Accessory and Cavitated Uterine Mass (ACUM) in an 18-Year-Old Woman: A Case Report and Literature Review

Accessory and Cavitated Uterine Mass (ACUM) in an 18-Year-Old Woman: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case report Accessory and Cavitated Uterine Mass (ACUM) in an 18-Year-Old Woman: A Case Report and Literature Review HaiJing He, XuZhi Liang, Jiangtao Fan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1120568/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Accessory and cavitated uterine mass (ACUM) is a rare uterine anomaly newly recognized as a form of developmental Mullerian anomaly, which represents a non-communicating uterus-like mass within an otherwise normal uterus. It is a benign gynecological disease associated with severe dysmenorrhea and chronic pelvic pain, which is most common in young nullipara women, and sometimes develops in parous women. Clinical manifestations combined with imaging examinations including ultrasonography (USG), magnetic resonance imaging (MRI), and hysterosalpingography (HSG) are the means to establish a correct diagnosis. Medical therapy is only marginally effective, but laparoscopic surgery for complete mass excision is a feasible technique to relieve patient’s symptoms. Our article is aimed to report a case of ACUM in an 18-year-old woman and summarize the diagnostic criteria of ACUM. Case presentation : An 18-year-old woman was admitted for severe pain in the right lower abdomen during menstruation, which lasted more than 1 year. The patient was misdiagnosed with focal adenomyosis at our hospital on March 4, 2021. After 4 months, she was diagnosed with ACUM. Once diagnosis as focal adenomyosis, nonsteroidal anti-inflammatory drugs (NSAIDs) and gestrinone were administered to the patient. Following the diagnosis of ACUM, she received laparoscopic surgery. Our follow-up indicated that the symptom was significantly relief without drug therapy after sixty days postoperatively. Conclusions Clinical manifestations and imaging examinations are used to establish the diagnosis of ACUM. Medical therapy is only marginally effective, but laparoscopic surgery for complete mass excision is a feasible technique to solve the pain symptom. The prevalence and pathogenesis of ACUM and its reproductive outcomes on patients remain unclear, which calls for more and deeper research to study. Medical Genetics Obstetrics & Gynecology accessory and cavitated uterine mass dysmenorrhea laparoscopic surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Background ACUM is a rare benign gynecological disease, which is newly recognized as a form of uterine anomaly related to the malformation of Mullerian duct, and is reported that most common in nulligravid females younger than 30 years old 1 , 2 . The most striking clinical feature of ACUM is early-onset, severe, progressive, and drug-resistant dysmenorrhea, which usually occurred soon after menarche 3 . The ACUM-associated dysmenorrhea was refractory to nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptive pills, GnRHa, and analgesic drugs, while surgical resection of the lesion is the only radical treatment at present 4 . Several case reports had demonstrated the feasibility of minimally invasive laparoscopic resection for ACUM 7 – 9 . It is a well-circumscribed mass with a cystic cavity filled with hematometra within the myometrium adjacent to the uterine horn on imaging tests. Histopathology reveals that the wall of the accessory cavity is lined with functional endometrial glands and stroma surrounded by irregularly arranged smooth muscle 5 . Because of the lack of specificity of the imaging findings, the ACUM is often misdiagnosed as non-communicating rudimentary horn of uterus, but HSG can be used to distinguish between the two. The pathogenesis of the disease is still controversial. Although various scholars have proposed different theories, the mainstream opinion is that ACUM suggests a new type of Mullerian anomaly 6 . Due to the published literature about ACUM consisting entirely of case reports and case reviews without population-based studies and long-term follow-up, the prevalence and long-term influences of ACUM are still unclear. There were forty-two cases of ACUM reported around the world, of which only fourteen cases provided a result of the patient’s CA125, and only nine cases had CA125 values above the normal range. Without uniform nomenclature and diagnostic criteria, so many diagnostic names of this disease also cause confusion. The purpose of our study is to report a case of ACUM admitted to the First Affiliated Hospital of Guangxi Medical University and put forward our opinion on the nomenclature, diagnostic criteria, pathogenesis, and treatment of the disease. 2. Case Presentation An 18-year-old adolescent female, gravida 0, was admitted to our hospital for excruciating dysmenorrhea since she was 17 years old. Menarche occurred when she was 14 years old, since then, she obtained a regular menstrual cycle (for 28 to 30 days) and a regular menstrual period (for 6 days) with normal menstrual flow. On March 18, 2020, she was diagnosed with the pelvic inflammatory disease at the local hospital. Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered to relieve her symptoms, but her menstrual cramps did not improve. On March 4, 2021, she was diagnosed with focal adenomyosis based on the transabdominal ultrasound findings of a 35×29×32mm uterine cystic mass on the right side of the uterine body at our hospital, and gestrinone was administered for her in the next 3 months. Her symptoms subsided within 3 months of taking gestrinone but recurred after withdrawal. On July 5, 2021, she was admitted to our hospital again for uncontrollable dysmenorrhea and called for a more definitive therapeutic regimen. Transrectal, three-dimensional, and transvaginal ultrasound detected an anechoic cystic lesion within a mixed echogenic mass located in the myometrium of the front right side of the uterine body, without connecting normal uterine cavity (Figure 1 ). The pelvic MRI was done to further characterize the adnexal mass. T1-weighted images revealed the cyst within the adnexal mass as an area of high signal intensity, while T2-weighted images showed it as an area of low signal intensity (Figure 2 ). She was diagnosed with ACUM based on the above clinical manifestations, as well as the results of ultrasound and MRI. After learning that surgery was the most effective solution to her problem, the patient requested surgery. After evaluation of the patient with indications for surgery and no contraindications, we performed conventional multi-incision laparoscopic surgery (MILS) on her on July 14, 2021. Our procedure for MILS was performed as follows: (1) The patient was placed in the reverse Trendelenburg position under general anesthesia and endotracheal intubation; (2) A 1cm transverse incision was made subcutaneously along the upon margin of the umbilicus, where a pneumoperitoneum needle inserted into the abdominal cavity, and then 2.0 L of carbon dioxide was used to inflate the abdomen; (3) A 10mm Trocar was inserted through the primary incision, where a laparoscope was put into. The second, third, and fourth puncture points were made in the avascular zone of the hypogastrium; (4) Under the laparoscopic vision, an irregular uterine shape was observed, and a 20×20×30mm mass was observed at the junction of the right uterine round ligament and the right fallopian tube (Figure 3 A). Bilateral ovaries and fallopian tubes were normal in appearance; (5) Six units of pituitrin diluted with normal saline were locally injected into the myometrium at the junction of the normal uterus and ACUM (Figure 3 B). The serosa and myometrium at the most prominent point of the mass were incised using electrocautery to separate the mass (Figure 3 C, D, E). Thereafter, the bottom myometrium of the mass cavity and the serosa were closed with a continuous suture using 2-0 barbed wire (Kehui) to restore uterine shape (Figure 3 -F). The above puncture points were sutured using 3-0 monofilament absorbable thread. The woman’s postoperative course was uneventful and she was discharged 2 days after surgery. Her dysmenorrhea had improved significantly. Postoperative pathological results showed that the specimen was smooth tissue with endometrial glands and blood (Figure 4 ). The inner layer of the cavity was lined by endometrial glandular epithelial cells and stroma, and the outer layer appeared similar to normal myometrium. The patient was discharged on postoperative day 2 without complications. We learned that the dysmenorrhea significantly improved and the patient was followed up closely. Our follow-up indicated that the symptom was significantly relief without drug therapy after sixty days postoperatively. 