{"paper_id":"21981d85-5bcc-413b-9daa-cfceb5958ffb","body_text":"Abstract\nObjectives\nTo describe MRI features of accessory cavitated uterine mass (ACUM) with surgical correlations.\nMethods\nEleven young women with an ACUM at pathology underwent preoperative pelvic MRI. Two experienced radiologists retrospectively analysed MR images in consensus to determine the lesion location within the uterus, its size, morphology (shape and boundaries), and structure reporting the signal and enhancement of its different parts compared to myometrium. The presence of an associated urogenital malformation or other gynaecological anomaly was reported. MRI features were correlated with surgical findings.\nResults\nAll 11 lesions were well correlated with surgical findings, lateralised (seven were left-sided), and located under the horn and the round ligament insertion. Nine were located within the external myometrium, bulging into the broad ligament. Two were extrauterine, entirely located within the broad ligament. On MRI, the mean size was 28 mm (range 17–60 mm). Nine lesions were round-shaped, two were oval; all had regular boundaries. At surgery, the ACUM were not encapsulated but were possible to enucleate. On MRI, all lesions were well defined and showed a central haemorrhagic cavity surrounded by a regular ring (mean thickness, 5 mm) which had the same signal compared to the junctional zone. ACUM was isolated in all women, without urogenital malformation, adenomyosis or deep endometriosis.\nConclusions\nOn MRI, ACUM was an isolated round accessory cavitated functional non-communicating horn-like aspect in an otherwise normal uterus. MRI may facilitate timely diagnosis and appropriate curative fertility-sparing laparoscopic resection.\nKey Points\n• ACUM is rare, with delayed diagnosis in young women with severe dysmenorrhoea. Pelvic MRI facilitates timely diagnosis and appropriate curative fertility-sparing laparoscopic resection.\n• Quasi-systematically located under the uterine round ligament insertion, ACUM may be intramyometrial and/or in the broad ligament.\n• On MRI ACUM resemble a non-communicating functional accessory horn within a normal uterus; the mass, most often round-shaped, had a central haemorrhagic cavity surrounded by a regular ring which had the same low signal compared to the uterine junctional zone.\nSimilar content being viewed by others\nAbbreviations\n- ACUM:\n-\nAccessory cavitated uterine mass\n- ESHRE:\n-\nEuropean Society of Human Reproduction and Embryology\n- ESGE:\n-\nEuropean Society for Gynaecological Endoscopy\n- FOV:\n-\nField of view\n- MR:\n-\nMagnetic resonance\n- MRI:\n-\nMagnetic resonance imaging\n- OR:\n-\nOestrogen receptor\n- PR:\n-\nProgesterone receptor\n- ST:\n-\nSection thickness\n- TE:\n-\nEcho time\n- TR:\n-\nRepetition time\nReferences\nOliver J (1912) An accessory uterus distended with menstrual fluid enucleated from the substance of the right broad ligament. Lancet 179:1609\nKataoka ML, Togashi K, Konishi I et al (1998) MRI of adenomyotic cyst of the uterus. J Comput Assist Tomogr 22:555–559\nTakeda A, Sakai K, Mitsui T, Nakamura H (2007) Laparoscopic management of juvenile cystic adenomyoma of the uterus: report of two cases and review of the literature. J Minim Invasive Gynecol 14:370–374\nHo ML, Raptis C, Hulett R, McAlister WH, Moran K, Bhalla S (2008) Adenomyotic cyst of the uterus in an adolescent. Pediatr Radiol 38:1239–1242\nTakeuchi H, Kitade M, Kikuchi I, Kumakiri J, Kuroda K, Jinushi M (2010) Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases. Fertil Steril 94:862–868\nKriplani A, Mahey R, Agarwal N, Bhatla N, Yadav R, Singh MK (2011) Laparoscopic management of juvenile cystic adenomyoma: four cases. J Minim Invasive Gynecol 18:343–348\nLiang YJ, Hao Q, Wu YZ, Wu B (2010) Uterus-like mass in the left broad ligament misdiagnosed as a malformation of the uterus: a case report of a rare condition and review of the literature. Fertil Steril 93:1347.e13–1347.e16\nPotter DA, Schenken RS (1998) Non communicating accessory uterine cavity. Fertil Steril 70:1165–1166\nAcién P, Acién M, Fernández F, José Mayol M, Aranda I (2010) The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus. Obstet Gynecol 116:1101–1109\nAcién P, Bataller A, Fernández F, Acién