Objective To investigate the clinical characteristics,treatment methods,and prognosis of accessory cavitated uterine mass(ACUM).Methods Nine patients with ACUM underwent surgical treatment in Henan Provincial People's Hospital from January,2017 to December,2023,and their clinical data were retrospectively analyzed.The degree and location of dysmenorrhea,preoperative blood biochemical indicators,tumor markers,ultrasound examination,pelvic MRI examination results,and surgical procedures were recorded.The follow up was conducted till March,2024,to record the relief of dysmenorrhea.Results The average age of these 9 patients was 27.6 years old,and the main clinical symptoms were progressive worsening of dysmenorrhea.Six patients had pain on the affected side,and three patients had pain in the center of the pelvis.Oral and contraceptives were ineffective or only partially relieved dysmenorrhea.All patients had normal hemoglobin,and 2 patients had elevated level of carbohydrate antigen 125 before surgery.All 9 patients underwent uterine and adnexal ultrasound examination,and the ultrasound imaging features were intramural hypoechogenicity or heterogeneous echogenicity,with visible endometrial hyperechogenicity,and no urinary system abnormalities.Five patients underwent pelvic enhanced MRI scan,showing abnormal intramural signals in 3 patients,with circular T,signals,a small strip-like high signal in T2,and a circular low signal around T2,suggesting the possibility of ACUM;showing abnormal intramural signals in 2 patients,suggesting adenomyosis with blood-like changes.Eight patients underwent laparoscopic ACUM resection,and one underwent open surgery.All lesions were completely removed,and no postoperative complications occurred.The follow up was conducted till March,2024,with a median follow-up time of 13 months,showing complete or significant relief of dysmenorrhea in 9 patients,with no need for analgesics.The preoperative elevated carbohydrate antigen 125 in 2 patients showed a decrease to normal one month after surgery.Conclusions ACUM is more common in young women with the clinical manifestation of progressive aggravation of dysmenorrhea,and sometimes it is complicated with adenomyosis.Ultrasound and MRI examination contribute to its diagnosis,and complete surgical resection of ACUM can effectively alleviate dysmenorrhea.
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