3. Results In 1996, Tamura et al. 10 proposed the concept of juvenile cystic adenomyoma (JCA) for the first time, pointing out that this disease is a rare disease that mostly occurs in nulligravid females and can cause dysmenorrhea. Since then, this kind of uterine cysts gradually arouses controversy among scholars all over the world. In 2010, Takeuchi et al. proposed the diagnostic criteria for JCA: First, the onset age ≤30 years; Second, cystic lesions ≥10mm in diameter that did not communicate with the normal uterine cavity; Third, associated with severe dysmenorrhea 11 . In the same year, by searching in the MEDLINE, Acién, et al. 12 suggested that most published cases of JCA, as well as those cases named noncommunicating accessory uterine cavities or uterine-like masses, are actually the same pathology: an accessory and cavitated uterine mass within an otherwise normal uterus, thus he terming it as ACUM. He proposed new criteria for ACUM in 2012: First, an isolated accessory mass containing a lumen; Second, uterus, tubes, and ovaries were normal; Third, surgical resection and pathological analysis of the lesion; Fourth, accessory cavity lined by endometrial epithelium with glands and stroma; Fifth, The content was chocolate-like liquid; Sixth, no adenomyosis (if uterus removed), but there could be small focus of adenomyosis in the myometrium adjacent to the accessory cavity 13 . The pathogenesis of ACUM is still controversial. At present, there are three main theories about pathogenesis, 14 including congenital anomaly theory, heterotopias theory, and metaplasia theory, but most scholars agree that ACUM is a congenital anomaly related to Mullerian duct 15 . We use the following search formula in PubMed: Accessory and Cavitated Uterine Mass OR ACUM OR JCA OR Juvenile cystic adenomyoma OR non-communicating accessory uterine cavities OR uterine-like masses OR cystic adenomyoma. Twenty-seven relevant studies including forty-five cases from 2000 to 2021 were obtained. After excluding four cases that didn’t line with the ACUM diagnostic criteria proposed by Acién in 2012, forty-one cases of ACUM have been reported in the present literature. Among the four cases excluded by us, one case was excluded because her symptoms appeared after curettage of cornual pregnancy, and we considered that her symptoms mostly attributed to endometriosis caused by curettage instead of ACUM. Another three cases did not meet the second diagnostic criteria of ACUM proposed by Acién, two cases underwent oophorectomy due to previous endometriosis of the ovary, and one case was excluded because of intraoperative endometriosis of bilateral ovary and round ligament. Table 1 reveals the main clinical findings of the forty-one cases with ACUM that have been reported in previous literature. And we add a case of an 18-year-old woman (gravida 0, para 0) with over 1-years’ history of progressive dysmenorrhea. In our case, we use the term ACUM and the diagnostic criteria proposed by Acién. After the minimally invasive laparoscopic resection of the lesion, dysmenorrhea significantly improved in our case. Table 1 Review of literature related to ACUM Author Age at diagnosis (year) Onset age (year) GP Symptom CA125 (U/ml) size of cyst(mm) lesion size(mm) imaging method lesion position diagnosis medical therapy treatment Nabeshima H 19 19 NA G0P0 severe dysmenorrhea 40.9 30 NA TVU、MRI、HSG in the right side of the uterus Cystic adenomyoma GnRHa Laparoscopic surgery Takeda A 20 20 13 G0P0 severe dysmenorrhea that began with menarche 25 15 30 TVU、MRI、HSG、DIP in the right anterior portion of the uterine corpus caudal to the round ligament Cystic adenomyoma NSAIDs, GnRHa Laparoscopic surgery 20 14 G0P0 severe dysmenorrhea that began with menarche 40.5 11 26 TVU、MRI、HSG、DIP in the left anterior portion of the uterine corpus caudal to the round ligament Cystic adenomyoma NSAIDs Laparoscopic surgery Takeuchi H 11 30 NA G0P0 Pelvic pain 43 23 35 TVU, MRI Three patients had the mass in the left side of the uterus and six patients on the right. Cystic adenomyoma N Laparoscopic surgery 29 NA G0P0 Pelvic pain and dysmenorrhea 141 15 30 TVU, MRI Cystic adenomyoma N Laparoscopic surgery 27 NA G2P2 Dyspareunia 36 19 42 TVU, MRI Cystic adenomyoma N Laparoscopic surgery 20 NA G0P0 Pelvic pain and dysmenorrhea 551 15 28 TVU, MRI Cystic adenomyoma OC Laparoscopic surgery 30 NA G2P2 Dyspareunia 34 15 30 TVU, MRI Cystic adenomyoma N Laparoscopic surgery 28 NA G0P0 Pelvic pain 12 19 25 TVU, MRI Cystic adenomyoma OC, GnRHa Laparoscopic surgery 23 NA G0P0 Pelvic pain 157 18 28 TVU, MRI Cystic adenomyoma OC Laparoscopic surgery 20 NA G0P0 Pelvic pain 34 10.5 40 TVU, MRI Cystic adenomyoma GnRHa Laparoscopic surgery 20 NA G0P0 Pelvic pain 14 16 34 TVU, MRI Cystic adenomyoma GnRHa Laparoscopic surgery Akar ME 7 15 15 G0P0 A 6-month history of intermittent episode right-sides periumbilical pain and severe dysmenorrhea NA 25 47 CT, TSU, in the right anterior fundal portion of the uterus JCA aromatase inhibitors, progestins, OC, GnRHa Robot-assisted laparoscopic surgery tijani 16 35 35 G0P0 Intense pain in the left iliac fossa and pelvic 161 NA 21 USG in the posterior fundus of the uterus and posterior face of the bladder Giant uterus-like mass of the uterus NA Laparoscopic surgery Kriplani A 8 16 14 G0P0 severe secondary dysmenorrhea NA NA 38 MRI, USG In the right uterine wall near fundus JCA OC, NSAIDs, mifepristone Laparoscopic surgery 18 17 G0P0 severe secondary dysmenorrhea NA NA 42 MRI, USG In the right uterine wall near fundus JCA OC, NSAIDs Laparoscopic surgery 16 15 G0P0 severe secondary dysmenorrhea NA NA 31 MRI, USG In the anterior myometrium of the uterus JCA NSAIDs Laparoscopic surgery 24 15 G0P0 severe secondary dysmenorrhea NA NA 30 MRI, USG In the right uterine wall near fundus JCA OC, NSAIDs Laparoscopic surgery Chun SS 21 19 12 G0P0 pelvic pain and progressive dysmenorrhea NA 21 30 MRI In the left posterior uterine fundus JCA NSAIDs Laparoscopic surgery Acién P 13 36 19 G2P2 abdominal pain that was more intense in the left iliac fossae and increased during menstruation NA NA 50 TVU in the left front side of the uterus ACUM OC Laparoscopic surgery 18 14 G0P0 left iliac fossae pain, hypogastric pain and progressive dysmenorrhea NA NA 26 MRI, TRU, on the left side of the uterine body ACUM NA Laparoscopic surgery 19 10 G0P0 pelvic pain and progressive dysmenorrhea NA NA 20 TVU, HSG in the anterior surface of the left horn ACUM OC, NSAIDs Laparoscopic surgery 20 15 G0P0 iliac fossae pain and progressive dysmenorrhea NA 3.5cm 40 TVU, MRI, HSG In the anterior left side of the uterus ACUM analgesic drugs, NSAIDs, OC Laparoscopic surgery Branquinho MM 22 17 15 