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中华医学超声杂志(电子版) ›› 2024, Vol. 21 ›› Issue (08) : 826 -828. doi: 10.3877/cma.j.issn.1672-6448.2024.08.014

病例报告

超声诊断子宫附腔畸形一例
周茂平1, 张芳芳1, 李军1, 周涵霄1, 王宏桥1,()   
  1. 1. 266000 青岛大学附属医院腹部超声科
  • 收稿日期:2024-06-18 出版日期:2024-08-01
  • 通信作者: 王宏桥

Ultrasound diagnosis of accessory cavitated uterine malformation: a case report

Maoping Zhou, Fangfang Zhang, Jun Li   

  • Received:2024-06-18 Published:2024-08-01
引用本文:

周茂平, 张芳芳, 李军, 周涵霄, 王宏桥. 超声诊断子宫附腔畸形一例[J]. 中华医学超声杂志(电子版), 2024, 21(08): 826-828.

Maoping Zhou, Fangfang Zhang, Jun Li. Ultrasound diagnosis of accessory cavitated uterine malformation: a case report[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(08): 826-828.

患者,女性,17岁,因"痛经3年,进行性加重1年"就诊。患者13岁初潮,月经规则,量适中,开始无明显痛经,初潮后1年出现痛经,症状逐渐加重,近1年痛经难以忍受,需要口服止痛药,每次持续2~3 d,严重时不能上学,伴呕吐,患者既往体健。遂2024年1月于青岛大学附属医院就诊,行经腹壁、经直肠妇科超声检查示:子宫上段偏右肌层内见2.8 cm×2.2 cm×2.4 cm的低回声结节,形态尚规则,边界清,内见1.4 cm×0.7 cm×1.1 cm类囊性回声,透声欠佳,边缘回声增高(图a,b),彩色多普勒血流成像(color Doppler flow imaging,CDFI)示:周边见环形血流信号(图c),该结节与宫腔不通,行子宫冠状切面三维超声检查示宫腔形态正常,两个子宫角存在(图d);考虑子宫附腔可能。进一步行盆腔MRI示:子宫形态可,宫腔形态未见异常,子宫右侧壁见类圆形长T1短T2信号影,内见结节状短T1长T2信号影,直径约25 mm;考虑子宫右侧壁异常信号(发育异常?子宫内膜异位症?)(图e,f)。患者行腹腔镜下肿块切除术,腹腔镜下见子宫右前壁突起直径约2.5 cm的肿块(图g),上缘紧贴右侧圆韧带,手术过程中于子宫右前壁切开肌壁,暴露肌层内肿物,直径约2 cm,切开肿物内少许为褐色血性液体(图h),囊内可见内膜样组织,小心将囊肿完整剥离,检查周围仍为肌壁,与宫腔不相通,术后病理结果为:(子宫附腔)送检腔隙样组织,镜下腔隙部分区域及平滑肌内见子宫内膜间质及腺体,部分子宫内膜间质蜕膜样变。术后随访5个月余,患者痛经症状消失无复发。

