2025 年 41 巻 1 号 p. 148-152
Accessory and cavitated uterine masses (ACUM) are cystic masses within the normal myometrium that cause dysmenorrhea. When analgesics and low-dose estrogen/progestin therapy are ineffective, excision of the ACUM is a treatment option. However, there is no clear consensus on how to reliably remove ACUM. In this study, we report a case in which ACUM was completely removed using a laparoscopic ultrasound probe.
The patient was 23 years old, nulligravida, and had been experiencing dysmenorrhea since the age of 19. Suspecting ACUM, we decided to perform a laparoscopic cystectomy, and the patient was removed without disrupting the contents of the mass, using a laparoscopic ultrasound probe to delineate the boundary region of the mass. The mass was removed without disrupting its contents. Pathologically, endometrial tissue was observed on the luminal surface, and uterine smooth muscle tissue covered the outer surface, leading to the diagnosis of ACUM. Postoperatively, dysmenorrhea disappeared and no analgesic medication was needed, and there was no recurrence 9 months after surgery.
It is important to remove ACUM completely, because its boundary with the normal myometrium is indistinct and its rupture may cause a relapse of symptoms. Using intraoperative ultrasonography, ACUM was easily identified and the operation could be completed laparoscopically. Intraoperative transtrocar ultrasonography was found to be useful for laparoscopic excision of endometrial tissue of ACUM.