G0P0 the right lower abdominal pain NA NA 3.3 TVU, TAU, MRI within the right uterine myometrium and adjacent to the right ovary JCA analgesics, OC medical therapy Jain N 23 19 19 G0P0 severe dysmenorrhea and menorrhagia NA NA NA TAU In the anterior right side of the uterus cystic adenomyoma OC, NSAIDs Laparoscopic surgery Kumakiri J 4 20 15 G0P0 severe dysmenorrhea NA 30 NA TVU, MRI In the right side of the uterus JCA OC, NSAIDs laparoscopy Bedaiwy MA 24 16 NA G0P0 severe dysmenorrhea and cyclic pelvic pain NA NA 30 USG, MRI in the left anterior wall of the uterus ACUM OC, NSAIDs laparoscopy Jain N 1 24 NA G0P0 severe dysmenorrhea and chronic pelvic pain NA NA 40 USG, MRI in the right adnexa between the uterus and right ovary ACUM OC, NSAIDs laparoscopy Pontrelli G 25 27 NA G0P0 menometrorrhagia, severe dysmenorrhea, dyspareunia, and chronic pelvic pain 96 80 NA USG, MRI In the posterior wall of the uterus ACUM Estrogen and progestin Laparoscopic surgery Pabuccu EG 9 20 20 G0P0 severe dysmenorrhea NA NA NA NA in the right anterior wall just below the cornual end JCA NA Laparoscopic surgery Garofalo A 26 17 15 G0P0 severe pelvic pain and progressive dysmenorrhea NA 17 28 USG, MRI in the anterior right side of the uterus ACUM OC, NSAIDs Laparoscopic surgery Dadhwal V 27 23 20 G0P0 severe dysmenorrhea, severe episodic pain in the lower abdomen for 2 months and severe dysmenorrhea for 3 years. NA NA 39 TAU, MRI in the anterior wall of the uterus near the cornual end ACUM NA Laparoscopic surgery 16 13 G0P0 acute episodic pain in the left lower abdomen, the pain was severe in nature and occurred every 2-3 months for the 3 years NA NA 40 TAU, MRI over the left uterine wall near the cornual end just below the insertion of the round ligament; ACUM NA Laparoscopic surgery Strelec M 24 , 28 14 NA G0P0 asymptom NA 20 40 USG, MRI NA ACUM N Laparoscopic surgery Protopapas A 17 14 13 G0P0 intolerable dysmenorrhea NA NA 38 MRI In the left side of the uterus and extended to the uterine isthmus JCA OC Laparoscopic surgery Wilcox A 29 18 13 G0P0 severe dysmenorrhea NA NA 23 TVU, MRI in the anterior left upper region of the uterus JCA OC, IUD laparoscopic surgery 18 NA G0P0 pelvic pain NA NA 36 TVU within the left side of the uterus JCA OC laparoscopic surgery Kiyak H 30 27 NA G2P1 pelvic pain and delayed menses NA 21 45 TVU in the right cornual area NA NA laparoscopic surgery Minelli F 31 19 18 G0P0 pelvic pain and dysmenorrhea NA NA 27 MRI, USG, in the middle of the anterior wall of the uterus JCA Hormone therapy sclerotherapy with ethanol Iranpour P 32 14 NA G0P0 chronic recurrent pelvic pain NA NA 35 CT, TVU, MRI In the left side of the uterus ACUM OC, NSAIDs laparoscopic surgery Arya S 6 18 NA G0P0 gradually worsening pelvic pain NA NA 30 CT, TVU, MRI in the left lateral myometrium JCA Hormone therapy laparoscopic surgery 16 NA G0P0 worsening of chronic dysmenorrhea NA NA 47 CT, USG, in the right side of the uterus JCA OC laparoscopic surgery Present study 18 17 G0P0 Severe dysmenorrhea TAU, TRU, TVU, MRI in the myometrium of the right side of the uterus ACUM Progestin, NSAIDs, laparoscopic surgery Note: G=gravida; P=parity; N=no; NA=not available; USG=ultrasonography; CT=computer tomography; TAU=transabdominal ultrasound; TVU=transvaginal ultrasound; MRI= magnetic resonance imaging; HSG=hysterosalpingography; JCA= juvenile cystic adenomyoma; ACUM= accessory and cavitated uterine mass; OC=oral contraceptive; NSAIDs= nonsteroidal anti-inflammatory drugs, IUD=intra uterine device. We thought the term JCA and the diagnostic criteria of Takeuchi limit the age to females younger than 30 years old, but in fact, there were some reports on patients over 30 years old with ACUM 13 , 16 . In addition, ACUM has a unique pathogenic site, which is located in the anterior lateral wall of the uterus near the corner of the uterus, and the size of the cyst within ACUM was all ༞0.5cm according to the current literature. Thus, we suggest that the pathogenic site of ACUM and the size of the cyst within ACUM should be included in the diagnostic criteria. What’s more, we tend to agree that ACUM is a congenital disease since dysmenorrhea usually occurs within 5 years after menarche 3 . The patient in our case was initially diagnosed with focal adenomyosis, however, ACUM is easily misdiagnosed as obstructed cavitated rudimentary uterus horn in fact. Both of them present as a cavitated mass lined with endometrium, the within of which is hematometra. HSG can be done to distinguish the two. In the cases of non-communicating rudimentary horn, the fallopian tube of the affected side can’t visualize on HSG 17 . It was considered that all congenital uterine anomalies have been implicated as a potential cause of infertility and adverse pregnancy events in a previous study 18 . Unfortunately, there is still a lack of literature that explore the reproductive outcomes of ACUM on patients. Since ACUM is a rare form of congenital uterine anomalies, the continuity of the myometrium and even the endometrium may have been disrupted. No matter how perfect the surgery is, there will be a scarred uterus after the surgery, which has a certain impact on the reproductive outcome of patients. But it still needs to be confirmed by long-term observational studies. According to the existing literature, a total of forty-two cases of ACUM have been reported around the world, of which only fourteen cases provided a result of the patient’s CA125, and nine cases had CA125 values above the normal range. Is the evaluation of CA125related to the occurrence of ACUM? We have no answer, because there are scarce reports of ACUM and even more scarce cases providing CA125. And it is unfortunate that our case didn’t provide the information about CA125. More cases are needed to explain the relationship between ACUM and CA125. 4. Conclusion ACUM is a rare form of uterine anomaly related to the malformation of Mullerian duct, which can cause severe dysmenorrhea and chronic pelvic pain. Surgical excision of the ACUM is still the most effective treatment, and laparoscopic surgery is proved to be a feasible and safe way. In our case, the patient benefits a lot after laparoscopic surgery. However, we can’t answer whether the elevation of CA125 in some patients is related to ACUM and whether it has a certain impact on the reproductive outcome of patients now. It calls for more cases and research to deal with these problems. Anyways, our report adds a case to the current literature, and we also tend to agree that ACUM is a congenital disease since dysmenorrhea occurs within 5 years after menarche in our patient. In addition, we put forward that the pathogenic site of ACUM and the size of the cyst within ACUM should be included in the diagnostic criteria. Declarations Authors’ contributions H.H wrote the first draft of the manuscript; X.L and H.H provided figures; X.L and J.F designed research, critically revised the paper, and provided funding support. All Authors read and approved the final version of the manuscript Funding This research was funded by the Natural Science Foundation of China (No.81960464). Availability of data and materials The data that support the findings of this article are available from the corresponding author upon reasonable request. Ethics approval and consent to participate Consent for the use of anonymized data and imaging was obtained from the next of kin. Consent for publication All authors read and approved the final manuscript. Competing interests Written informed consent was obtained from the patient for publication of this case report any accompanying images. The authors declare no competing interests. Acknowledgments Not applicable References Jain N, Verma RJTIjor, imaging. