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European Radiology

, Volume 29, Issue 3, pp 1144–1152 | Cite as

Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity

  • N. Peyron
  • E. Jacquemier
  • M. Charlot
  • M. Devouassoux
  • D. Raudrant
  • F. Golfier
  • P. RoussetEmail author
Urogenital
  • 157 Downloads

Abstract

Objectives

To describe MRI features of accessory cavitated uterine mass (ACUM) with surgical correlations.

Methods

Eleven young women with an ACUM at pathology underwent preoperative pelvic MRI. Two experienced radiologists retrospectively analysed MR images in consensus to determine the lesion location within the uterus, its size, morphology (shape and boundaries), and structure reporting the signal and enhancement of its different parts compared to myometrium. The presence of an associated urogenital malformation or other gynaecological anomaly was reported. MRI features were correlated with surgical findings.

Results

All 11 lesions were well correlated with surgical findings, lateralised (seven were left-sided), and located under the horn and the round ligament insertion. Nine were located within the external myometrium, bulging into the broad ligament. Two were extrauterine, entirely located within the broad ligament. On MRI, the mean size was 28 mm (range 17–60 mm). Nine lesions were round-shaped, two were oval; all had regular boundaries. At surgery, the ACUM were not encapsulated but were possible to enucleate. On MRI, all lesions were well defined and showed a central haemorrhagic cavity surrounded by a regular ring (mean thickness, 5 mm) which had the same signal compared to the junctional zone. ACUM was isolated in all women, without urogenital malformation, adenomyosis or deep endometriosis.

Conclusions

On MRI, ACUM was an isolated round accessory cavitated functional non-communicating horn-like aspect in an otherwise normal uterus. MRI may facilitate timely diagnosis and appropriate curative fertility-sparing laparoscopic resection.

Key Points

• ACUM is rare, with delayed diagnosis in young women with severe dysmenorrhoea. Pelvic MRI facilitates timely diagnosis and appropriate curative fertility-sparing laparoscopic resection.

• Quasi-systematically located under the uterine round ligament insertion, ACUM may be intramyometrial and/or in the broad ligament.

• On MRI ACUM resemble a non-communicating functional accessory horn within a normal uterus; the mass, most often round-shaped, had a central haemorrhagic cavity surrounded by a regular ring which had the same low signal compared to the uterine junctional zone.

Keywords

Uterine anomalies Magnetic resonance imaging Dysmenorrhoea Pelvic pain Adenomyosis 

Abbreviations

ACUM

Accessory cavitated uterine mass

ESHRE

European Society of Human Reproduction and Embryology

ESGE

European Society for Gynaecological Endoscopy

FOV

Field of view

MR

Magnetic resonance

MRI

Magnetic resonance imaging

OR

Oestrogen receptor

PR

Progesterone receptor

ST

Section thickness

TE

Echo time

TR

Repetition time

Notes

Acknowledgements

The authors would like to thank Philip Robinson (DRCI, Hospices Civils de Lyon) for help in manuscript preparation.

Funding:

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Professor Pascal Rousset, Lyon, France.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Supplementary material

330_2018_5686_MOESM1_ESM.docx (5.1 mb)
ESM 1 (DOCX 5261 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Radiology DepartmentLyon Sud University Hospital, Hospices Civils de LyonPierre BéniteFrance
  2. 2.Pathology DepartmentLyon Sud University Hospital, Hospices Civils de LyonLyonFrance
  3. 3.Lyon 1 Claude Bernard UniversityLyonFrance
  4. 4.Gynaecology and Obstetrics DepartmentLyon Sud University Hospital, Hospices Civils de LyonLyonFrance

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