Sonography-guided laparoscopic surgery for an accessory and cavitated uterine mass

Tomoaki Kikuchi, Yūko Hasegawa, Kaori Gomi, Yuki Mori, Madoka Yamaguchi, Naoki Kita, Yumi Ochi, Hajime Okamoto
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2024 · vol. 39(2) , pp. 61–66 · doi:10.5180/jsgoe.39.2_61 · W4390964484
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This case report describes a successful ultrasound-guided laparoscopic lumpectomy to treat an accessory and cavitated uterine mass (ACUM) causing severe dysmenorrhea and pelvic pain in a young woman.

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This case report describes a 28-year-old nulligravida woman diagnosed with an accessory and cavitated uterine mass (ACUM) during infertility treatment, who had worsening dysmenorrhea and chronic pelvic pain after stopping hormone therapy. Using ultrasound-guided laparoscopic lumpectomy, the authors removed a lesion located in the uterine attachment zone of the round ligament, noting that it was unrelated to uterine adenomyosis. They report that the patient’s pain medication needs decreased after surgery and that ultrasound facilitated complete laparoscopic excision despite the mass being difficult to visualize from the uterine surface and as small as 1 cm. This paper is centrally about adenomyosis-adjacent pelvic pain (cystic adenomyosis/juvenile cystic adenomyoma spectrum) via ACUM, explicitly framing ACUM as a developmental disorder distinct from uterine adenomyosis.

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Abstract

Chocolate cyst-like lesions found in the uterus are referred to as cystic adenomyosis. Recently, a specific type of this condition, thought to be a developmental disorder of Müllerian ducts, has been termed an accessory and cavitated uterine mass (ACUM). Herein, we report the case of a 28-year-old nulligravida woman who was diagnosed with ACUM during infertility treatment and underwent an ultrasound-guided laparoscopic lumpectomy for treatment. The patient initially experienced pelvic pain after discontinuing hormone therapy for dysmenorrhea, which gradually worsened and became difficult to manage, leading to the decision for surgical intervention. Preoperatively, the patient relied on non-narcotic opioid analgesics for pain relief, but analgesics were no longer needed promptly postoperatively. ACUM was found in the uterine attachment zone of the round ligament of the normal uterus, unrelated to uterine adenomyosis. It can cause severe dysmenorrhea and chronic pelvic pain even when the mass is as small as 1 cm in diameter. Due to its location and size, the mass was difficult to identify intraoperatively from the surface of the uterus, but we were able to complete the removal of the mass laparoscopically with the use of ultrasound.
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症例報告 Accessory and cavitated uterine mass（ACUM）に対する超音波検査ガイド下腹腔鏡下手術の一例 キーワード: accessory and cavitated uterine mass (ACUM), juvenile cystic adenomyoma (JCA), intraoperative ultrasonography 2024 年 39 巻 2 号 p. 61-66 詳細 抄録 Chocolate cyst-like lesions found in the uterus are referred to as cystic adenomyosis. Recently, a specific type of this condition, thought to be a developmental disorder of Müllerian ducts, has been termed an accessory and cavitated uterine mass (ACUM). Herein, we report the case of a 28-year-old nulligravida woman who was diagnosed with ACUM during infertility treatment and underwent an ultrasound-guided laparoscopic lumpectomy for treatment. The patient initially experienced pelvic pain after discontinuing hormone therapy for dysmenorrhea, which gradually worsened and became difficult to manage, leading to the decision for surgical intervention. Preoperatively, the patient relied on non-narcotic opioid analgesics for pain relief, but analgesics were no longer needed promptly postoperatively. ACUM was found in the uterine attachment zone of the round ligament of the normal uterus, unrelated to uterine adenomyosis. It can cause severe dysmenorrhea and chronic pelvic pain even when the mass is as small as 1 cm in diameter. Due to its location and size, the mass was difficult to identify intraoperatively from the surface of the uterus, but we were able to complete the removal of the mass laparoscopically with the use of ultrasound. © 2024 日本産科婦人科内視鏡学会

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adenomyosischronic_pelvic_paindysmenorrheainfertility

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