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly. 2014;24(2):178-181. Benagiano G, Brosens I, Habiba MJRbo. Adenomyosis: a life-cycle approach. 2015;30(3):220-232. Brosens I, Gordts S, Habiba M, Benagiano G. Uterine Cystic Adenomyosis: A Disease of Younger Women. J Pediatr Adolesc Gynecol. 2015;28(6):420-426. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1120568","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case report","associatedPublications":[],"authors":[{"id":73639419,"identity":"76dde29b-a516-4958-87be-f88e0d2dab35","order_by":0,"name":"HaiJing He","email":"","orcid":"","institution":"Guangxi Medical University First Affiliated Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"HaiJing","middleName":"","lastName":"He","suffix":""},{"id":73639420,"identity":"36453e8d-503c-458a-841a-0fea7159a7eb","order_by":1,"name":"XuZhi Liang","email":"","orcid":"","institution":"Guangxi Medical University First Affiliated Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"XuZhi","middleName":"","lastName":"Liang","suffix":""},{"id":73639421,"identity":"5fdfdaad-12df-47e3-af81-eac4d0785ca3","order_by":2,"name":"Jiangtao Fan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIie3QvQrCMBDA8QtC6nC1mwTE9hUqXRx8mHZx6uAjtATOxe4VB1/B0bEScNIncBGchYw6iF+Tk8komN8WuD+XBMBxfhArADTACLknm0ZfbBICVgOMww5us818ZrOGvxOVhCJPVJtbFK1lwYrrupUR7rQChCjoNuaLldWOZ+RVKzUZwmC+SI2Jd/QJn1v2K1UjpPHBnLDyRiIjkR8VcstE+hQnXORgm6RM9ikNOW7j5ycL81sGsmHlme4YTeVJ68soCnqmpAj051l8H3+JzCOO4zh/7wEqo0U4BA0f+AAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-1308-4533","institution":"Guangxi Medical University First Affiliated Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jiangtao","middleName":"","lastName":"Fan","suffix":""}],"badges":[],"createdAt":"2021-11-28 05:31:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1120568/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1120568/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":16994769,"identity":"1c0ef120-6012-4945-83e7-77e159f0fb0d","added_by":"auto","created_at":"2022-01-04 23:28:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":123233,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Transvaginal ultrasound in a longitudinal section, (B) Transvaginal ultrasound in a transverse section, (C) Transrectal ultrasound and (D) Three-dimensional ultrasound show the ACUM (white arrow) located in the myometrium of the right side of the uterus. (CX: Cervix, EN: Endometrium, L: Left, R: Right.)\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1120568/v1/e3d120858831d9d0c6cde4f5.jpg"},{"id":16995007,"identity":"68ca3006-46e3-40c7-bd2c-8529b4621aa0","added_by":"auto","created_at":"2022-01-04 23:31:13","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":65944,"visible":true,"origin":"","legend":"\u003cp\u003e(A)T1-weighted MRI of the content within ACUM (white arrow) was high signal intensity. (B)T2-weighted MRI of ACUM (white arrow) was low signal intensity.\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1120568/v1/f813b9e4bcfd9c644d217450.jpg"},{"id":16994771,"identity":"3bc42c45-b8c7-423f-8a34-c85209308bbd","added_by":"auto","created_at":"2022-01-04 23:28:13","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":173244,"visible":true,"origin":"","legend":"\u003cp\u003e(A) A 2*2*3cm mass was observed at the junction of the right uterine round ligament and the right fallopian tube. (B) Six units of pituitrin diluted with normal saline were locally injected into the myometrium. (C, D, E) An incision between the normal myometrium and lesion was performed. (F) The surface of the wound in the uterine serosa sutured using unidirectional barbed string.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1120568/v1/3d7772b04d59589c568c2d2c.jpg"},{"id":16994770,"identity":"702eb229-3b6f-4fdf-a5cc-579d1db2c456","added_by":"auto","created_at":"2022-01-04 23:28:13","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":114495,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Excised lesions. (B) The inner layer was lined by endometrial glandular epithelial cells and stroma (yellow arrow), and the outer layer appeared similar to normal myometrium (yellow triangle). (C) The myometrium is irregularly arranged around the cyst. (D) Myometrium with endometrial gland invasion (white arrow).\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1120568/v1/beb7dd2bd2346555bd4a8c3e.jpg"},{"id":16995008,"identity":"23bd3c6f-9f94-44a8-869c-3c9ecef8c04d","added_by":"auto","created_at":"2022-01-04 23:31:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":639325,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1120568/v1/e21e7ae4-ab17-4307-b22a-bc017f6b7e9c.pdf"}],"financialInterests":"","formattedTitle":"Accessory and Cavitated Uterine Mass (ACUM) in an 18-Year-Old Woman: A Case Report and Literature Review","fulltext":[{"header":"1. Background","content":"\u003cp\u003eACUM is a rare benign gynecological disease, which is newly recognized as a form of uterine anomaly related to the malformation of Mullerian duct, and is reported that most common in nulligravid females younger than 30 years old\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The most striking clinical feature of ACUM is early-onset, severe, progressive, and drug-resistant dysmenorrhea, which usually occurred soon after menarche\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The ACUM-associated dysmenorrhea was refractory to nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptive pills, GnRHa, and analgesic drugs, while surgical resection of the lesion is the only radical treatment at present\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Several case reports had demonstrated the feasibility of minimally invasive laparoscopic resection for ACUM\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. It is a well-circumscribed mass with a cystic cavity filled with hematometra within the myometrium adjacent to the uterine horn on imaging tests. Histopathology reveals that the wall of the accessory cavity is lined with functional endometrial glands and stroma surrounded by irregularly arranged smooth muscle\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Because of the lack of specificity of the imaging findings, the ACUM is often misdiagnosed as non-communicating rudimentary horn of uterus, but HSG can be used to distinguish between the two.\u003c/p\u003e \u003cp\u003eThe pathogenesis of the disease is still controversial. Although various scholars have proposed different theories, the mainstream opinion is that ACUM suggests a new type of Mullerian anomaly\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Due to the published literature about ACUM consisting entirely of case reports and case reviews without population-based studies and long-term follow-up, the prevalence and long-term influences of ACUM are still unclear. There were forty-two cases of ACUM reported around the world, of which only fourteen cases provided a result of the patient\u0026rsquo;s CA125, and only nine cases had CA125 values above the normal range. Without uniform nomenclature and diagnostic criteria, so many diagnostic names of this disease also cause confusion. The purpose of our study is to report a case of ACUM admitted to the First Affiliated Hospital of Guangxi Medical University and put forward our opinion on the nomenclature, diagnostic criteria, pathogenesis, and treatment of the disease.\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cp\u003eAn 18-year-old adolescent female, gravida 0, was admitted to our hospital for excruciating dysmenorrhea since she was 17 years old. Menarche occurred when she was 14 years old, since then, she obtained a regular menstrual cycle (for 28 to 30 days) and a regular menstrual period (for 6 days) with normal menstrual flow. On March 18, 2020, she was diagnosed with the pelvic inflammatory disease at the local hospital. Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered to relieve her symptoms, but her menstrual cramps did not improve. On March 4, 2021, she was diagnosed with focal adenomyosis based on the transabdominal ultrasound findings of a 35\u0026times;29\u0026times;32mm uterine cystic mass on the right side of the uterine body at our hospital, and gestrinone was administered for her in the next 3 months. Her symptoms subsided within 3 months of taking gestrinone but recurred after withdrawal.\u003c/p\u003e \u003cp\u003eOn July 5, 2021, she was admitted to our hospital again for uncontrollable dysmenorrhea and called for a more definitive therapeutic regimen. Transrectal, three-dimensional, and transvaginal ultrasound detected an anechoic cystic lesion within a mixed echogenic mass located in the myometrium of the front right side of the uterine body, without connecting normal uterine cavity (Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The pelvic MRI was done to further characterize the adnexal mass. T1-weighted images revealed the cyst within the adnexal mass as an area of high signal intensity, while T2-weighted images showed it as an area of low signal intensity (Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). She was diagnosed with ACUM based on the above clinical manifestations, as well as the results of ultrasound and MRI. After learning that surgery was the most effective solution to her problem, the patient requested surgery. After evaluation of the patient with indications for surgery and no contraindications, we performed conventional multi-incision laparoscopic surgery (MILS) on her on July 14, 2021.\u003c/p\u003e\u003cp\u003eOur procedure for MILS was performed as follows: (1) The patient was placed in the reverse Trendelenburg position under general anesthesia and endotracheal intubation; (2) A 1cm transverse incision was made subcutaneously along the upon margin of the umbilicus, where a pneumoperitoneum needle inserted into the abdominal cavity, and then 2.0 L of carbon dioxide was used to inflate the abdomen; (3) A 10mm Trocar was inserted through the primary incision, where a laparoscope was put into. The second, third, and fourth puncture points were made in the avascular zone of the hypogastrium; (4) Under the laparoscopic vision, an irregular uterine shape was observed, and a 20\u0026times;20\u0026times;30mm mass was observed at the junction of the right uterine round ligament and the right fallopian tube (Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). Bilateral ovaries and fallopian tubes were normal in appearance; (5) Six units of pituitrin diluted with normal saline were locally injected into the myometrium at the junction of the normal uterus and ACUM (Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). The serosa and myometrium at the most prominent point of the mass were incised using electrocautery to separate the mass (Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC, D, E). Thereafter, the bottom myometrium of the mass cavity and the serosa were closed with a continuous suture using 2-0 barbed wire (Kehui) to restore uterine shape (Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e-F). The above puncture points were sutured using 3-0 monofilament absorbable thread. The woman\u0026rsquo;s postoperative course was uneventful and she was discharged 2 days after surgery. Her dysmenorrhea had improved significantly.\u003c/p\u003e\u003cp\u003ePostoperative pathological results showed that the specimen was smooth tissue with endometrial glands and blood (Figure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The inner layer of the cavity was lined by endometrial glandular epithelial cells and stroma, and the outer layer appeared similar to normal myometrium. The patient was discharged on postoperative day 2 without complications. We learned that the dysmenorrhea significantly improved and the patient was followed up closely. Our follow-up indicated that the symptom was significantly relief without drug therapy after sixty days postoperatively.\u003c/p\u003e "},{"header":"3. Results","content":"\u003cp\u003eIn 1996, Tamura et al.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e proposed the concept of juvenile cystic adenomyoma (JCA) for the first time, pointing out that this disease is a rare disease that mostly occurs in nulligravid females and can cause dysmenorrhea. Since then, this kind of uterine cysts gradually arouses controversy among scholars all over the world. In 2010, Takeuchi et al. proposed the diagnostic criteria for JCA: First, the onset age \u0026le;30 years; Second, cystic lesions \u0026ge;10mm in diameter that did not communicate with the normal uterine cavity; Third, associated with severe dysmenorrhea\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. In the same year, by searching in the MEDLINE, Aci\u0026eacute;n, et al.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e suggested that most published cases of JCA, as well as those cases named noncommunicating accessory uterine cavities or uterine-like masses, are actually the same pathology: an accessory and cavitated uterine mass within an otherwise normal uterus, thus he terming it as ACUM. He proposed new criteria for ACUM in 2012: First, an isolated accessory mass containing a lumen; Second, uterus, tubes, and ovaries were normal; Third, surgical resection and pathological analysis of the lesion; Fourth, accessory cavity lined by endometrial epithelium with glands and stroma; Fifth, The content was chocolate-like liquid; Sixth, no adenomyosis (if uterus removed), but there could be small focus of adenomyosis in the myometrium adjacent to the accessory cavity\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The pathogenesis of ACUM is still controversial. At present, there are three main theories about pathogenesis,\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e including congenital anomaly theory, heterotopias theory, and metaplasia theory, but most scholars agree that ACUM is a congenital anomaly related to Mullerian duct\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe use the following search formula in PubMed: Accessory and Cavitated Uterine Mass OR ACUM OR JCA OR Juvenile cystic adenomyoma OR non-communicating accessory uterine cavities OR uterine-like masses OR cystic adenomyoma. Twenty-seven relevant studies including forty-five cases from 2000 to 2021 were obtained. After excluding four cases that didn\u0026rsquo;t line with the ACUM diagnostic criteria proposed by Aci\u0026eacute;n in 2012, forty-one cases of ACUM have been reported in the present literature. Among the four cases excluded by us, one case was excluded because her symptoms appeared after curettage of cornual pregnancy, and we considered that her symptoms mostly attributed to endometriosis caused by curettage instead of ACUM. Another three cases did not meet the second diagnostic criteria of ACUM proposed by Aci\u0026eacute;n, two cases underwent oophorectomy due to previous endometriosis of the ovary, and one case was excluded because of intraoperative endometriosis of bilateral ovary and round ligament. Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e reveals the main clinical findings of the forty-one cases with ACUM that have been reported in previous literature. And we add a case of an 18-year-old woman (gravida 0, para 0) with over 1-years\u0026rsquo; history of progressive dysmenorrhea. In our case, we use the term ACUM and the diagnostic criteria proposed by Aci\u0026eacute;n. After the minimally invasive laparoscopic resection of the lesion, dysmenorrhea significantly improved in our case.