[Clinical analysis of 30 patients with atypical glandular hyperplasia or malignant transformation in foci of adenomyosis]

Objective: To explore the clinical characteristics of patients with pre-malignant or malignant transformation in ectopic endometrium of adenomyosis. Methods: A retrospective study was performed on 4 818 patients received surgical treatment in Peking Union Medical College Hospital and pathologically confirmed as adenomyosis from January 2010 to October 2016. The clinical features and prognosis of 30 patients among these with pre-malignant or malignant transformation in ectopic endometrium were reviewed. Results: A total of 4 818 patients pathologically diagnosed with adenomyosis. Among these,30 (0.62%,30/4 818) patients were diagnosed with pre-malignant or malignant transformation in foci of adenomyosis, including 16 (0.33%, 16/4 818) of atypical endometrial hyperplasia and 14 (0.29%, 14/4 818) of endometrioid carcinoma. The average age of 30 patients was (50.8±3.0) years (range: 27-65 years). Patients with atypical hyperplasia in foci of adenomyosis coexist with 13 cases of endometrioid carcinoma in situ, 1 case of borderline serous papilloma in eutopic endometrium, 1 case of atypical hyperplasia in eutopic endometrium, and 1 case of normal eutopic endometrium. Fourteen patients with endometrioid carcinoma in foci of adenomyosis coexist with endometrioid carcinoma in situ. Among the 27 patients with pre-malignant or malignant transformation in adenomyosis and coexisting with endometrioid carcinoma in situ, 23 of them were in International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰa (85%, 23/27), 2 in stage Ⅰb (7%, 2/27), and 2 in stage Ⅲa (7%, 2/27). Seven percent (2/27) of patients had deep myometrial infiltration, and 7% (2/27) of patients had lymphovascular space invasion. The median follow-up time was 60 months (range: 32-104 months), and there were no recurrence or death. Conclusions: The incidence of atypical glandular hyperplasia or malignant transformation in foci of adenomyosis is rare, and it may be closely related to endometrial disease in situ. Pre-malignant or malignant change in foci of adenomyosis seems not to increase the risk of deep myometrial invasion, lymphovascular space invasion, and recurrence or mortality in patients of adenomyosis with endometrial adenocarcinoma.