of atypical polypoid adenomyoma and there was no other associated pathology. Since the patient desired fertility preservation, a conservative management plan with follow up was done. This lesion mostly involves women of fertile age group, hence differentiation from pre-malignant/malignant lesions is of utmost importance as fertility preservation can be done for this lesion. In older patients where fertility preservation is not required hysterectomy is advised in view of risk of recurrence.