case_images: PMC10469797_01
case_images: (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.
case_images: frph-05-1197931-g001.jpg
case_images: PMC10469797_01_frph-05-1197931-g001.jpg
case_images: F1
case_images: As part of the clinical workup, the patients first underwent a pelvic ultrasound (Figure 1).
case_images: 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.
case_images: frph-05-1197931-g002.jpg
case_images: PMC10469797_01_frph-05-1197931-g002.jpg
case_images: F2
case_images: 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).
case_images: 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.
case_images: frph-05-1197931-g003.jpg
case_images: PMC10469797_01_frph-05-1197931-g003.jpg
case_images: F3
case_images: The same laparoscopic resection technique was used by four surgeons on all patients (Figure 3).
case_images: 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.
case_images: frph-05-1197931-g004.jpg
case_images: PMC10469797_01_frph-05-1197931-g004.jpg
case_images: F4
case_images: In all patients, microscopic examination showed a cystic cavity lined by thin endometrium lining and stroma (Figure 4).
case_images: Schematic representation of the location of the left ACUM.
case_images: frph-05-1197931-g005.jpg
case_images: PMC10469797_01_frph-05-1197931-g005.jpg
case_images: F5