2024 年 39 巻 2 号 p. 61-66
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.