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReview of literature related to ACUM\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge at diagnosis (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOnset age (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSymptom\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCA125\u003c/p\u003e \u003cp\u003e(U/ml)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003esize of cyst(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003elesion size(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eimaging method\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003elesion position\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ediagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003emedical therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003etreatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNabeshima H\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU、MRI、HSG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the right side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGnRHa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakeda A\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea that began with menarche\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU、MRI、HSG、DIP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the right anterior portion of the uterine corpus caudal to the round ligament\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNSAIDs, GnRHa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea that began with menarche\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU、MRI、HSG、DIP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the left anterior portion of the uterine corpus caudal to the round ligament\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakeuchi H\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eThree patients had the mass in the left side of the uterus and six patients on the right.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePelvic pain and dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG2P2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDyspareunia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePelvic pain and dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e551\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG2P2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDyspareunia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, GnRHa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGnRHa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eGnRHa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAkar ME\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA 6-month history of intermittent episode right-sides periumbilical pain and severe dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT, TSU,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the right anterior fundal portion of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003earomatase inhibitors, progestins, OC, GnRHa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eRobot-assisted laparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etijani\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntense pain in the left iliac fossa and pelvic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUSG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the posterior fundus of the uterus and posterior face of the bladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eGiant uterus-like mass of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKriplani A\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere secondary dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI, USG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the right uterine wall near fundus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs, mifepristone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere secondary dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI, USG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the right uterine wall near fundus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere secondary dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI, USG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the anterior myometrium of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere secondary dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI, USG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the right uterine wall near fundus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChun SS\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epelvic pain and progressive dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the left posterior uterine fundus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAci\u0026eacute;n P\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG2P2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eabdominal pain that was more intense in the left iliac fossae and increased during menstruation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the left front side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eleft iliac fossae pain, hypogastric pain and progressive dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI, TRU,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eon the left side of the uterine body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epelvic pain and progressive dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, HSG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the anterior surface of the left horn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eiliac fossae pain and progressive dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI, HSG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the anterior left side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eanalgesic drugs, NSAIDs, OC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBranquinho MM\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ethe right lower abdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, TAU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ewithin the right uterine myometrium and adjacent to the right ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eanalgesics, OC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003emedical therapy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJain N\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea and menorrhagia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTAU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the anterior right side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ecystic adenomyoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKumakiri J\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the right side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBedaiwy MA\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea and cyclic pelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUSG, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the left anterior wall of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJain N\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea and chronic pelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUSG, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the right adnexa between the uterus and right ovary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePontrelli G\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emenometrorrhagia, severe dysmenorrhea, dyspareunia, and chronic pelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUSG, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the posterior wall of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eEstrogen and progestin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePabuccu EG\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the right anterior wall just below the cornual end\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGarofalo A\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere pelvic pain and progressive dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUSG, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the anterior right side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDadhwal V\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea, severe episodic pain in the lower abdomen for 2 months and severe dysmenorrhea for 3 years.