To investigate the clinical characteristics, treatment and prognosis of atypical polypoid adenomyomas (APA), so as to provide the diagnosis and treatment ideas for this disease.

From September 1, 2012 to October 1, 2019, a total of 16 patients with APA finally diagnosed by pathological examination in West China Second University Hospital, Sichuan University were selected as research subjects. The clinical data of those 16 patients were collected by retrospective analysis method, so as to summarize clinical characteristics, histopathological examination results, auxiliary examination results, treatment and prognosis of APA patients. This study met the requirements of World Medical Association Declaration of Helsinki revised in 2013.

Clinical data analysis results of 16 APA patients included in the study were as follows. ①General clinical data: patients′ age ranged from 23 to 59 years old [(40.8±10.7) years old]. There were 15 cases of premenopausal women, and 1 case of postmenopausal woman. ②Clinical manifestations: 12 cases presented irregular vaginal bleeding, 2 cases presented abnormal vaginal fluid, 1 case presented frequent urination and pain, and 1 case was with pelvic mass. ③Preoperative complications: 11 cases had one or more complications, such as infertility, uterine fibroids, atypical endometrial hyperplasia, and the remaining 5 cases had no complications. ④Preoperative transvaginal color Doppler ultrasound: 3 cases had no obvious abnormalities in uterine cavity; 5 cases were not observed exact space occupation, but their endometrial echo was uneven and had the dark area of vesicular fluid, and 8 cases were observed exact space occupation and all the occupation were located in the middle and lower part of uterine cavity. Transvaginal color Doppler ultrasonography showed abundant blood flow in uterine cavity of these 13 cases. ⑤Postoperative histopathological examination: 5 cases indicated APA complicated with uterine malignant tumor or its precancerous lesion, including 2 cases of APA with endometrial focal canceration, 1 case of APA with highly endometrial differentiated adenocarcinoma, 1 case of APA with endometrial carcinosarcoma, 1 case of APA with atypical endometrial hyperplasia. Among the remaining 11 cases, 1 case was APA with endometrial polyp, 1 case was APA with endometrial complex hyperplasia, and another 9 cases were simple APA with squamous metaplasia. ⑥Treatment and follow-up: 6 cases underwent hysterectomy; the other 10 cases underwent hysteroscopic focal resection. Among the later 10 patients, 6 cases had fertility requirements, but only 1 case had natural pregnancy after surgery, and finally miscarried, the remaining 5 cases had no pregnancy. All of these patients, 1 case was lost and the remaining 15 cases was followed up for 7-85 months (median follow-up time was 42 months), no one was recurrent with APA.

APA mostly occurs in premenopausal women and often complicated with endometrial malignant tumor, which is difficult to be diagnosed preoperatively and depends on postoperative pathological examination. For APA patients with fertility desire, the natural pregnancy rate is low after fertility preservation treatment.