# Fertility-sparing treatment for atypical polypoid adenomyoma

## TL;DR

This study explores fertility-preserving treatments for a rare uterine condition called atypical polypoid adenomyoma, finding that hysteroscopic resection is more effective than hormone therapy in resolving the condition.

## Contribution

The study provides long-term clinical outcomes of fertility-sparing treatments for atypical polypoid adenomyoma, comparing hysteroscopic resection and hormone therapy.

## Key findings

- Hysteroscopic resection achieved resolution of APA in 33.3% of patients.
- Hormone-only therapy showed lower resolution rates, especially with oral progesterone.
- Approximately one-third of patients progressed to hyperplasia or carcinoma within 4.5 years.

## Abstract

•Atypical polypoid adenomyoma (APA), defined as complex glands within fibroid stroma, is a rare endometrial lesion.•However, incidence of APA is rising, particularly amongst reproductive-aged patients.•Fertility-sparing treatment may be a feasible option for these women.•Hysteroscopic resection has the highest rates of regression of APA among these patients.•Hormone-only therapy, including oral progesterone or IUD, has lower rates of regression.

Atypical polypoid adenomyoma (APA), defined as complex glands within fibroid stroma, is a rare endometrial lesion.

However, incidence of APA is rising, particularly amongst reproductive-aged patients.

Fertility-sparing treatment may be a feasible option for these women.

Hysteroscopic resection has the highest rates of regression of APA among these patients.

Hormone-only therapy, including oral progesterone or IUD, has lower rates of regression.

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.

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.

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.

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.