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTAU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the anterior wall of the uterus near the cornual end\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eacute episodic pain in the left lower abdomen, the pain was severe in nature and occurred every 2-3 months for the 3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTAU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eover the left uterine wall near the cornual end just below the insertion of the round ligament;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStrelec M\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003easymptom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUSG, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtopapas A\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eintolerable dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the left side of the uterus and extended to the uterine isthmus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWilcox A\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003esevere dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the anterior left upper region of the\u003c/p\u003e \u003cp\u003euterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, IUD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ewithin the left side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKiyak H\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG2P1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epelvic pain and delayed menses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTVU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the right cornual area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinelli F\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003epelvic pain and dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMRI, USG,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the middle of the anterior wall of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eHormone therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003esclerotherapy with ethanol\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIranpour P\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003echronic recurrent pelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT, TVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIn the left side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC, NSAIDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArya S\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003egradually worsening pelvic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT, TVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the left lateral myometrium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eHormone therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eworsening of chronic dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCT, USG,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the right side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eJCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG0P0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSevere dysmenorrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTAU, TRU, TVU, MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ein the myometrium of the right side of the uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eACUM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eProgestin, NSAIDs,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003elaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eNote: G=gravida; P=parity; N=no; NA=not available; USG=ultrasonography; CT=computer tomography; TAU=transabdominal ultrasound; TVU=transvaginal ultrasound; MRI= magnetic resonance imaging; HSG=hysterosalpingography; JCA= juvenile cystic adenomyoma; ACUM= accessory and cavitated uterine mass; OC=oral contraceptive; NSAIDs= nonsteroidal anti-inflammatory drugs, IUD=intra uterine device.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe thought the term JCA and the diagnostic criteria of Takeuchi limit the age to females younger than 30 years old, but in fact, there were some reports on patients over 30 years old with ACUM\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In addition, ACUM has a unique pathogenic site, which is located in the anterior lateral wall of the uterus near the corner of the uterus, and the size of the cyst within ACUM was all ༞0.5cm according to the current literature. Thus, we suggest that the pathogenic site of ACUM and the size of the cyst within ACUM should be included in the diagnostic criteria. What\u0026rsquo;s more, we tend to agree that ACUM is a congenital disease since dysmenorrhea usually occurs within 5 years after menarche\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The patient in our case was initially diagnosed with focal adenomyosis, however, ACUM is easily misdiagnosed as obstructed cavitated rudimentary uterus horn in fact. Both of them present as a cavitated mass lined with endometrium, the within of which is hematometra. HSG can be done to distinguish the two. In the cases of non-communicating rudimentary horn, the fallopian tube of the affected side can\u0026rsquo;t visualize on HSG\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIt was considered that all congenital uterine anomalies have been implicated as a potential cause of infertility and adverse pregnancy events in a previous study\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Unfortunately, there is still a lack of literature that explore the reproductive outcomes of ACUM on patients. Since ACUM is a rare form of congenital uterine anomalies, the continuity of the myometrium and even the endometrium may have been disrupted. No matter how perfect the surgery is, there will be a scarred uterus after the surgery, which has a certain impact on the reproductive outcome of patients. But it still needs to be confirmed by long-term observational studies.\u003c/p\u003e \u003cp\u003eAccording to the existing literature, a total of forty-two cases of ACUM have been reported around the world, of which only fourteen cases provided a result of the patient\u0026rsquo;s CA125, and nine cases had CA125 values above the normal range. Is the evaluation of CA125related to the occurrence of ACUM? We have no answer, because there are scarce reports of ACUM and even more scarce cases providing CA125. And it is unfortunate that our case didn\u0026rsquo;t provide the information about CA125. More cases are needed to explain the relationship between ACUM and CA125.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eACUM is a rare form of uterine anomaly related to the malformation of Mullerian duct, which can cause severe dysmenorrhea and chronic pelvic pain. Surgical excision of the ACUM is still the most effective treatment, and laparoscopic surgery is proved to be a feasible and safe way. In our case, the patient benefits a lot after laparoscopic surgery. However, we can\u0026rsquo;t answer whether the elevation of CA125 in some patients is related to ACUM and whether it has a certain impact on the reproductive outcome of patients now. It calls for more cases and research to deal with these problems. Anyways, our report adds a case to the current literature, and we also tend to agree that ACUM is a congenital disease since dysmenorrhea occurs within 5 years after menarche in our patient. In addition, we put forward that the pathogenic site of ACUM and the size of the cyst within ACUM should be included in the diagnostic criteria.