图1 患者,女性,17岁,痛经并进行性加重。图a,b为经直肠二维超声检查,图a为子宫横切面,显示子宫上段偏右肌层内低回声结节,边界清,略外突,图b显示结节内见透声差的空腔样回声,壁上见薄环样高回声,周边可见肌层包绕;图c为彩色多普勒超声图像示空腔内未见明显血流信号,周边见环形血流信号;图d为子宫冠状切面三维超声图像示宫腔形态正常,两个子宫角存在;图e,f为盆腔MRI示子宫宫腔形态未见异常,子宫右侧壁见类圆形长T1短T2信号影,内见结节状短T1长T2信号影;图g为腹腔镜下可见子宫右侧圆韧带下方结节样肿物突出;图h为切开子宫肌层暴露肌层内肿物,可见褐色血性液体流出,囊内可见内膜样组织注:E为子宫内膜;UT为子宫
1
Oliver J. An accessory uterus distended with menstrual fluid enucleated from the substance of the right broad ligament [J]. The Lancet, 1912, 179(4633): 1609.
2
Acién P, Bataller A, Fernández F, et al. New cases of accessory and cavitated uterine masses (ACUM): a significant cause of severe dysmenorrhea and recurrent pelvic pain in young women [J]. Hum Reprod, 2012, 27(3): 683-694.
3
Takeda A, Sakai K, Mitsui T, et al. Laparoscopic management of juvenile cystic adenomyoma of the uterus: report of two cases and review of the literature [J]. J Minim Invasive Gynecol, 2007, 14(3): 370-374.
4
Acién P, Sánchez del Campo F, Mayol MJ, et al. The female gubernaculum: role in the embryology and development of the genital tract and in the possible genesis of malformations [J]. Eur J Obstet Gyneclo Reprod Biol, 2011, 159(2): 426-432.
5
Setty T, Naftalin J, Jurkovic D. Accessory cavitated uterine malformations (ACUMs): an unfamiliar cause of dysmenorrhoea [J]. Obstet Gynaecol, 2022, 24(1): 40-49.
6
Peyron N, Jacquemier E, Charlot M, et al. Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity [J]. Eur Radiol, 2019, 29(3): 1144-1152.
7
Naftalin J, Bean E, Saridogan E, et al. Imaging in gynecological disease (21): clinical and ultrasound characteristics of accessory cavitated uterine malformations [J]. Ultrasound Obstet Gynecol, 2021, 57(5): 821-828.
8
Dadhwal V, Sharma A, Khoiwal K. Juvenile cystic adenomyoma mimicking a uterine anomaly: a report of two cases [J]. Eurasian J Med, 2017, 49(1): 59-61.
9
Branquinho MM, Marques AL, Leite HB, et al. Juvenile cystic adenomyoma [J]. BMJ Case Rep, 2012, 2012: bcr2012007006.
10
Strelec M, Banović M, Banović V, et al. Juvenile cystic adenomyoma mimicking a Mullerian uterine anomaly successfully treated by laparoscopic excision [J]. Int J Gynecol Obstet, 2019, 146(2): 265-266.
11
戴晴. 浅谈子宫附腔畸形的临床特征及超声影像学应用进展 [J/OL]. 中华医学超声杂志(电子版), 2022, 19(10): 5.
12
Supermaniam S, Thye WL. Diagnosis and laparoscopic excision of accessory cavitated uterine mass in young women: two case reports [J]. Case Rep Womens Health, 2020, 26: e00187.
13
Ho M-L, Raptis C, Hulett R, et al. Adenomyotic cyst of the uterus in an adolescent [J]. Pediatr Radiol, 2008, 38(11): 1239-1242.
14
Jain N, Verma R. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly [J]. Indian J Radiol Imaging, 2014, 24(2): 178-181.
15
Kumakiri J, Kikuchi I, Sogawa Y, et al. Single-incision laparoscopic surgery using an articulating monopolar for juvenile cystic adenomyoma [J]. Minim Invasive Ther Allied Technol, 2013, 22(5): 312-315.
16
Acién P, Acién M, Fernández F, et al. The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus [J]. Obstet Gynecol, 2010, 116(5): 1101-1109.
17
Takeuchi H, Kitade M, Kikuchi I, et al. Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases [J]. Fertil Steril, 2010, 94(3): 862-868.
18
Kriplani A, Mahey R, Agarwal N, et al. Laparoscopic management of juvenile cystic adenomyoma: four cases [J]. J Minim Invasive Gynecol, 2011, 18(3): 343-348.
19
Nabeshima H, Murakami T, Terada Y, et al. Total laparoscopic surgery of cystic adenomyoma under hydroultrasonographic monitoring [J]. J Am Assoc Gynecol Laparosc, 2003, 10(2): 195-199.
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