MI, Rodríguez JM, Mayol MJ (2012) New cases of accessory and cavitated uterine masses (ACUM): a significant cause of severe dysmenorrhea and recurrent pelvic pain in young women. Hum Reprod 27:683–694\nAcién P, Sánchez del Campo F, Mayol MJ, Acién M (2011) The female gubernaculum: role in the embryology and development of the genital tract and in the possible genesis of malformations. Eur J Obstet Gynecol Reprod Biol 159:426–432\nAcién P, Acién MI (2011) The history of female genital tract malformation classifications and proposal of an updated system. Hum Reprod Update 17:693–705\nBedaiwy MA, Henry DN, Elguero S, Pickett S, Greenfield M (2013) Accessory and cavitated uterine mass with functional endometrium in an adolescent: diagnosis and laparoscopic excision technique. J Pediatr Adolesc Gynecol 26:e89–e91\nJain N, Verma R (2014) Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly. Indian J Radiol Imaging 24:178–181\nPaul PG, Chopade G, Das T, Dhivya N, Patil S, Thomas M (2015) Accessory cavitated uterine mass: a rare cause of severe dysmenorrhea in young women. J Minim Invasive Gynecol 22:1300–1303\nPeters A, Rindos NB, Guido RS, Donnellan NM (2018) Uterine-sparing laparoscopic resection of accessory cavitated uterine masses. J Minim Invasive Gynecol 25:24–25\nWorld Health Organization (2003) World Health Organization classification of tumours: pathology and genetics of tumours of the breast and female genital organs. World Health Organization, Geneva http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb4/. Accessed 10 Jul 2018\nBehr SC, Courtier JL, Qayyum A (2012) Imaging of mullerian duct anomalies. Radiographics 32:E233–E250\nGrimbizis GF, Di Spiezio Sardo A, Saravelos SH et al (2016) The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 31:2–7\nMunro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113:3–13\nLakhman Y, Veeraraghavan H, Chaim J et al (2017) Differentiation of uterine leiomyosarcoma from atypical leiomyoma: diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur Radiol 27:2903–29152\nHall-Craggs MA, Williams CE, Pattison SH, Kirkham AP, Creighton SM (2013) Mayer-Rokitansky-Kuster-Hauser syndrome: diagnosis with MR imaging. Radiology 269:787–792\nGrimbizis GF, Gordts S, Di Spiezio Sardo A et al (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28:2032–2044\nParazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG (1997) Risk factors for adenomyosis. Hum Reprod 12:1275–1279\nTamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25:21–40\nBazot M, Daraï E (2018) Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril 109:389–397\nChamié LP, Blasbalg R, Pereira RM, Warmbrand G, Serafini PC (2011) Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics 31:E77–E100\nBazot M, Deux JF, Dahbi N, Chopier J (2001) Myometrium diseases. J Radiol 82:1819–1840\nMoyle PL, Kataoka MY, Nakai A, Takahata A, Reinhold C, Sala E (2010) Nonovarian cystic lesions of the pelvis. Radiographics 30:921–938\nProtopapas A, Milingos S, Markaki S et al (2008) Cystic uterine tumors. Gynecol Obstet Invest 65:275–280\nAcknowledgements\nThe authors would like to thank Philip Robinson (DRCI, Hospices Civils de Lyon) for help in manuscript preparation.\nFunding\nThe authors state that this work has not received any funding.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nGuarantor\nThe scientific guarantor of this publication is Professor Pascal Rousset, Lyon, France.\nConflict of interest\nThe authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.\nStatistics and biometry\nNo complex statistical methods were necessary for this paper.\nInformed consent\nWritten informed consent was waived by the institutional review board.\nEthical approval\nInstitutional review board approval was obtained.\nMethodology\n• retrospective\n• observational\n• performed at one institution\nElectronic supplementary material\nESM 1 (download DOCX )\n(DOCX 5261 kb)\nRights and permissions\nAbout this article\nCite this article\nPeyron, N., Jacquemier, E., Charlot, M. et al. Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity. Eur Radiol 29, 1144–1152 (2019). https://doi.org/10.1007/s00330-018-5686-6\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-018-5686-6","source_license":"CC0","license_restricted":false}