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.H wrote the first draft of the manuscript; X.L and H.H provided figures; X.L and J.F designed research, critically revised the paper, and provided funding support. All Authors read and approved the final version of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by\u0026nbsp;the Natural Science Foundation of China (No.81960464).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this article are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for the use of anonymized data and imaging was obtained from the next of kin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report any accompanying images. The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJain N, Verma RJTIjor, imaging. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly. 2014;24(2):178-181.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenagiano G, Brosens I, Habiba MJRbo. Adenomyosis: a life-cycle approach. 2015;30(3):220-232.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrosens I, Gordts S, Habiba M, Benagiano G. Uterine Cystic Adenomyosis: A Disease of Younger Women. \u003cem\u003eJ Pediatr Adolesc Gynecol.\u003c/em\u003e 2015;28(6):420-426.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumakiri J, Kikuchi I, Sogawa Y, Jinushi M, Aoki Y, Kitade M, Takeda S. 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Juvenile cystic adenomyoma. \u003cem\u003eBMJ Case Rep.\u003c/em\u003e 2012;2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJain N, Goel S. Cystic Adenomyoma simulates uterine malformation: A diagnostic dilemma: Case report of two unusual cases. \u003cem\u003eJ Hum Reprod Sci.\u003c/em\u003e 2012;5(3):285-288.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBedaiwy MA, Henry DN, Elguero S, Pickett S, Greenfield M. Accessory and cavitated uterine mass with functional endometrium in an adolescent: diagnosis and laparoscopic excision technique. \u003cem\u003eJ Pediatr Adolesc Gynecol.\u003c/em\u003e 2013;26(4):e89-91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePontrelli G, Bounous VE, Scarperi S, Minelli L, Di Spiezio Sardo A, Florio P. Rare case of giant cystic adenomyoma mimicking a uterine malformation, diagnosed and treated by hysteroscopy. \u003cem\u003eJ Obstet Gynaecol Res.\u003c/em\u003e 2015;41(8):1300-1304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarofalo A, Alemanno MG, Sochirca O, Pilloni E, Garofalo G, Chiado Fiorio Tin M, Viora E. Accessory and cavitated uterine mass in an adolescent with severe dysmenorrhoea: From the ultrasound diagnosis to surgical treatment. \u003cem\u003eJ Obstet Gynaecol.\u003c/em\u003e 2017;37(2):259-261.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDadhwal V, Sharma A, Khoiwal KJTEjom. Juvenile Cystic Adenomyoma Mimicking a Uterine Anomaly: a Report of Two Cases. 2017;49(1):59-61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrelec M, Banović M, Banović V, Sirovec AJIjog, Gynaecology otoootIFo, Obstetrics. Juvenile cystic adenomyoma mimicking a Mullerian uterine anomaly successfully treated by laparoscopic excision. 2019;146(2):265-266.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilcox A, Schmidt M, Luciano DJO, gynecology. Identification of Juvenile Cystic Adenomyoma Using High-Resolution Imaging. 2020;136(5):1021-1024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiyak H, Seckin K, Karakis L, Karacan T, Ozyurek E, Resit Asoglu MJF, sterility. Decidualized juvenile cystic adenomyoma mimicking a cornual pregnancy. 2020;113(2):463-465.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinelli F, Agostini A, Siles P, Gnisci A, Pivano AJJogo, reproduction h. Treatment of juvenile cystic adenomyoma by sclerotherapy with alcohol instillation: A case report. 2021;50(6):102081.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIranpour P, Haseli S, Keshavarz P, Dehghanian A, Khalili NJCrim. Pelvic Pain and Adnexal Mass: Be Aware of Accessory and Cavitated Uterine Mass. 2021;2021:6649663.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"accessory and cavitated uterine mass, dysmenorrhea, laparoscopic surgery","lastPublishedDoi":"10.21203/rs.3.rs-1120568/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1120568/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAccessory and cavitated uterine mass (ACUM) is a rare uterine anomaly newly recognized as a form of developmental Mullerian anomaly, which represents a non-communicating uterus-like mass within an otherwise normal uterus. It is a benign gynecological disease associated with severe dysmenorrhea and chronic pelvic pain, which is most common in young nullipara women, and sometimes develops in parous women. Clinical manifestations combined with imaging examinations including ultrasonography (USG), magnetic resonance imaging (MRI), and hysterosalpingography (HSG) are the means to establish a correct diagnosis. Medical therapy is only marginally effective, but laparoscopic surgery for complete mass excision is a feasible technique to relieve patient\u0026rsquo;s symptoms. Our article is aimed to report a case of ACUM in an 18-year-old woman and summarize the diagnostic criteria of ACUM.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003e: An 18-year-old woman was admitted for severe pain in the right lower abdomen during menstruation, which lasted more than 1 year. The patient was misdiagnosed with focal adenomyosis at our hospital on March 4, 2021. After 4 months, she was diagnosed with ACUM. Once diagnosis as focal adenomyosis, nonsteroidal anti-inflammatory drugs (NSAIDs) and gestrinone were administered to the patient. Following the diagnosis of ACUM, she received laparoscopic surgery. Our follow-up indicated that the symptom was significantly relief without drug therapy after sixty days postoperatively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eClinical manifestations and imaging examinations are used to establish the diagnosis of ACUM. Medical therapy is only marginally effective, but laparoscopic surgery for complete mass excision is a feasible technique to solve the pain symptom. The prevalence and pathogenesis of ACUM and its reproductive outcomes on patients remain unclear, which calls for more and deeper research to study.\u003c/p\u003e","manuscriptTitle":"Accessory and Cavitated Uterine Mass (ACUM) in an 18-Year-Old Woman: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-01-04 23:28:11","doi":"10.21203/rs.3.rs-1120568/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2021-11-29T05:42:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-11-28T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-11-28T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2021-11-28T00:30:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4451e00e-1b2b-4e89-980d-0f755e01de49","owner":[],"postedDate":"January 4th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":9498760,"name":"Medical Genetics"},{"id":9498761,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2022-01-04T23:28:11+00:00","versionOfRecord":[],"versionCreatedAt":"2022-01-04 23:28:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1120568","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1120568","identity":"rs-1120568","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}