Yeungnam Univ J Med.  2021 Jul;38(3):235-239. 10.12701/yujm.2020.00696.

Successful laparoscopic surgery of accessory cavitated uterine mass in young women with severe dysmenorrhea

• Park JC
• Kim DJ

• KMID: 2518666
• DOI: http://doi.org/10.12701/yujm.2020.00696

Abstract

Accessory cavitated uterine mass (ACUM) is a rare and unique condition seen in young women. We report cases of ACUMs in two patients, a 14-year-old girl and a 25-year-old woman, both with complaints of severe dysmenorrhea that had started at menarche and had progressively worsened since. A large cystic lesion was localized in the anterolateral wall of the myometrium separate from the endometrium, which was difficult to distinguish from congenital uterine anomalies. Laparoscopic excision of the ACUMs was successful and completely resolved the dysmenorrhea. Early investigation of severe dysmenorrhea in young women can provide appropriate management and relieve symptoms.

Keyword

Adenomyoma; Adolescent; Dysmenorrhea; Laparoscopy; Uterus

Figure

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  Fig. 1. Pelvic magnetic resonance imaging revealing a large cystic lesion (accessory cavitated uterine mass, asterisk) localized in the right side of the uterus, independent of the normal endometrium and ovaries. EM, endometrial cavity.

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  Fig. 2. Laparoscopic mass excision. (A) After incision, chocolate-like fluid was expressed from the cystic cavity. (B) Cystic cavity seen after irrigation. (C) The surrounding endometrial and myometrial tissue of the cyst completely resected using the monopolar hook. (D) Myometrial defect sutured for two to three layers.

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  Fig. 3. Histological section showing cyst wall lined with endometrial stromal cells, surrounded by myometrium (hematoxylin and eosin stain, ×200).

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  Fig. 4. Pelvic magnetic resonance imaging revealing a large cystic lesion (accessory cavitated uterine mass, asterisk) localized in the left side of the uterus, apart from the normal endometrium. Polycystic ovaries were also found. EM, endometrial cavity.

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  Fig. 5. (A) The excised specimens are irregularly shaped cystic structure with focal hemorrhage. (B) Histologic section showing the cyst wall lined with endometrial glandular epithelium and stromal cells, surrounded by myometrium. Adenomyotic lesions were not revealed in the surrounding myometrium (hematoxylin and eosin stain, ×100).

Reference

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