# Fertility-sparing management of atypical polypoid adenomyoma in a premenopausal woman: a two-case report and literature review

## TL;DR

This paper discusses managing a rare uterine condition in two premenopausal women while preserving their fertility through surgery and hormonal therapy.

## Contribution

The paper presents two new case studies and a literature review on fertility-sparing treatment of atypical polypoid adenomyoma.

## Key findings

- Complete hysteroscopic resection combined with hormonal therapy may effectively manage APA while preserving fertility.
- Close follow-up is essential due to the risk of recurrence and potential malignant transformation.
- Individualized management is recommended to optimize fertility outcomes in APA patients.

## Abstract

To describe fertility-sparing management of atypical polypoid adenomyoma (APA) in two premenopausal women and to review the relevant literature on treatment strategies aimed at preserving fertility.

A 39-year-old nulliparous woman presented with heavy menstrual bleeding and was diagnosed with APA via hysteroscopy and histopathology. Rapid recurrence prompted a second-look hysteroscopy and complete lesion resection. The second case involved a 30-year-old nulliparous woman with prolonged bleeding and a suspected submucosal fibroid; hysteroscopic resection confirmed APA. She received a levonorgestrel-releasing intrauterine device and regular follow-up. Both cases highlight diagnostic and therapeutic challenges in managing APA while preserving fertility.

These cases illustrate the diagnostic and therapeutic challenges of APA while preserving fertility. Based on our cases and a review of the literature, complete hysteroscopic resection, combined with hormonal therapy when appropriate, may be effective. Close follow-up is essential due to the risk of recurrence and potential malignant transformation, and individualized management is recommended to optimize fertility outcomes.