PMC10469797_01
(A) Patient 3_TAUS shows a left antero-fundic sub-serous mass of 3.8 cm x 3.6 cm. (B) Patient 4_axial plan of TVUS showing the right-lateralized mass separated from the normal uterine cavity by a thick myometrial wall. (C) Patient 5_axial echography showing a round right-lateralized mass with hypoechogenic content surrounded by a ring-shaped vascularized capsule.
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F1
As part of the clinical workup, the patients first underwent a pelvic ultrasound (Figure 1).
Pelvic MRI. (A) Patient 3_round mass in the left anterior myometrial wall suggestive of an accessory endometrial cavity within. (A1) T2-weighted coronal image. (A2) T2-weighted left lateral sagittal cut. (B) Patient 4_a round mass in the right anterior myometrial wall. (B1) T2-weighted coronal image. (B2) T2-weighted right lateral sagittal cut. (C) Patient 5_round mass in the right anterior myometrial wall. (C1) T2-weighted coronal image. (C2) T2-weighted right lateral sagittal cut.
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F2
In addition to an ultrasound, all patients in our series underwent an MRI in order to have a precise description of the lesion (Figure 2).
Laparoscopic resection. (A) Patient 3_(A1) Uterine left-sided mass bulging into the anterior part of the broad ligament under the insertion of the round ligament. (A2) Incision of the mass draining chocolate-brown fluid. (A3) Excision of the lesion wall. (A4) Myometrial defect sutured. (B) Patient 5: (B1) Right ACUM. (B2) Incision of the mass. (B3) Excision of the cyst wall with a view of the cystic cavity. (B4) Myometrial defect sutured. (C) Patient 6: (C1) Left ACUM. (C2) Excision of the lesions wall.
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F3
The same laparoscopic resection technique was used by four surgeons on all patients (Figure 3).
Histological sections with haematoxylin and eosin (HE) stain and immunohistological section showing the ACUM with endometrial epithelium "E", surrounded by myometrium "M". (A) Patient 1_HE x 1.25. (B) Patient 1_HE x 10, zooming in on the highlighted as found in exhibit A. (C) Patient 2_HE x 5. (D) Patient 3_HE x 0.79. (E) Patient 3_HE x 20. (F) Patient 5_HE x 5. (G) Patient 5_CD10 x 200 immunohistochemistry positivity confirming the presence of endometrial stroma.
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F4
In all patients, microscopic examination showed a cystic cavity lined by thin endometrium lining and stroma (Figure 4).
Schematic representation of the location of the left ACUM.
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F5