Hysteroscopic treatment of atypical polypoid adenomyoma diagnosed incidentally in a young infertile woman.

OBJECTIVE: To describe the conservative treatment of an atypical polypoid adenomyoma (APA) in a young infertile patient using a modification of the technique previously reported for the conservative treatment of stage IA endometrial cancer.
DESIGN: Case report.
SETTING: Department of Gynaecology and Obstetrics and Pathophysiology of Human Reproduction of the University of Naples "Federico II." PATIENT(S): A 35-year-old woman diagnosed incidentally with an APA during routine investigation for primary infertility. INTERVENTION(S): Conservative resectoscopic treatment using a four-step technique in which each step is characterized by a pathological analysis: the removal of the APA (step 1), the removal of endometrium adjacent to the APA (step 2), the removal of the myometrium underlying the APA (step 3), and multiple random endometrial biopsies (step 4). MAIN OUTCOME MEASURE(S): Complete resection of the APA and ruling out of any malignancy. RESULT(S): The conservative surgery was effective as histological examination of all specimens confirmed an APA confined to the endometrium without any other premalignant or malignant lesion. Transvaginal ultrasound and office hysteroscopy with target biopsies at 1 and 6 months after surgery were negative for atypia and malignancy. CONCLUSION(S): Our technique under a close, intermittent postoperative surveillance might represent a good therapeutic option for those women with APA who wish to preserve their fertility as well as for those at high medical risk for hysterectomy.