EP15.01: Sonographic features in two cases with accessory cavitated uterine mass (ACUM) successfully treated with robotic‐assisted laparoscopic surgery

Two cases of nulliparous women aged 14 and 27 presented to our clinic with a long history of severe dysmenorrhea refractory to intensified analgesia and continuous hormonal contraceptive treatment. The patients underwent expert 3D transvaginal (TVU) or transrectal (TRU) ultrasound (virgo patient) showing a thick walled cystic lesion, with hypoechoic to ground-glass content, protruding from the right lateral uterine wall just below the insertion of the round ligament. The mass was highly suggestive of ACUM given its morphology, the normally shaped uterine cavity and the absence of adenomyosis features. The diagnosis was confirmed by MRI. Due to failure of conservative treatment the patients underwent robotic-assisted laparoscopic surgery where the mass was resected leaving the normal uterine cavity intact. Short-time follow-up showed a normal postoperative recovery and both patients experienced substantial symptom relief. Pathologic analysis suggested ACUM and no histological features of adenomyosis were found. We suggest that a higher awareness of ACUM among expert sonographers would promote earlier adequate treatment, preferably robotic-assisted laparoscopic surgery, which proved to be a safe and feasible treatment for these young patients suffering from therapy-refractory dysmenorrhea. 3D-TVU or TRU are non-invasive and cost-effective examination techniques to evaluate congenital uterine malformations and TRU is feasible even in many cases where the patient is virgo. In doubt MRI can be helpful to confirm the diagnosis. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.